Survey-based Evaluation of a Fish Consumption Information Dissemination Campaign Within an Integrated Health System: Learnings From ChooseYourFish.

INTRODUCTION/OBJECTIVES: Safe fish consumption is important for people who are or could become pregnant. A health system in Minnesota partnered with the Minnesota Department of Health to develop and disseminate messages to promote safe fish consumption for this population via the ChooseYourFish initiative. The ChooseYourFish message was delivered through 5 channels: the Healthy Pregnancy Program (HPP) with phone-based coaching, a clinic brochure, in the clinic after visit summary (AVS), direct mailing of the brochure with a letter, and in images on clinic waiting room monitors. METHODS: We designed a pragmatic evaluation to understand the likelihood that each channel would result in awareness of the message and increase a recipient's intent to act on the information. We surveyed 1050 women aged 18 to 40 in March-May 2020. Results are reported with descriptive statistics. RESULTS: The survey was completed by 524 respondents (51%). Respondents receiving the ChooseYourFish message through any channel except clinic monitors reported a higher awareness of recommendations about eating fish (42%-56%) than respondents in the no-message comparison group (21%). The after visit summary and Healthy Pregnancy Program channels had more confidence in following recommendations (50%-54%) and showed more intention to eat fish (61%-62%) compared to lower-intensity channels (24%-31% and 19%-32%, respectively). CONCLUSIONS: Messages delivered by an often-trusted source (eg, healthcare provider) were more likely to increase confidence and intent. Despite the trend toward online health information, physical brochures still have large reach. Repetition of exposure may be important. Because all communication channels have advantages and drawbacks, using multiple delivery channels is appropriate in communication campaigns.

Behaviors, Beliefs, and Recommendations to Optimize Promotion of Safe Fish Consumption Before and During Pregnancy: A Physician Survey.

INTRODUCTION: Eating fish before and during pregnancy is important but care must be taken to choose fish which maximize developmental outcomes. Physicians, a trusted health information source, could provide this nuanced communication. This cross-sectional survey of a representative sample of 400 family medicine and obstetrics and gynecology (OB-GYN) physicians in Minnesota was designed to understand physician behaviors and beliefs about safe fish consumption, describe barriers to physician-patient conversations about safe fish consumption generally and as part of prenatal care and to identify resources to help facilitate conversations on this topic. METHODS: Data was collected January to April 2020. Two hundred nineteen surveys were completed (55% response rate) with 194 reporting seeing patients at least 1 day a week. Descriptive survey results from all were summarized and analyzed overall and by physician specialty. Responses to 3 open-ended questions were thematically coded to enrich the quantitative results. RESULTS: While 62% of these reported discussing nutrition topics, only about one-third reported discussing with patients the benefits and about one-quarter the risks of eating fish. Despite the relative infrequency of fish discussions, almost all (>90%) respondents agreed that it is important to discuss fish consumption with people who are or may become pregnant. The largest reported barrier to these conversations was time (82%), and the most endorsed resource to overcome identified barriers was talking points (72%). CONCLUSIONS: Because physicians report limited time, resources that facilitate fish consumption should be succinct while serving to both nudge the message and direct clinicians and their patients to robust information.

Promoting Fish Consumption Messages: Perspectives of Hmong Women of Childbearing Age.

Objectives: Through focus groups, we aimed to understand ways to promote safe and healthy fish consumption among Hmong women in Minnesota. Methods: English-speaking Hmong women aged 18-40 were eligible to participate in 90-minute focus groups. Through our questions, we sought to gain understanding of the women's health-seeking behaviors and to obtain feedback on current messaging. We recorded the focus groups and transcribed and double-coded the data using sequential directed content analysis. Results: Thirteen Hmong women participated across 3 focus groups. The final coding tree included 6 primary themes related to health messaging, with adequate inter-coder reliability for each. Women identified the Internet as the primary source of health information with website preferences driven in-part by preferences of elders. Discrepancies between health beliefs of elder and younger generations were noted, with some evidence that personal fish consumption preferences outweighed cultural norms. Messages clearly targeting the Hmong population were preferred, with discrepancy in risk-versus benefit-framed messages. Conclusions: Findings highlight the need for culturally informed messages that are clear and carefully tailored. Our findings will inform future development of safe and healthy fish consumption messaging to better support the Hmong community in Minnesota.

Responses to a Social Media Campaign Promoting Safe Fish Consumption Among Women.

We used a framework to systematically evaluate which Facebook advertisements promoting safe fish consumption increased traffic to our website. Keeping images and headlines constant, we tested 11 message types in 5 categories between 2 audiences over a 24-hour weekday period. We identified clear preferences in 9 of 10 comparisons and evidence to suggest that more women prefer presentation of question format compared with narratives, marketing compared with patient education copy, and uncertain compared with certain copy. Our test of messages on a social media platform is a quick and inexpensive way to select the most engaging public health messages for broad dissemination.

