|
March 2005
A series of focus groups were conducted to help develop the format and content for the 2004 joint Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) advisory on "What you need to know about the risks to your unborn baby or young child from mercury in fish and shellfish." ORC Macro, under a contract with the FDA's Center for Food Safety and Applied Nutrition (CFSAN), completed the groups and reported the key findings.
The objective of these focus groups was twofold. The first objective was to determine how well pregnant women and women of childbearing age understood the information being presented to them through this advisory. The second objective was to ascertain how they actually would use this information in making decisions about what to eat and what to feed their young children.
A total of eight focus groups were conducted for this study, with two groups held in each of four cities: Calverton, Maryland (Washington, DC area); San Diego; Boston; and Miami. One group in each city consisted of pregnant women; the second group included women of childbearing age, including mothers of children under 7 and nursing mothers. Some groups included women with higher education, while other groups were limited to women with two years of college or less to see if there were differences dependent upon level of education.
The same moderator was used for all eight groups.
Most participants said that they wanted a clear, simple message. They said that it was important to know that methylmercury in fish harms a child's developing nervous system, and they wanted to know exactly what should be done to avoid the harm.
Some participants asked for more information about the precise developmental effects and symptoms resulting from excessive amounts of methylmercury. Said one participant in the San Diego pregnant women group, "I know what mercury is now, but I'm not exactly sure what it does to you and your infant."
Others asked for data about particular species of fish; and a number of participants wanted to know how methylmercury would affect people other than those specifically listed in the advisory. A common comment was, "If it's not good for pregnant women and young children, it can't be good for anyone."
Some participants in the pregnant women groups said that, prior to the focus group, they had heard that they should avoid tuna. For most attendees, the advisory content about light tuna having lower levels of methylmercury was both new and welcome. Information about the different methylmercury levels in tuna steaks and albacore tuna versus light tuna was new to most participants, leading some participants to say that they would avoid tuna steaks and albacore tuna as a result of this information.
The recommendation to avoid commercial fish when consuming recreational fish was new information to most of the attendees. Some participants indicated that they think of fish consumption as a whole rather than separating commercial and sport caught fish.
Almost all participants said that they would avoid the fish listed on the DO NOT EAT list. Some of the participants said that they will eat less fish as a result of the advisory, and some of the pregnant women said that they probably would avoid fish altogether while they were pregnant to make sure that they did not get exposed to methylmercury. Some participants also said that they would serve less fish to their children.
Many participants said that they would tell others who are not in the at-risk groups about the risks of fish because if fish can be risky for pregnant women, it probably isn't good for other people.
While some participants said that they would have appreciated specific information about serving sizes for children, others said that their children generally ate smaller portions anyway, so the advisory was helpful to them. When asked specifically what a "smaller" serving size might be, several participants indicated that they probably would give their children about half of a regular adult serving size - 3 ounces compared to the 6 ounces recommended for adults.
Some participants wanted clearer instructions about what was meant by the recommendation to eat "a variety of fish." Most, however, indicated that this recommendation made sense to them, and found the list of fish with lower methylmercury levels helpful.
Participants were largely unaware that fish with lower methylmercury levels are used in fish sticks and fast food sandwiches and thought this information was helpful.
A number of participants in all of the sites had heard something about the issue of methylmercury in fish.
In each focus group, the moderator had the participants read through the one-page advisory first, and then comment upon it. Following are the comments that generally were made in response to the advisory.
Most participants did not know that there were specific fish to avoid, and
appreciated having the DO NOT EAT list.
Some participants had heard that
they should "avoid tuna," so the information that light canned
tuna was low in mercury was welcome news to them.
Participants also were
pleased to hear that shrimp were low in mercury.
Many of the groups expressed
confusion about the fact that salmon was listed as low in mercury, because
they had recently heard that salmon was "bad for you," and their
assumption was that this had something to do with methylmercury.
Participants
were not pleased to hear that albacore tuna was higher in methylmercury than
light tuna. Some pregnant women said that they either would avoid albacore
tuna entirely during their pregnancies, or that they would limit their tuna
intake to once a week so that they could continue eating the albacore tuna
rather than light tuna.
