# Health Advisories for Consumers of Great Lakes Sport Fish: Is the Message 

# Being Received?

John Tilden,1 Lawrence P. 

### Hanrahan,2 HenryAnderson,2 Charles Palit,3 Joseph Olson,2 WilliamMac Kenzie,1 and the Great Lakes 

### Sport Fish Consortium 1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta GA 30333 USA; 2Bureau of Public Health, Wisconsin Division of Health, Madison, WI 53703 USA; 3Wisconsin Survey Research Laboratory, University ofWisconsin, Madison, WI 53703 USA



### Nationwide, 45 states issuehealthadvisories for

### sportfishconsumers. Ch 

### cal coninnts in

some Great Iakes (GL) sportfish include compounds 

### suspeted of

### causingadvese reproductve and 

### developmental 

### effects. Although advisories to 

### reduce consumption of contaminated fish, espeiallybywomen, havebeen issued

### byGLstates 

### (.e., Illinois, Indiana, Mich n, Minnesota, New

### York, Ohio, Penyani, andWison) ce themid-1970., l i aboutad

### soryawarness andGL sportfishcons pion in the

### generalpopulation. To estimate theprevalence ofGL sport fish ptio an health

### advisoryawarenes, we otd a pulationbasedteephone 

### surveyof8,306adultresidentsoftheeight GL ste We information concerning respondents' d a fish 

### consumption during the p

### greeding
year, and sport fish 

### coadvisory aw nss. The se was 69%. GL sport fishwere eaten

### duringthep iyear

### by8A4% 

### [95%c i 

### id 9.2] ofadults intheGL sates, 

### tely4.7millionpersons. Wo n a 439% (CI, 

### 39.4-48.4) of

### consumers. Alhouh 

### 49.9% ofGL sport fish cse 

### ofa

### health advisory, awareness varied

### significantybyse 58.2% (CI, 51.7-64.7) ofmales and 39.1% (CI, 32.645.6) offemaleswereaware. 

### Usinglogistic

### regrsion, we foundawaree associatedwith male sex 

### [odds ratio 

### (OR) =2.3; 

### CI, 

### 1.5-3.5), whiterace 

### (OR

- 

### 4.2; CI, 

### 1.9-9.1), 

### college

### degree (OR = 3.1; CI, 

### 1.3-7.6), and

### couns i 

### 224 GL sport fish

### meals/year (OR

- 2.4; CI, 1.4-4.3). 