Estimated exposure to mercury from fish consumption among women anglers of childbearing age in the Great Lakes region.

Women of childbearing age (WCBA) are advised by state, tribal, and federal agencies to limit their consumption of certain fish, in part, because of concerns about the ingestion of methylmercury and its impact on the development of fetuses. We studied the fish-eating habits of WCBA who had a fishing license and lived near the Great Lakes, where mercury in locally-caught fish is a concern, as these women were likely at greater risk of elevated mercury exposure than the general population. We used a web-based diary method to gather fish consumption data from WCBA anglers over a 4-month period in the summer of 2014. We estimated mercury intake based on reported mercury content of species consumed, frequency of consumption, and meal portion size, and calculated percent exceeding the USEPA reference dose (RfD). Based on these calculations, we estimated that study participants (n = 1395) ingested 0.031 ±â€¯0.002 (95% CI) ug/kg/d of methylmercury (arithmetic mean). We also found that 3.4% of study participants exceeded the RfD when we averaged estimated intake over the 4-month study period. While most (82%) of the fish meals WCBA anglers ate were purchased fish meals generally low in mercury, study participants ingested a disproportionate amount of mercury from locally-caught fish meals (18% of meals contributed 37% of mercury intake). We estimated 11% of WCBA anglers who did not follow state and federal guidelines in effect at the time of our study exceeded the mercury RfD, whereas fewer than 1% of WCBA anglers who followed the guidelines exceeded the RfD. These findings highlight the importance of encouraging WCBA to follow guidelines from agencies for locally-caught fish, in combination with guidelines for purchased fish.

Geographical distribution of perfluorinated compounds in fish from Minnesota lakes and rivers.

In response to growing interest in human exposure to perfluorinated compounds (PFCs), the state of Minnesota measured and reported PFC concentrations in fish collected from the Minneapolis-St. Paul area. To better determine the geographical distribution of PFC contamination throughout Minnesota, fish were collected from 59 lakes throughout the state and several areas along the Mississippi River. Composite fish samples were analyzed for 10 PFC analytes by solid-phase extraction (SPE) and liquid chromatography-tandem mass spectrometry (LC/MS/MS). PFOS (perfluorooctanesulfonate) was the most commonly detected PFC, occurring in 73% of fish from the Mississippi River but only 22% of fish from lakes. Fish from Mississippi River Pool 2 near the Minneapolis-St. Paul area had the highest levels of PFOS, whereas locations upstream had PFOS concentrations below 40 ng/g, the concentration at which Minnesota issues "one meal per week" fish consumption advice. Fish from most Minnesota lakes tested (88%) had PFOS concentrations below 3 ng/g. Two lakes, McCarrons and Zumbro, contained fish with PFOS levels above 40 ng/g. The results reported here will help researchers to better understand the extent of PFC contamination in Minnesota fish and evaluate potential sources of contamination and will provide a basis for comprehensive fish consumption advice.

Determination of ten perfluorinated compounds in bluegill sunfish (Lepomis macrochirus) fillets.

A rigorous solid phase extraction/liquid chromatography/tandem mass spectrometry method for the measurement of 10 perfluorinated compounds (PFCs) in fish fillets is described and applied to fillets of bluegill sunfish (Lepomis macrochirus) collected from selected areas of Minnesota and North Carolina. The 4 PFC analytes routinely detected in bluegill fillets were perfluorooctane sulfonate (PFOS), perfluorodecanoic acid (C10), perfluoroundecanoic acid (C11), and perflurododecanoic acid (C12). Measures of method accuracy and precision for these compounds showed that calculated concentrations of PFCs in spiked samples differed by less than 20% from their theoretical values and that the %RSD for repeated measurements was less than 20%. Minnesota samples were collected from areas of the Mississippi River near historical PFC sources, from the St. Croix River as a background site, and from Lake Calhoun, which has no documented PFC sources. PFOS was the most prevalent PFC found in the Minnesota samples, with median concentrations of 47.0-102 ng/g at locations along the Mississippi River, 2.08 ng/g in the St. Croix River, and 275 ng/g in Lake Calhoun. North Carolina samples were collected from two rivers with no known historical PFC sources. PFOS was the predominant analyte in fish taken from the Haw and Deep Rivers, with median concentrations of 30.3 and 62.2 ng/g, respectively. Concentrations of C10, C11, and C12 in NC samples were among the highest reported in the literature, with respective median values of 9.08, 23.9, and 6.60 ng/g in fish from the Haw River and 2.90, 9.15, and 3.46 ng/g in fish from the Deep River. These results suggest that PFC contamination in freshwater fish may not be limited to areas with known historical PFC inputs.