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Seafood Choices: Balancing Benefits and Risks 6 Understanding Consumer Decision Making as the Basis for the Design of Consumer Guidance Chapter 5 outlined the three steps the committee deemed necessary to designing guidance to consumers about balancing benefits and risks in making seafood consumption decisions (see Box 5-1): scientific assessment and analysis of the benefits and risks; analysis of the consumer’s decision making context; and production and evaluation of the guidance. Chapter 5 then detailed Step One: the evidence base for the information to include in the guidance (or what the consumer needs to know to make an informed decision). This chapter presents an approach to Step Two: developing an understanding of how consumers make seafood choices and the informational environment in which they do so. This environment includes both what information the consumer has access to and what the consumer needs or wants to know. Included in this chapter is an overview of the types of information that are currently available and evidence of the degree to which consumer choice has been influenced by it. The chapter then discusses reasons why consumer guidance may have weak or unintended impacts on consumer choice and what must be understood about the consumer decision-making context in order to design effective guidance. INTRODUCTION As noted in the previous chapters, there is a wide variety of guidance on seafood consumption currently available to consumers. Based on their analysis of nutritional benefits, some governmental agencies and nongovernmental organizations (NGOs) have recommended that most Americans consume two 3-ounce (cooked) servings of seafood weekly, with one of these
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Seafood Choices: Balancing Benefits and Risks being a fatty fish (see Chapter 1). Other guidance cautions some consumers against specific types of seafood due to health risks. As shown in preceding chapters, different populations have different benefit-risk profiles, and guidance to consumers should be tailored to reflect this. Receiving new information, such as dietary guidance, does not automatically lead consumers to change their food consumption patterns. Food choice is influenced by a complex informational environment that also includes labeling, point-of-purchase information, commercial advertising and promotion, and Web-based health information. Specific guidance may have a limited impact, although evidence suggests that this varies significantly and in general is not well measured or understood; current advice may create unintended consequences in consumer choices. A better understanding of the sociocultural, environmental, economic, and other individual factors that influence consumer choice is necessary for the design of effective consumer guidance, especially where the intent is to communicate balancing of benefits and risks associated with its consumption. FOOD CHOICE BEHAVIOR Food Consumption Decisions Identification of Factors Influencing Food Consumption Decisions Studies of food choice behavior have identified both individual and environmental factors that influence the complex process of decision making (Lutz et al., 1995; Galef, 1996; Drewnowski, 1997; Nestle et al., 1998; Booth et al., 2001; Wetter et al., 2001; Bisogni et al., 2002; Devine, 2005; Raine, 2005; Shepard, 2005). Factors influencing seafood consumption choices are similar to those for other foods (e.g., taste, convenience, or ease of preparation) (Gempesaw et al., 1995). Individual Influences When consumers are asked what is most important when choosing food, taste is the most likely response (Drewnowski, 1997). However, a variety of other individual factors (e.g., habit) (Honkanen et al., 2005) also influence consumer decisions about consumption or avoidance of specific foods (Lutz et al., 1995; Galef, 1996; Drewnowski, 1997; Nestle et al., 1998; Booth et al., 2001; Bisogni et al., 2002; Devine, 2005). For example, some people will override taste to select foods to benefit their health (Stewart-Knox et al., 2005). The choice for healthfulness is further affected by choice of preparation method and food consumption outside the home (Blisard et al., 2002). For other consumers, issues of convenience, availability, and cost may play greater roles than concerns about health. What is unknown is the degree to which these factors determine final food selection.