Many participants were unaware of local fish advisories
and had questions about where to obtain information about local advisories.
While
some participants said that they would have appreciated specific information
about serving sizes for children, some commented that their children generally
ate smaller portions. When asked specifically what a "smaller" serving
size might be, several participants indicated that they probably would give
their children about half of a regular adult serving size - 3 ounces
compared to the 6 ounces recommended for adults.
Following the discussion of the advisory, the moderator had participants read the frequently asked questions one at a time, and then comment upon the questions and the answers provided. Following are the comments that generally were made in response to these questions.
"What is mercury?"
Participants appreciated the explanation, but many still wanted to know exactly how methylmercury was harmful. "What exactly does it do?" was a question asked in most of the groups in response to this explanation.
"I'm not pregnant - so why should I be concerned about methylmercury?"
The fact that methylmercury builds up in the body and can remain in their bodies for more than a year was new information to almost everyone in these groups. It helped to clarify for them why women who were planning to get pregnant should avoid eating fish with excessive amounts of methylmercury. However, this information also raised the question for them, if methylmercury builds up in the body over time, then isn't methylmercury harmful to anyone - men, women or children?
"Is there methylmercury in all fish and shellfish?"
While this fact made sense to many participants, some of the respondents seemed surprised when reading that there are traces of methylmercury in almost all fish and shellfish.
"I don't see the fish I eat in the advisory. What should I do?"
Some participants had mentioned in previous discussion that the fish they often ate were not listed either as DO NOT EAT or as low in mercury. Therefore, they appreciated having resources to go to that would provide them information about the specific fish that they ate. Some participants recommended including comprehensive listings of fish and levels of methylmercury in the advisory itself, while others said that having this information available on a website met their needs.
"The advice about canned tuna is in the advisory, but what's the advice about tuna steaks?"
Many participants were unfamiliar with the term "tuna steaks." Others recognized that tuna steaks often were served in restaurants, and therefore appreciated having this clarification.
"What if I eat more than the recommended amount of fish and shellfish in a week?"
There were two general reactions to this question. Some participants interpreted it to mean that they should use their judgment, and simply reduce the amount of fish they ate over a period of time if they happened to eat a lot of fish or shellfish in a given time period. Others found the answer to be "contradictory" or "confusing," since it did not seem to be following the "rule" of limiting fish and shellfish to 12 ounces in any given week.
"Where do I get information about the safety of fish caught recreationally by family or friends?"
Most participants did not eat fish caught by family or friends. Of those who did, most indicated that they were not familiar with the Fishing Regulations Booklet. However, some did say that they appreciated knowing how to obtain information about local advisories, and probably would do so if they were going to eat recreationally-caught fish while they were pregnant. Most, however, indicated that they were more likely to avoid eating locally-caught fish, or that they would simply eat small amounts of it, rather than try to get information about local advisories.
"If you think you've been exposed to large amounts of methylmercury, see your doctor or health care provider."
Many participants again asked what the symptoms of methylmercury exposure would be, both for themselves and for their children.
"For further information about..."
Participants in all
groups like having access to 800 numbers and websites where they could obtain
additional information.
While the message presented to these groups did not answer all of the questions participants raised in the focus groups, it was clear that most participants understood the content of the message as presented. After reading the advisory, they recognized that almost all fish contain some methylmercury, and that amounts vary by type of fish and the waters in which they are caught. They also understood that the advisory recommends avoiding certain fish, choosing a certain amount of fish to be eaten in the course of a week, and varying the types of fish eaten. Some participants said they intend to use the advisory guidelines in determining how much fish to serve their children and themselves. Many pregnant women said that they were inclined to reduce the amounts of fish that they would eat during their pregnancy, and some said they would eliminate fish altogether from their diets, in order to avoid any potential risk from methylmercury.
FDA-EPA Advisory: What You Need to Know about Mercury in Fish and Shellfish March 19, 2004
