Healthy Fish Choices Grocery Store Pilot Project

2. Healthy Fish ChoicesGrocery Store Pilot Project Participating Stores: Mega Foods Tumwater, Bayview Thriftway, Ralph’s Thriftway, and Olympia Foods Co-ops. Rachel Donnette Thurston County Public Health Liz Carr & Dave McBride WA Department of Health Denise LaFlamme WA Department of Health Survey Development and Evaluation

3. Outline • What is a fish advisory? • Types of fish advisories in Washington State • DOH monitoring which supports this project • Analysis of Chemical Contaminant Levels in Store-Bought Fish (WA) • Behavioral Risk Factors Surveillance System (BRFSS) • Overview of the Healthy Fish Choices Pilot Project • Social Marketing Approach • Product line • Primary sources of data for the fish list • How we plan to evaluate the pilot • Survey, we invite your input.

4. What is a fish advisory? Issue advice about safe fish consumption Primarily for women who are pregnant, plan to become pregnant, nursing mothers and young children or high-end consumers (for example: Tribes, API communities). Eat Fish, Be Smart, Choose Wisely • Emphasize the health benefits gained from eating fish • Balance benefits with the risks, importance of choosing fish with lower contaminant levels • Provide healthy hints: How to cook and prepare fish to reduce exposure • Emphasize importance of eating a variety of fish Issue meal limits Species specific advice – Main drivers for are methylmercury and PCBs

5. Fish Advisories in Washington Two Types of Advisories Waterbody Specific Recreational fish advisories. Currently there are 10 advisories statewide which includes Puget Sound. Statewide Fish Consumption Advisory for Mercury Commercial Species: Avoid shark, swordfish, tilefish, king mackerel, marlin & tuna steaks Canned tuna – choose light not white. Freshwater Species: Smallmouth and largemouth freshwater bass (6/03).

6. DOH Monitoring One thing we know: The public is confused about which fish are safe to eat. What we didn’t know: How much fish the public was really eating Where were they consuming these fish from? What level of contaminants are in these fish? Our Goal: To provide info that balances the known health benefits of fish with the risks at point of purchase. Two studies that supported reaching our goal: Analysis of Chemical Contaminant Levels in Store-Bought Fish (WA) Behavioral Risk Factors Surveillance System (BRFSS)

7. Analysis of Chemical Contaminant Levels in Store-Bought Fish from Washington State Dave McBride, MS Jim VanDerslice, PhDDenise Laflamme, MS, MPH Asnake Hailu, Dr PH Liz Carr, MS Species chosen based on frequency of consumption and expected contaminant levels

8. Study Objectives • To characterize levels of mercury and PCBs in canned tuna and fresh fish sold in grocery stores • To estimate contaminant levels in the most frequently consumed fish in Washington State • To identify fish with lower levels for making recommendations to consumers • Expanded analysis to include PBDEs

9. Location of Grocery Stores

10. Behavioral Risk Factor Surveillance System (BRFFS) • Nationwide ongoing telephone survey sponsored by CDC • Collects information about health behaviors, attitudes and knowledge • Population based random selection of non-institutionalized adults ≥ 18 years • Includes core questions asked by all states, optional questions for states to choose from, and state-developed questions • WA added fish consumption questions in 2002, 2004, and 2005

11. BRFSS Results (2004)Consumption of different types of fish

12. Healthy Fish Choices Project Goal: To highlight the healthy choices and the benefits. Mention fish to avoid, but not have the warning be the focus, and have minimal impact on Healthy Choice fish sales.

13. Social Marketing Approach Identify the benefits and barriers to a behavior change Design a strategy with behavior change tools- prompts. “Look for the Healthy Choice Symbol” “Three Steps to a Healthier Heart and Brain” Pilot the strategy with a small segment of a community Evaluate the impact of the program once it has been implemented. Doug McKenzie-Mohr, Ph.D. Environmental Psychologist

14. Benefits and Barriers Prior to developing the materials: 1) Internally, we identified the benefits and barriers that the stores may have by providing this information 2) Met with the store managers and identified the ‘actual’ benefits and barriers to the stores

15. Benefits and Barriers Unexpected outcomes: Stores were positive – they wanted to provide info – they get a lot of ?s Stores wanted to be proactive and wanted this to be a voluntary effort. Prop 65 – California has mandated that seafood counters have information about mercury risks. Stores requested info about fish choices that protect fish populations and habitat.

16. Graphic Artist: Barb McConkey, Inform Design

19. Primary Sources of Data 1) DOH- Office of Environmental Health Assessments. 2005. Analysis of Chemical Contaminant Levels in Store-Bought Fish from Washington State. 2) U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency. 2001 (updated 2006). Mercury Levels in Commercial Fish and Shellfish. 3) U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Seafood. 2004 (updated 2006). Mercury Concentrations in Fish: FDA Monitoring Program (1990-2004). 4) Hawaii Department of Health, Mercury Levels in Hawaiian Commercial Fish. 2004.

25. Evaluation of Materials Survey Please see handout. We invite your input. We will be surveying 75 participants. • 25 Ralph’s Thriftway • 25 Bayview Thriftway • 25 Mega Foods

26. Summary –We would like to share these materials- We invite your comments- If you would like to use them and put your logo on them - great. Most important is a clear, cconsistent, science based message in region 10 which provides fish consumption advice that balances the benefits with the risks.