### OnlyhalfofGL sport fish coum 

### reportedaness ofahealthadvisry ning tg GL sport fish. 

### Awarns was ep l 

### low ngwomen, s theneed 

### ofae risk communication 

### prga f f le

. I work e G health 

### adsories, Illinois, Indi

, Mihi i New r Oo ion-based 

### random-Jigit-dial svy s t fish i EnvironHealh

### Perpn10 3 

### (199T 

## hap/.Iehks ihsi.ge:

Great 

### Lakes 

### (GL) sport 

### fish consumption 

### advisories were 

### first issued in 

### the 1970s 

### after extensive 

### testing 

### detected chemical contaminants in 

### fish tissue. 

### Of 

### particular concern
were 

### environmentally persistent 

### lipophilic pollutants such as 

### polychlorinated biphenyls (PCBs) 

### and DDT. 

### These 

### compounds are 

### often found in 

### the 

### highest concentrations in 

### the 

### olderand 

### largerpredatoryfish, whichare 

### sought and

### preferredbymanysport 

### anglers. In 

### 1991, an 

### estimated 2.55 

### million licensedanglers 

### fished on one ormore 

### ofthe Great 

### Lakes 

### (1). 

### Thus, the

### popularity ofthis sport presents a 

### significant potential for human exposure to 

### chemical residues in 

### fish tissue. 

### Although two 

### decades of environ

### mental 

### regulation have 

### substantially reduced 

### chemical residues 

### (2-3), some 

### sport 

### fish still contain 

### levels 

### thought to 

### be 

### potentially harmful to 

### human health 

### (Anderson et 

### al., 

### unpublisheddata). Studies of

### long-term consumption 

### of GL 

### sport 

### fish 

### confirmed an association 

### between 

### contaminatedfish consumption

### and increased PCB or DDT\DDE 

### body burdens (47). The 

### potential adverse 

### health effects of these contaminants 

### have been studied 

### extensively 

### (8-10). The EPA 

### has 

### classified PCBs 

### and DDT\DDE as 

### probable human carcinogens. Consistent 

### with low exposure 

### effects observed in 

### nonhuman primates, some 

### human 

### epidemiologic studies have 

### found associations 

### between maternal/fetal PCB 

### levels, Lake 

### Michigan sport 

### fish consumption, 

### and adverse 

### reproductive and 

### developmental 

### effects (11-13). 

### These studies are not 

### conclusive, however, and scientists 

### disagree 

### regarding interpretation 

### of

### their findings 

### (14-17). This level of uncertainty 

### complicates the process 

### of communicating 

### risk

### information to 

### sport 

### fishconsumers. Current GL 

### sport 

### fish consumption 

### advisories seek to 

### 1) inform the 

### public about the chemical contaminants 

### contained in some 

### sport 

### fish, 2) 

### educate consumers as to 

### how 

### they can minimize 

### their exposure to 

### contaminants, 

### 3) remind consumers 

### of the health

### benefits offish consumption 

### (18,19), and 4) present 

### advisory information in a manner 

### conducive to 

### maximal 

### voluntary 

### compliance (Anderson et 

### al., unpublished 

### data). Because 

### of

### potential adverse repro

### ductive and 

### developmental 

### effects, all current 

### advisories make 

### specific consumption 

### frequency recommendations 

### for women 

### of 

### childbearing age. GL 

### advisories seek to 

### help individual consumers 

### make 

### informed decisions 

### regardingsport 

### fish consumption. In 

### the GL states, 

### the level of advisory

awareness 

### among 

### licensed 

### anglers has been used to assess 

### the 

### adequacy ofadvisory communication programs 

### (20). Licensed anglers

are a 

### relatively easy-to-identify group 

### of GL 

### sport 

### fish consumers 

### who can 

### be 

### surveyedby mail (5,21-22). One 

### drawback of this 

### approach is 

### that the results 

### of surveys con

### ducted 

### solely on 

### anglers with 

### fishing licenses might not 

### be generalizable to 

### all persons

### who eat GL 

### sport 

### fish. To overcome 

### this limitation, we 

### conducted a 

### random-digit-dial telephone survey 

### of the general population. We 

### surveyed 

### adult residents 

### of the 

### eight GL states to 

### characterize the types 

### of fish eaten 

### by the general 

### population, the demographic characteristics 

### ofpersons 

### who ate GL 

### sport 

### fish, and the 

### level of 

### advisory.awareness among

### these GL 

### sport 

### fishconsumers. 

### Materials and 

### Methods Survey 

### design. From 

### April 1993 

### through February 1994, 

### trained interviewers 

### from theUniversity

### ofWisconsin 

### Survey

### Research Laboratory 

### conducted a 

### population-based random-digit-dialed telephone survey 

### (23-25) 

### ofadults (i.e., persons >18 

### years 

### of 

### age) 

### residing in 

### Indiana, Illinois, Michigan, Minnesota, New 

### York, Ohio, Pennsylvania, and Wisconsin). One 

### randomly selected adult from 

### each participating 

### householdwas 

### interviewed. Interview 

### dates were 

### scheduled

so 

### that 

### approximately equal numbers of interviews were 

### completed during each 

### of the four seasons. 

### Informed consent was 

### obtained before the start 

### of the interview, 

### and the data acquisition 

### procedures main

### tained

### complete respondent anonymity. Interviewers 

### used a 

### standard questionnaire to 

### collect 

### information regardingdemo

### graphiccharacteristics, the types 

### offish eaten

Address correspondence to L.P. Hanrahan, Bureau of Public Health, Wisconsin Division of Health, Room 138, 1414 E. WashingtonAvenue, Madison, WI 53703 USA. The Great Lakes Sport Fish Consortium includes James Boddy, Marvin Budd, Mandy Burkett, Claire Falk, Beth Fiore, Grace Lee, Bob Johnson, Marty Kanarek, SusanMonaghan, DanReed, TracyShelley, WilliamSonzogni, GregSteele, andDollisWright. This work is a result of research sponsored by the U.S. Public Health Service, Agency for Toxic Substances and Disease Registry under grant 75/ATH598322-03. Received 11 February 1997, accepted 2 September 1997.



