Imm et al. large, predatory fish. As shown in Table 4, > 2.8 million residents fall into this subgroup. Most were female, college educated, and ≥ 45 years of age. People reporting a household income > $50,000/year were more likely to fall into this category than were those with lower incomes. Residents of New York were three times more likely to fall into this high-intake subgroup than were residents of any other state and approximately eight times more likely than residents of Wisconsin and Minnesota. Fifty- one percent of these high-intake individuals ate tuna at least once a week. Advisory awareness. All GL states have issued consumption advisories for GL fish. Approximately half of adults who consumed fish from the Great Lakes were aware of the health advisory that had been issued by their state health department (Table 5). This aware- ness rate had not changed since the 1993–1994 survey. On the basis of multivariate logistic regression analysis, advisory awareness varied signiﬁcantly (p < 0.05) by gender, black/white race, and fish consumption rate (Table 6). Whites were > 6 times more likely to be aware of their state’s advisory than blacks and men were four times more likely to be aware than women. Also, advisory awareness was positively associated with annual ﬁsh consumption rates. Most GL ﬁsh consumers who were aware of the advisories issued by their state complied with them. Compliance rates for the types and sizes of ﬁsh that were safe to eat, preparation methods, and ﬁshing locations ranged from 63 to 77%. The least popular recommendation was the restriction on the amount of ﬁsh that should be eaten in a given time period. Compliance with this guideline was only 52% (Table 7). Discussion Although persistent, bioaccumulative contami- nants in the Great Lakes Basin continue to be a public health concern, our survey results indi- cate that sport ﬁshing in these lakes remains a popular activity. According to the survey results, 7% of adults living in the GL states had eaten at least one meal of GL sport ﬁsh during the previous 12 months. This percentage corre- sponds to an estimated population of 4.2 mil- lion adult residents in these states. Compared with national dietary estimates, residents of these states appear to consume more ﬁsh than do people living in other regions. Including residents who did not eat fish, our study revealed an average fish consumption rate of 38 meals/year. The U.S. Department of Agriculture 1994–1996 and 1998 Continuing Survey of Food Intakes by Individuals found that the average number of ﬁsh meals (grams per day converted to 6-oz prepared ﬁsh meals per year) consumed by adults ≥ 18 years of age was approximately 32/year (U.S. EPA 2002). Comparison of responses to our 1993–1994 and 2001–2002 surveys indicates that ﬁsh con- sumption rates and awareness prevalence have remained stable over this time period. As in 1993–1994, the 2001–2002 study suggests that most GL sport-ﬁsh consumers choose to eat ﬁsh that are low in contaminants, such as perch, smelt, and walleye. Findings from this survey suggest that sig- nificant exposure to GL contaminants from ﬁsh is limited to a small subpopulation of avid Table 5. Advisory awareness among GL sport-fish consumers. Table 6. Multivariate logistic regression model for advisory awareness among GL sport-fish consumers. Demographic characteristic Age (years) 18–34 35–44 ≥ 45 Race White Black Gender Male Female Education Less than high school High school graduate Some college College graduate Consumption 0–5 meals/year 6–23 meals/year ≥ 24 meals/year Total 1328 2001–2002 1993–1994 n % Aware n % Aware 73 93 131 258 24 153 146 25 91 86 97 107 135 34 299 38 56 52 55 15 65 30 33 50 55 48 41 57 70 49 217 190 276 638 38 355 337 50 278 195 165 291 248 120 692 49 56 49 53 23 60 38 33 50 50 61 45 53 61 51 Demographic characteristic Race Black White Gender Female Male Fish consumption < 6 meals/year 6–23 meals/year ≥ 24 meals/year Odds ratio (95% conﬁdence interval) Referent 6.6 (2.0–21.5) Referent 4.0 (2.3–7.1) Referent 2.3 (1.3–4.1) 5.0 (1.7–14.6) All odds ratios reported in table were statistically signiﬁcant at p < 0.05 level. Regression calculated using weighted data. Statistics are not provided for other races because of small sample sizes. Table 7. Self-reported compliance with advisories. Advisory component Cooking/cleaning methods Consumption frequency Fish species and size Fishing locations n 81 92 65 57 % Always complying 77 52 63 71 Percentages are based on weighted data. Statistics are not provided for other races because of small sample sizes. Percentages are based on weighted data. n = number of GL sport-ﬁsh consumers who reported awareness of each guideline. sport-caught ﬁsh consumers. The mean num- ber of sport-caught ﬁsh meals reported by GL sport-caught ﬁsh consumers was 13 meals/year. Only one person (a man from Michigan, 35–44 years of age) consumed more than 2 GL ﬁsh meals/week. These consumption rates are similar to those reported by respondents of the 1993–1994 survey (Tilden et al. 1997). The overall percentage of GL sport-caught ﬁsh consumers who were aware of the advisory in their state was similar to that observed in 1993–1994. In both studies, awareness preva- lence was approximately 50%. However, women and black residents reported the lowest awareness rates. In 1993–1994, less than half (38%) the women who ate GL sport-caught fish were aware that their state had issued a consumption advisory for contaminants in these ﬁsh. As a result of the 1993–1994 survey of the GL states, the health departments of these states chose as a priority to augment their ongoing activities with the development of outreach materials aimed at young women and children. This group was targeted because of methods available to reach this population and because of an emphasis on the health of this more vulnerable population because of con- cerns regarding the effects of ﬁsh contaminants on the developing nervous system. The first group effort produced the “Hook into Healthy Fish” campaign where the states customized a set of common outreach materials that were distributed at WIC (Women, Infants and Children) clinics and public health fairs and sent to pediatricians. These materials included coffee mugs, posters, fact cards, T-shirts, memo pads, and refrigerator magnets pro- duced by the Wisconsin Department of Health and Femily Services, Division of Public Health and funded the the Agency for Toxic Substances and Disease Registry. Despite efforts that were intended to raise awareness among this group, from 1993 to 2002 aware- ness prevalence among women had slipped from 38 to 30% (although this was not a statis- tically significant difference). However, on a positive note, the estimated number of women who ate GL sport fish > 35 times a year declined by approximately 99,000 over this same time period. The overall effectiveness of the outreach cannot be directly evaluated because of other community and environmen- tal action group campaigns that ran concur- rently during this time period. Awareness rates also slipped among minorities and younger age groups but rose slightly from 58 to 65% among men and con- tinued to be highest in men ≥ 45 years of age (67% in 2001–2002). Although temporal changes related to awareness among these groups were not statistically significant, our ﬁndings suggest that outreach to GL ﬁshermen and their families may not be reaching some segments of the population. This study does VOLUME 113 | NUMBER 10 | October 2005 • Environmental Health Perspectives