Delivering complex environmental messages in cultural context

Fifty state public health agencies and federal agencies have issued fish consumption advisories due to mercury contamination. Consumers who are the least aware of advisories, and the most likely to consume higher than recommended amounts of high-mercury fish, are those with low-income/low educational attainment, limited English proficiency, and recent immigration status – all characteristics of the growing Latino population in North Carolina and across the U.S. Avoiding fish consumption is undesirable as omega-3 fatty acids and other nutrients in fish are associated with better birth and developmental outcomes. Thus, well-informed fish choices are critical to limiting methylmercury exposure and improving overall birth outcomes. In 2007, the North Carolina Supplemental Nutrition Program for Women, Infants, and Children (WIC) served 17,000 Latino mothers and their children. This program is a trusted source of health and nutrition information for Latinas, yet did not offer any advice to mothers about fish consumption despite providing breastfeeding mothers with a food coupon for one can of chunk light tuna per week. A partnership between Duke University, the NC WIC program and the North Carolina Healthy Start Foundation developed outreach materials for the Latino population using peer-to-peer interviews, focus groups, and collaborative evaluation. Materials had a comprehension rate of at least 90%, and a self-reported adherence to recommendation of at least 75%. The end products are now incorporated into the nutrition education curriculum of the NC WIC program. Nutritionists were trained with an online training module, which was also accredited for continuing education for registered dieticians.