### Volume 

### 105, Number 

### 12, December 1997 * EnvironmentalHealth

### Perspectives 1360Articles * Awareness of sport fish health advisories



### during the 

### preceding 12 

### months, and an estimate 

### ofthe average 

### number offishmeals eaten 

### during a time 

### interval 

### selected by respondents (e.g., during a

### week, month, or year). 

### Respondents were 

### characterized as 

### persons 

### who either 1) ate no 

### fish, 2) ate 

### only 

### commercially purchased 

### fish, 3) ate 

### sport 

### fish not 

### caught in a Great 

### Lake, or 

### 4) ate some GL 

### sport 

### fish. 

### Respondents who reported 

### eating GL sport 

### fishprovided additional 

### information, 

### including estimates 

### of the 

### number 

### of GL 

### sport fish meals they consumed 

### during the 

### preceding 12 

### months, whether 

### they had heard 

### of their state's 

### health 

### advisory for sport 

### fish consumers, 

### and if 

### they had followed 

### specific advisory recommendations (e.g., 

### cleaning and cooking 

### practices). 

### They provided consumption estimates 

### for six GL 

### sport 

### fish groups: 

### lake trout, 

### carp/catfish, brown trout, 

### rainbow trout/chinook salmon/coho 

### salmon, 

### perch/smelt/walleye, and all other GL 

### sport 

### fish. These fish species were 

### grouped according to 

### the 

### level of chemical contaminants 

### reported

### byfederal and state monitor

### ing programs. 

### These groups are 

### listed in 

### approximate 

### rank-order, from 

### highest to 

### lowest, 

### by level 

### of chemical contaminants 

### detected. We 

### defined 

### advisory awareness as
a 

### self-report ofhaving heard 

### of the health 

### advisory. Compliance was 

### defined as a 

### selfreport 

### of 

### always or 

### usually 

### following an 

### advisory recommendation. None 

### ofthe self

### reported information was 

### independently verified. 

### Analyticmethods. We 

### calculated overall 

### and 

### state-specific response rates 

### using stan

### dard 

### procedures (26) (see 

### Appendix 1). To 

### obtain 

### population-based estimates, we 

### weighted each 

### respondent's information (27,28). 

### Appendix 2 

### describes the case 

### weighting

### methodology. The lownumber of

### respondents with less than a 

### high school 

### degree was 

### insufficient to 

### weight 

### separately; thus, onlytwo 

### categories 

### of educational attainment were 

### used to 

### calculate 

### weights. These categories were

### persons 

### with a 

### high school 

### degree or

### less andpersons

### with at 

### least some 

### post-high school education. In 

### all 

### analyses, respondent agewas 

### codedas a

### threelevel 

### categorical variable (i.e., 

### 18-34 years, 

### 35-44 years, and 

### 45 or more 

### years 

### of 

### age) based on 

### the likelihood of

### childbearing. We 

### initially explored the data 

### through univariate 

### and

### stratified

### analysis. Using SUDAANstatis

### tical software 

### (Research 

### Triangle Institute, 

### Research 

### Triangle 

### Park, NC) 

### (29), we 

### calculatedoverall 

### prevalence estimates 

### for 

### fourdifferent fish consumption patterns, 

### advisory

awareness 

### among GL 

### sport 

### fish consumers, 

### and 

### self-reported compliance among GL sport 

### fish consumers 

### who 

### reported 

### advisory

awareness. We 

### conducted a 

### stratified 

### analysis to 

### determine how 

### advisory awareness 

### varied bysociodemographic group 

### andwe 

### conducted a 

### multivariable 

### logistic regression 

### analysis (30). 

### Possible interactive 

### effects between sex 

### and other variables were 

### assessed. Models 

### of 

### significant variables were 

### derived by a 

### back

### ward model-selection method (31) 

### and 

### by comparison 

### ofhierarchical models using 

### likelihood ratio 

### chi-square statistics. Age 

### group 

### and state 

### of 

### residence variables were 

### kept in 

### all 

### models. To 

### adjust for the 

### study's sampling design, the 

### final 

### logistic regression 

### analysis used SUDAAN

### software. 

### Results

A 

### total 

### of 8,306 persons were 

### interviewed, 

### including over 1,000 

### adult residents per

### state. 

### The overall survey

### response ratewas 

### 69% 

### (see 

### Appendix 1). 

### State-specific response 

### rates 

### ranged from 57% in New 

### York to 78% in 

### Wisconsin. Persons 

### who 

### had less than a

### high school 

### degree were 

### underrepresented, com

### prising 14% 

### of our 

### weighted sample com

### pared with the 23% 

### indicated 

### by the 1990

census 

### forthesestates 

### (28). Fish 

### consumption. The estimated per

### centages 

### of persons in 

### the eight GL states 

### who ate 

### fish 

### obtained fromdifferent sources are 

### shown in 

### Table 1. 

### The 

### median number of total 

### fish meals eaten 

### (from all 

### sources)

was not 

### significantly different between groups. An estimated 8.4% 

### [95% confidence 

### interval (CI), 7.6-9.2] 

### of adult residents in 

### the GL 

### states 

### had eaten GL 

### sport fish 

### during the 

### preceding year 

### (approximately 4.7 million persons). 

### Ninety-two percent of 

### GL sport fish consumers in 

### this survey were 

### white, the median age was 

### 39 years, 

### 44% were women, 

### and 52% 

### lived in 

### either 

### Michigan or 

### Ohio. Results 

### of the 1990 census 

### indicates that, 

### amongadult res

### idents of 

### the GL states, 84% 

### were white, 53% were 

### women, and 26% 

### lived in 

### either Michigan or

### Ohio. 

### The 

### estimated distribution 

### of GL sport 

### fish consumers 

### by fish consumption 

### level and sex 

### is 

### shown in 

### Figure 1. 

### A 

### median of 6.5 fish 

### meals were eaten 

### per 

### year 

### (range, 1-292 

### fish meals per 

### year). We 

### estimated that 830,000 persons in 

### the 

### eight GL states 

### had eaten 

### .24 GL sport 

### fish 

### meals peryear. Men 

### reported having eaten 

### GL sport 

### fish

more 

### frequently than 

### did women. 

### The median consumption 

### levels for men 

### and

womenwere 8.2 

### (CI, 6.7-9.6)] 

### and 5.8 

### (CI, 5.0-7.6) 

### meals, respectively. The median number of GL sport 

### fish meals reportedly consumed by whites and nonwhites were 

### 6.4 (CI, 5.8-7.2) 

### and 9.8 

### (CI, 

### 6.1-18.8), 

### respectively. This difference

was not 

### statistically significant because of

Table 1. Estimated prevalence and frequencyof consumption byadultresidents ofGreat Lakes states", by type offish consumed during the precedingyear (1993-1994)

Percent Median Sample estimated fishmealsb Type offish consumed size prevalence eaten/year Cl
Ate commercial fish only 4,825 61.3 33.6 32.4-36.0 Ate non-GLsportfish 1702 18.3 34.8 31.2-37.2 Did not eatfish 872 12.0

- Ate GLsportfish 679 8.4 34.8 31.2-38.4 Total 8,078c 100.0 28.8 27.6-30.0
Abbreviations: GL, Great Lakes; Cl, 95% confidence interval. alllinois, Indiana, Michigan, Minnesota, NewYork, Ohio, Pennsylvania, andWisconsin. 

### bFish ofalltypes. 

### clnformationmissing for 228 of 8,306 surveyrespondents.

12

10

0~

a 8

6

4

<5.0 5-11 >35

Figure 1. Number of Great Lakes sport fish consumers by consumption level and sex in eight Great Lakes states (Indiana, Illinois, Michigan, Minnesota, New York, Ohio, Pennsylvania, and Wisconsin) from April 1993 to February 1994). aSportfish caught inthe Great Lakes.

Environmental Health Perspectives * Volume 105, Number 1Z December 1997 12-23 Sportfishmeals8 peryear

1361Articles * Tilden et al.



