Something fishy: Fish advisory considerations for public health nurses

Background and Issues: Both federal and state health agencies issue fish advisories for the general population and/or vulnerable groups Advisories can be confusing because recommendations differ based on fish species, and contaminant levels vary depending on size of fish, species, location and type of water bodies. Consumption assumptions such as portion size and background exposure are not consistent across advisories. Description: Using a broad group of scientists including developmental toxicologists and epidemiologists, environmental public health leaders, public health nurses, risk analysts, and community members who are subsistence fishers and/or community leaders, we have constructed a case-study that helps public health and primary care providers (nursing and medicine) understand the benefit tradeoffs and ways to minimize risks and maximize the benefits of eating locally caught or purchased fish. A source of high quality, low fat protein and of essential omega 3-fatty acids, fish is free or nearly to subsistence and sport fishers. The case is well-grounded in the science of methylmercury and fat-soluble environmental chemicals (polychlorinated biphenyls [PCBs] and dioxins) and uses scenarios from ethnic communities to illustrate the application of fundamental concepts to practice. Revisions followed pre- and post-beta testing. Lessons Learned: Practitioners are able to provide accurate instruction to their patients and the public regarding the benefits of eating fish and reducing the risk of consuming neurotoxic and endocrine disrupting contaminants. Recommendations: This case study helps educate public health and private practitioners about the benefits and risks of eating fish and clears-up some of the confusion accompanying fish advisories.