### the small number (n = 50) 

### ofnonwhite GL 

### sport-caught fish eaters in our 

### unweighted 

### sample. The GL sport fish group eaten 

### by the 

### greatest number of respondents was 

### perch/smelt/walleye (n = 

### 500) 

### followed by 

### rainbow trout/chinook salmon/coho salmon 

### (n = 

### 316), lake 

### trout (n = 

### 254), other GL 

### sport fish (n = 

### 162), brown trout (n = 73), 

### and

### carp/catfish (n = 

### 64). Sport 

### fish consumption 

### advisory



### awareness. The 

### prevalence of advisory



### awareness among adult GL sport 

### fish con
### sumers 

### byvarious 

### sociodemographic charac

### teristics is 

### shown in 

### Table 2. 

### Approximately half ofall GL 

### sport fish 

### eaters 

### reported that 

### theyhad heard oftheir state's health 

### advisory. 

### Advisory

### awareness varied 

### significantly by
race, 

### sex, 

### educational attainment, GL 

### sport

### caught fish consumption 

### level, and state 

### of 

### residence. Advisoryawareness was not 

### signifi

### candy different by 

### age 

### category. Our 

### sample 

### contained small numbers of GL sport fish 

### eaters 

### from some states. This 

### resulted in 

### unstable state-specific estimates of advisory



### awareness as indicated by wide 95% confidence intervals. InMinnesota andNewYork, 

### the level of awareness indicated by the 

### weighted sample was approximately 10% less than that indicated by the unweighted data. 

### In 

### these states, persons with relatively high 

### weighting (e.g., males 18-34 years of age 

### who did not have a

### high school degree) 

### tend

### ed to 

### report that they had not heard of the 

### advisory. The final logistic regression model for 

### variables associated with advisory awareness 

### among GL 

### sport fish eaters is shown in 

### Table 3. 

### The risk estimates displayed in 

### Table 3 are odds ratios (OR). In the analy

### sis, 

### Wisconsin was 

### used as the 

### referent group in 

### the 

### logistic regression model 

### because the level ofGL sport fish 

### consumption 

### and advisory awareness among 

### Wisconsin anglers had been 

### documented previously. Statistical 

### significance 

### (p<0.05)

was 

### assessed by 95% 

### confidence intervals. Parameters with 

### confidence intervals that

Table 2. Prevalence of advisory awarenessa among adults who had eaten sport fish caught from the Great Lakes bysociodemographic characteristicsbApril 1993-February 1994

Percent prevalence Sample advisory Characteristic size awareness Cl
Total 671 49.9 45.2-54.6 Age (years) 18-34 215 46.9 38.7-55.1 35-44 188 56.1 47.9-64.3 >45 268 49.2 41.8-56.6 Racec White 618 52.1 47.2-57.0 Other 50 22.1 9.4-34.8 Sex Male 347 58.2 51.7-64.7 Female 324 39.1 32.6-45.6 Educational attainment <High school degree 49 33.7 17.6-49.8 High school graduate 272 47.9 40.5-55.3 Some college 189 49.9 41.1-58.7 College graduate 161 61.7 52.9-70.5 GLSCF consumption leveld <6 fishmeals/year 291 44.7 37.5-52.0 6-23.9 fishmeals/year 256 50.4 42.8-58.0 >24fishmeals/year 122 62.4 52.4-72.4 State of residence Michigan 184 60.3 52.7-67.9 Ohio 135 37.9 28.9-46.9 Wisconsin 92 65.3 53.7-76.9 Minnesota 67 37.5e 24.4-50.6 Illinois 57 51.3 36.8-65.8 Indiana 50 42.0 26.7-57.3 Pennsylvania 44 47.8 31.3-64.3 NewYork 42 50.2e 32.2-68.2
Abbreviations: Cl, 95% confidence interval; GLSCF, Great Lakes sport-caught fish. 

### aAwareness defined as having heard of the sport fish advisory; 8 of 679 consumers had missing information onadvisory awareness. 

### bPrevalence estimates based on analysis of weighted data using SUDAAN software (Research Triangle Institute, ResearchTriangle Park, NC). cThree individuals missing race information. dTwo individualswere missing GLSCF consumption level information. 

### eThisweighted estimate is unstable, being 10% less than the estimate derived from unweighted data. 

### did 

### not include an OR of 1.0 were therefore 

### the ones that were significant. After adjusting for other variables in the model, adviso

### ry awareness was significantly associated 

### with male sex, white race, having a college 

### degree, and eating .24 GL sport fish meals 

### per year. GL sport fish consumers in Ohio



### were 

### significantly less likely than GL sport 

### fish eaters in Wisconsin (the referent state) 

### to be 

### aware of an advisory. None of the 

### interaction terms investigated were 

### statisti

### cally

### significant. Of 

### those GL sport fish consumers who



### were 

### aware of an advisory, compliance with 

### advisory recommendations differed signifi

### cantly between men and women (Table 4). 

### Use of 

### recommended cleaning and 

### cooking methods was the most frequently reported 

### risk 

### reduction 

### practice, reported by 69% 

### of

men and 55% of

### women. Compliance was 

### significantly lower for advisory 

### recommen

### dations that 

### required changes in 

### fishing

Table 3. Multivariable logistic regression modela for advisory awarenessb among adult Great Lakes states residents who had eaten sport fish caught in the Great Lakes during the preceding 12 months (telephone survey dates: April 1993-February 1994)
Characteristic Odds Ratio Cl Age (years) 18-34 Reference 35-44 1.6 0.9-2.6 .45 1.3 0.8-2.1 Race Other Reference White 4.2 1.9-9.1 Sex Female Reference Male 2.3 1.5-3.5 Education <High School Reference High school graduate 1.7 0.7-4.0 Some college 1.8 0.8-4.3 College graduate 3.1 1.3-7.6 GL sport fish consumption level <6 fish meals/year Reference 6-23.9fish meals/year 1.3 0.8-2.1 >24 fish meals/year 2.4 1.4-4.3 State of residence Wisconsin Reference Illinois 0.5 0.2-1.2 Indiana 0.5 0.2-1.1 Michigan 0.9 0.5-1.6 Minnesota 0.5 0.2-1.0 NewYork 0.7 0.3-1.7 Ohio 0.4 0.2-0.7 Pennsylvania 0.7 0.3-1.7
Abbreviations: Cl, 95% confidence interval; GL, Great Lakes. aModel includes 666 out of the 671 total persons for whom complete data was known for all variables in the model; three persons had missing

race information and two persons had missing GLSCF consumption level information (see also Table 2for categoryfrequencies). bAwareness is defined as having heard of the sportfish advisory.

Volume 105, Number 12, December 1997 * 

### Environmental 

### Health 

### Perspectives 1

### 362Articles

-Awareness of sport fish health advisories



### behavior (e.g., 

### changing 

### fishing locations to 

### catch 

### fishwith lower 

### levels 

### ofchemical con

### tamination). 

### Discussion The popularity 

### ofsport 

### fishing on 

### the Great 

### Lakes is 

### indicated by our estimate 

### that 

### approximately 4.7 million persons 

### had eaten GL 

### sport 

### fish 

### during the year 

### preceding the survey. Our 

### results indicate that the majority ofthesepersons 

### infrequentlyateGL 

### sport 

### fish and that 

### they tended to eat 

### fish species that contain

### relatively low contaminant 

### levels (i.e., 

### perch/smelt/walleye). The GL 

### sport 

### fish con

### sumption 

### levels 

### reportedbymost 

### respondents

were 

### highlyunlikely to 

### result in

### bodyburden levels 

### previously associated with 

### adverse humanhealth

### effects. However, the

### frequency of GL 

### sport 

### fish consumption varied 

### widely, suggesting 

### substantially different 

### potentials for chemical contaminant 

### exposure 

### among 

### individual consumers. Because environmen

### tally persistent 

### chemical contaminants are 

### present in some GL 

### sport 

### fish, consumers

### will 

### probably continue to 

### seek information 

### regarding the risks and 

### benefits ofeating GL 

### sport 

### fish. In 

### the United States, state 

### governments
are 

### primarily responsible for managing 

### potential risks 

### associated with contaminants in 

### locally caught sport 

### fish (32). As 

### of 

### September 1993, 

### 45 of the 50 states 

### had issued one ormore 

### fish or

### shellfish consumption

### advisories or

### bans 

### (33). Each

### ofthe

### eight GL states 

### has 

### issued sport 

### fish consumption advisories since 

### the 

### mid-1970s. The overall 

### effectiveness of sport 

### fish 

### advisory programs 

### depends on 

### the 

### effectiveness ofboth the rec

### ommendations 

### made and communication 

### methods used 

### (21,34,35). 

### Unfortunately, inconsistency 

### between state-issued 

### advisories has been 

### recognizedas a

### nationwide

### problem 

### (32). Inconsistencies in GL 

### sport 

### fish advisories 

### have at times 

### confused consumers 

### and limited the 

### effectiveness of advisories in 

### the region. Representatives 

### ofthe

### eight GL states 

### have 

### drafted a 

### uniform 

### advisory for the Great 

### Lakes 

### (Anderson et 

### al., unpublished data), but it 

### has not 

### yet 

### been 

### adopted. In 

### this survey, 

### although 

### ability to make 

### interstate comparisons was 

### limited, state 

### of resi

### dence predicted 

### the level 

### of advisory awareness, suggesting 

### that 

### significant differences in 

### advisoryprograms 

### continue toexist. In 

### general, GL sport 

### fish advisories encourage sport 

### fishconsumers to eat 

### fewerof the

### fishspecies

### andsizes

### knownto 

### contain

### elevatedlevels ofchemical 

### contaminants andrec

### ommend the use 

### of 

### cleaning and cooking 

### methods that can 

### substantially reduce the lev

### els of PCBs 

### and other 

### fat-soluble contaminants 

### contained in 

### a 

### fish meal [Anderson et 

### al., unpublished data; 

### (36-38)]. Since GL 

### advisorieswere 

### first

### issued, several studies

### have documented a 

### decline in GL 

### sport 

### fish consumption 

### (22,39,40). In 

### our survey, 

### the most 

### widelyacceptedadvisory

### recommendationwas 

### deaning and 

### cooking methods. 

### The results of

a 

### survey 

### ofNew 

### York 

### anglers indicated that 

### theuse

### ofthese

### cleaningandcookingmethods

was 

### significantly higher among persons 

### who

were aware 

### ofthat state's

### healthadvisory (21). 

### These 

### findings support 

### the 

### belief that sport 

### fish consumption 

### advisories can 

### decrease chemical contaminant 

### exposures among sport 

### fish consumers 

### if 

### effective communication 

### programs are

### used. Communication 

### programs in 

### the GL states 

### have 

### traditionally targeted licensed 

### anglers, who are 

### predominantly white men. Written 

### advisory information (e.g., 

### fishing regulation booklets and advisory brochures) has 

### usually been distributed through the 

### recreational 

### fishingindustryandgovernmental 

### offices. GL 

### sport 

### fish consumers 

### who 

### do not 

### purchase licenses 

### might not 

### have access to 

### information distributed in 

### this way. Because we 

### did not 

### ask 

### respondents if 

### they 

### hadpurchased fishing licenses, we 

### could not 

### directly assess 

### advisory awareness 

### among 

### licensed 

### anglers and 

### nonlicensed GL 

### sport 

### fish consumers. 

### However, our 

### estimated number 

### of GL sport 

### fish consumers 

### was 

### roughly twice 

### that of the most recent estimate 

### of

### licensed GL 

### anglers, suggesting 

### that

a 

### substantial proportion 

### of GL 

### sport 

### fish

consumers were not 

### licensed 

### anglers. Only half of the 

### adults in 

### our 

### population-based

Table 4. Self-reported compliance with health advisory recommendations by sex of consumers of Great Lakes sportfishawho had heard ofthe advisory
Percentage following recommendations

Men Women
Area of recommendation Percent Cl Percent Cl Cleaning and cooking methods 68.8 61.5-76.5 54.6 44.6-64.6 Consumption frequency 50.1 41.9-58.3 42.8 33.0-52.6 Fish species and size 50.3 42.1-58.5 29.4 20.4-38.4 Fishing locations 43.6 35.6-51.6 28.2 19.1-37.2 Cl, 95% confidence interval. aAdult residents of Illinois, Indiana, Michigan, Minnesota, NewYork, Ohio, Pennsylvania, and Wisconsin who reported eating Great Lakes sportfish during the year preceding their interview (surveydates were April 1993-February 1994). 

### survey 

### who 

### had eaten 

### GL sport 

### fish had heard of their state's health advisory. 

### When 

### contrasted with the overall high levels 

### of 

### advisory awareness 

### found by previous 

### mail surveys of licensed GL 

### anglers (7,21,22), it 

### appears 

### that 

### substantial numbers 

### of nonanglers arenot receivingadvisorymessages. Our survey 

### results indicate that existing advisory communication programs 

### are 

### less 

### effectively reaching women, 

### nonwhites, and persons 

### with 

### lower levels of 

### educational attainment. 

### The 

### results ofprevious 

### surveys 

### of

### licensed GL 

### anglers also support this 

### con

### clusion 

### (21,225. Well-accepted principles 

### of risk communication indicate that 

### messages 

### designed for 

### specific audiences are 

### often needed to 

### reach diverse subgroups within a 

### population 

### (41,42). The weight 

### of evidence from the 

### risk communication literature, 

### surveys 

### oflicensedGL 

### anglers, and this 

### population-based survey 

### of GL 

### sport 

### fish consumers 

### suggests 

### that expanded use 

### oftarget

### ed 

### advisory communication 

### methods are 

### needed. To 

### accomplish this, the EPA 

### has 

### developed a 

### detailed and 

### comprehensive 

### guidance 

### document 

### (42) to assist 

### health 

### professionals with the task of 

### fish consumption 

### advisory risk communication. 

### The manual provides 

### specific advice to

### health

### professionals on 

### all aspects 

### of health 

### advisory risk communication, 

### including risk communication as a 

### process 

### of 

### sharing 

### information, problem analysis and program 

### objectives, audience 

### identification and needs assessment, communication 

### strategy 

### design and 

### implementation, program 

### evaluation, and 

### methods of responding to 

### public inquiries. 

### By 

### following the 

### principles outlined in 

### the EPA

### guidance, state 

### jurisdictions can 

### develop 

### successful risk communication 

### programs 

### for those who have not 

### been receiving this very

### important message. In an era 

### of 

### shrinking 

### governmental budgets, individual state 

### agencies must 

### balance 

### the costs 

### ofmanaging 

### potential health risks against 

### the 

### magnitude 

### of the 

### potential 

### healthrisk. It is 

### unlikelythat sport 

### fishadvisory 

### programs will 

### have sufficient resources to mount extensive communication cam

### paigns. However, 

### targeted communication 

### programs 

### designed to 

### reach 

### specific groups
are 

### possible. Our 

### results suggest 

### that additional communication 

### efforts are 

### particularlyneeded to 

### reach 

### persons most sensitive to 

### the 

### effects of the chemical contaminants 

### (i.e., women 

### of 

### childbearing age). Greater 

### collaboration between government agencies 

### and risk communication 

### specialists would 

### probablyreduce the costs 

### ofdeveloping and 

### evaluating new communication 

### programs, 

### and this 

### collaboration would reap 

### the additional 

### benefit 

### of increased consistency among

### state-issued advisories.

EnvironmentalHealth 

### Perspectives * Volume 

### 105, Number 

### 12, December 1997 1363Articles * Tilden et al.



## Appendix 1'

........... ......;i;~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~..

... .. ...

RnaI sempi. 

## ...co e



## .. .......
e., Kriwm fowm1I

...:

. hj tWt oreke ds. tic pr. tedy .rt_i

.......... . .... ... nu be

g, Knowneligiblenonresponse all! h. Complete 

## inteviwte.el

The.CASRO

### response ratef.oa

.. .h 

### (g.+.h. h + b...+.e

gI)' `d+f)

State April iPa ulyt



## ................. .1. u.a,y O erl

il.i.nois 6;......

4% 66 69% 67 7 Michigan 65% 66% 73% 76%

. 

### 70%. Minnesota 73% 7% 7% 83 7% NewYork 51% 

### .53%.. 61% 6 57%

Ohio 66% 68% 76% ~74% 71 Pennsylvania 60% 56% 74% 74% c7% Weconsin 79%. 

### --.?79% .%

. Tot a ..61% 61%.

6I 9 70% 69% 

## .Appendix 2

To obtain

## population-basedestimates 

## gwew.eigted..ach by 

## he. i.v 

### .r.. the probabily of h s thesate response

### ktatee the number adults residing i andthe quantiysof tele-

: ,~~~~~~~~~~~ W

. .~~~~~~~~~.1199. eamS.".....A.M.1.0 wereusedtoweight each stasdo the 

### population a

### g.e,. sex. en duca.tional a.ttainmet

.........

distibutio (72....

. T:hus standard tlephone w metos were used inthe 

### sdyl(22i. Th'e comput onot finl weihtfor each observation is 

### describedinthefollowing

### eqiations.

F_W= DWx PSWx0.25,

.where FW= finalweight, DW= desgn

### weight and PSW= poststratifica- 

### *tio weight

..~~~~~

~ ~ ~ ~~~~~~~ 

# E-c. IS . ..... .. !k 

### DWSS..R.Rx

### lISPx

### NRP)/10 

### x. NAN), .:.

. ..:.


### W.hr 

### S.8 =satep

### ecificeo rate p ercent:, ; , 

### HP.IS,P husehold unit selctonpobbil ity

NR.P= ubroeieta phones inthehouse.holdd unit, and NAH= number ofadultsinth hu hold

.. unit

~~~.0 u

where CPC= state-specific censuspopulationinthestatification cell and 

### -DW= sumofthe designweights. forte completed sample cases in the 

### ...stratificationcell.

.Thefinalweightisaproductoft deign

### w.eig9htandithepoststratification weight, and 

### the 

### constant.25. The :const-anintcluded so that all four 

### p.li waves could be ud estima annual preva

### lence>.The design!wei.ght

is constructed front the

sotatspecific

### responsp:.. rate, the hou.shold unit..selectio.n pr 

### obiliy,eInumber of resiea 

### p.hones inthehousehold u eheume of ts residing in the

Polteiiain atI.v r

hF u & c constr tJrec lco mbinatio of. eighsats three age ou i, w sexi rdtwoeducaion groups. Deinwegt were su nndwrtehbsnain itth statificatio 

### *... cet serve 

### as1* thetenorinstern. The lSSc ur..i populationestimatewas 

### obtaRinedforeach

### ataifie io tLThs th. 

### l_cistatiiato weightwas the 

### ratio of the 

### census populatin eimtes to the sum of the desin 

### weights in 

### eachstatification cell. REFERENCES

1. U.S. Department of the Interior, Fish and Wildlife Service and the U.S. Department of Commerce, Bureau of The Census. National Survey ofFishing, Hunting andWildlife-associated Recreation. Washington, DC:U.S. Government PrintingOffice, 1993. 2. U.S. EPA. ProceedingsoftheU.S. EPA'sNational Technical Workshop "PCB's in Fish Tissue." EPA-823-R-93-003. Washington, DC:U.S. Environmental ProtectionAgency, 1993. 3. DeVault DS, ClarkJM, Lahvis G. Contaminants andtrends infall run coho salmon. J Great Lakes Res 14:23-33 (1988). 4. Schwartz PM, Jacobson SW, Fein G, Jacobson JL, Price HA. Lake Michigan fish consumption

as a source of polychlorinated biphenyls in human cord serum, maternal serum, and milk.
AmJ PublicHealth 73:293-296 (1983). 5. Fiore BJ, Anderson HA, Hanrahan LP, Olson LJ, Sonzogni WC. Sport fish consumption and bodyburden levels ofchlorinatedhydrocarbons:

a study of Wisconsin anglers. Arch Environ Health 44:82-88 (1989). 6. DarE, KanarekMS, Anderson HA, SonzogiWC. Fish consumption and reproductive outcomes in Green Bay, Wisconsin. Environ Res 59:189-201 (1992). 7. Humphrey HD. Population studies of PCBs in Michigan residents. In: PCBs Human and Environmental Hazards (D'Itri FM, Kamrin MA, eds). Ann Arbor, MI:Ann Arbor Science Publishers, 1983;299-310. 8. Conner MS. Comparison of the carcinogenic risks from fish vs. groundwater contamination by organic compounds. Environ Sci Technol 18:628-631 (1984). 9. ATSDR Toxicological profile for selected PCBs (Aroclor

-1260, -1248, -1242, -1232, -1221, and -1016). ATSDR/TP-88/21. Adanta GA:Agency forToxicSubstances andDiseaseRegistry, 1989. 10. ATSDR Toxicological Profile for DDT, DDE, and DDD. ATSDR/TP-89/08. Atlanta GA: Agency for Toxic Substances and Disease Registry, 1989. 11. Fein GG, Jacobson JL, Jacobson SW, Schwartz PM, Dowler JK Prenatal exposure to polychlorinatedbiphenyls: effects onbirthsizeandgestational age. J Pediatr 105:315-320 (1984). 12. Jacobson SW, Fein GG, Schwartz PM, Dowler JK. Perinatal exposure to an environmental toxin: a test of multiple effects model. Dev Psychol 20:523-532 (1984). 13. Jacobson JL, Jacobson SW, Humphrey HEB. Effects of in utero exposure to polychlorinated biphenyls (PCBs) and related contaminants on cognitive functioning in young children. J Pediatr 116:38-45 (1990). 14. Humphrey HEB. Environmental contaminants and reproductive outcomes. Health Environ Digest 5:1-4 (1991). 15. Tilson HA, Jacobson JL, Rogan WJ. Polychlorinated biphenyls and the developing nervous system: cross-species comparisons. Neurol Teratol 12:239-248 (1990). 16. Paneth N. Human reproduction after eating PCB-contaminated fish. Health Environ Digest 5:4-6 (1991). 17. Kimbrough RD. Consumption of fish: benefits and perceived risk. J Toxicol Environ Health 33:81-91 (1991). 18. Knapp HR, FitzGerald GA. The antihypertensive effects of fish oil: a controlled study of polyunsaturated fatty acid supplements in essential hypertension. N EnglJ Med 320:1037-1043 (1989). 19. Olsen SF, Sorensen JD, Secher NJ, Hedegaard M, Henriksen TB, Hansen H, Grant A. Randomized controlled trial ofeffect offish-oil supplementation onpregnancyduration. Lancet 339:1003-1007 (1992). 20. Knuth BA, Connelly NA. Objectives and Evaluation Criteria for Great Lakes Health Advisories: Perspectives from Fishery, Health, and Environmental Quality Agencies. Human Dimensions Research Unit Series No. 91-11. Ithaca, NY:Department ofNatural Resources, Cornell University, 1991. 21. Connelly NA, Knuth BA, Vena JE. New York State Angler Cohort Study: Health Advisory Knowledge andRelatedAttitudes and Behavior, with a Focus on Lake Ontario. Human



### 1364 Volume 105, Number 

### 12, December 1997 * EnvironmentalHealth

### PerspectivesArticles aAwareness of

### sport fish health advisories

Dimensions Research Unit Series No. 93-9. Ithaca, NY:Department ofNatural Resources, Cornell University, 1993. 22. Connelly NA, Knuth BA. Great Lakes Fish Consumption HealthAdvisories: Angler Response to Advisories and Evaluation of Communication Techniques. Human Dimensions Research Unit Series No.93-3. Ithaca, NY:Department of Natural Resources, CornellUniversity, 1993. 23. Palit CD. Design strategies in random digit dialing sampling. In: Proceedings of the Annual Meeting of the American Statistical Association, August 1983, Toronto, Ontario, Canada. Alexandria, VA: American Statistical Association, 1983;627-629. 24. Palit CD, Sharp HP. Strategies in RDD sampling. Presented at the International Conference

on Telephone Survey Methodology, 8-11 November 1987, Charlotte, NC. 25. Palit CD. Some comments on stratified RDD designs. Presented at the 10th Annual Meeting of the Behavioral Risk Factor Surveillance System, 6June 1993, Atlanta, GA. 26. CASRO. Report of the CASRO Task Force on Completion Rates. PortJefferson, NY: Council of American SurveyResearchOrganizations, 1982. 27. CDC. UsingChronic Disease Data AHandbook for Public Health Practitioners. Atlanta, GA: Centers forDiseaseControlandPrevention, 1992. 28. U.S. Bureau of the Census. Education in the United States. Washington, DC:Government PrintingOffice, 1994. 29. Shah BV, Barnwell BG, Bieler GS. SUDAAN User's Manual: Software for Analysis of Correlated Data, Release 6.35. ResearchTriangle Park, NC:ResearchTriangle Institute, 1993. 30. Hosmer DW, Lemeshow S. Applied Logistic Regression. NewYorkJohnWlAey & Sons, 1989. 31. SAS/STAT Users Guide; Version 6. 4th ed. Cary, NC:SAS Institute Inc., 1990. 32. Reinert RE, Knuth BA, Kamrin MA, Stober QJ. Risk assessment, riskmanagement, and fish consumption advisories in the United States. Fisheries 16:5-12 (1991). 33. Center for Environmental Analysis. National Listing ofState Fish and Shellfish Consumption Advisories and Bans. Research Triangle Park, NC:ResearchTriangle Institute, 1993. 34. Belton T, RoundyR, Weinstein N. Urban fishermen: managing the risks of toxic exposures. Environment 28:19-20,30-37 (1986). 35. Knuth BA. Risk communication: a newdimension in sport fisherymanagement. NAmJ Fish Manage 10:374-381 (1990). 36. Voiland MP, Gall KL, Lisk DJ, MacNeill DB. Effectiveness of recommended fat-trimming procedures on the reduction ofPCB and Mirex levels in brown trout (Salmo trutta) from Lake Ontario. J Great Lakes Res 17:454-460 (1991). 37. Skea JC, Simonin HA, Harris EJ, Jackling S, SpagnoliJJ, SymulaJ, ColquhounJR Reducing levels of Mirex, Aroclor 1254, and DDE by trimming and cooking Lake Ontario brown trout (Salmo truttaLanais) and smallmouth bass (Micropterus dolomieui Lacepede). J Great Lakes Res 5:153-159 (1979). 38. ZabikME, Zabic MJ, BoorenAM, Daubenmire S, Pascall MA, Welch R, Humphrey H. Pesticides and total polychlorinated biphenyls residues in raw and cooked walleye and white bass harvested from the Great Lakes. Bull Environ ContamToxicol 54:396-402 (1995). 39. Fitzgerald EF, Hwang G, Brix KA, Bush B, Quinn J. Chemical Contaminants in the Milk of Mohawk Women from Akwesasne. Albany, NY:NewYorkDepartment ofHealth, 1992. 40. Hovinga ME, Sowers MF, Humphrey HEB. Historical changes in serum PCB and DDT levels in an environmentally-exposed cohort. Arch Environ ContamToxicol 22:362-366 (1992). 41. National Research Council. Improving Risk Communication. Washington DC:National AcademyPress, 1989. 42. U.S. EPA. Guidance for Assessing Chemical Contaminant Data for Use in Fish Advisories. Vol 4: Risk Communication. Washington, DC:Office ofScience andTechnology, 1995.



# National 

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EnvironmentalHealth 

### Perspectives * Volume 105, 

### Number 12, 

### December 1997 

### 1365