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Seafood Choices: Balancing Benefits and Risks Environmental Influences Taste is influenced by genetics (Birch, 1999; Mennella et al., 2005a) and exposure throughout life (Birch, 1998; Birch and Fisher, 1998; Mennella et al., 2005b). Other environmental factors that influence seafood choices include accessibility of seafood as a subsistence food (Burger et al., 1999b), cultural tradition (Willows, 2005), price of seafood and of seafood substitutes (Hanson et al., 1995), and health and nutrition concerns (Gempesaw et al., 1995; Trondsen et al., 2003). For example, some consumers make seafood choices based on concerns about environmental impact (see Monterey Bay Aquarium’s Seafood Watch [http://www.mbayaq.org/cr/seafoodwatch.asp], production methods, or geographical origin (Figure 6-1). An individual’s food choices are made based on their history but are influenced by a changing environment over time (Devine, 2005; Wethington, 2005). While most patterns of choice (trajectories) are stable throughout life, significant societal and personal events, as well as relationships, influence these patterns. The timing of these events may greatly influence subsequent food choices. In response to these external events and internal changes, individuals may or may not choose to adopt strategies to improve their health and change their lifestyle behaviors. Using the pregnant woman as an example (see Appendix C-1), one can examine the complexity of food choice using the Life Course Perspective framework (see Appendix C-2). Economic Considerations Associated with Food Choice Behavior Economic considerations may also influence consumer food choice behavior. Evidence suggests that seafood is a good substitute for other protein foods (Salvanes and DeVoretz, 1997; Huang and Lin, 2000). US consumers have the lowest income elasticity of demand (the percentage change in demand for a 1 percent change in income) for the overall category of “food, beverages, and tobacco” of 114 countries, based on an analysis of 1996 data (Seale et al., 2003). This indicates that, on average, their food expenditures are not very sensitive to income changes. For the subcategory of fish, Seale et al. also found the US expenditure elasticity (the percentage change in demand for a 1 percent change in expenditures on a category) lowest among the 114 countries studied. Similarly, US consumers had the lowest own-price elasticities of demand (the percentage change in demand for a one percent change in price) for fish among the countries studied. More detailed analysis within the United States suggests further income and price considerations that may influence how consumers implement guidance on seafood choices. For example, Huang and Lin (2000) used 1987–1988 National Food Consumption Survey data to estimate expenditure and own-price elasticities adjusting for changes in the quality of the foods consumed across different income groups. Expenditure and own-
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Seafood Choices: Balancing Benefits and Risks FIGURE 6-1 Framework for factors influencing healthy eating and physical activity behaviors. The schema depicts a psychobiological core composed of genetic, psychological (e.g., self-esteem, body image, disagreement with personal vulnerability or gain from choices), and physiological influences (e.g., gender, age, health status, responses to specific components in food, hunger, and satiety). This core is embedded within a social-cultural context (e.g., families and friends, religion and tradition, economic and other resources, awareness and knowledge of the implications of choice), and impact of consumer advertising and information that can either enhance or inhibit healthful food choices and other lifestyle behaviors. In addition to these individual characteristics, the larger environment (e.g., neighborhoods, communities, schools, worksites) along with policy decisions (e.g., health advisories and guidance; economic and political priorities) greatly influence the individual’s food decisions (Wetter et al., 2001; Raine, 2005). Food availability, convenience, cost considerations, and food subsidies also are included in the environmental layers of influence. SOURCE: Adapted, with permission, from Booth et al. (2001). Copyright 2001 by International Life Sciences Institute.
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Seafood Choices: Balancing Benefits and Risks price elasticities vary between low-, medium-, and high-income consumers, although the extent differs between food products (Yen and Huang, 1996; Huang and Lin, 2000). They also conclude that the quality of items chosen by consumers (e.g., different cuts of beef within the beef subcategory) is clearly linked to income level. Similarly, an analysis of household expenditures on fruits and vegetables shows significant differences in expenditure per capita between low-income and higher-income households, as well as differences in the income elasticity of demand (Blisard et al., 2004). These results suggest that population averages may conceal significant differences between income groups in terms of their demand responses to income, expenditure, and price changes. Impact of Factors Influencing Food Consumption Decisions In general, when consumers are presented with new information, e.g., balancing health benefits with risks of seafood choices, food choice behavior theories suggest that they will interpret and respond to this information in light of their existing beliefs, attitudes, and habits, and will be influenced by situational factors as much as or more than by the content of the information. For example, in a long-term, randomized controlled study involving advice to men with angina to eat more fish and vegetables, small increases in fish consumption were observed (Ness et al., 2004), but this did not appear to improve survival (Ness et al., 2002). Even with carefully planned prospective studies of the consequences of giving advice, it can be difficult to discern the effect of advice, due to potentially confounding influences (see also Impact of State Advisories below). Advice provided publicly may be focused on by the media, reinforced or contradicted by other policy measures, or obscured by other news (Kasperson et al., 2003). As Ness et al. (2004) illustrated, knowledge does not necessarily lead to the intended changes in consumption patterns. In addition, once a decision is made, many processes are involved in implementing and sustaining a change (Appendix C-3). Among the many theories used to explain both food choice behavior (and its subsequent impact on health) and behavior change (Achterberg and Trenker, 1990), a few are highlighted in Appendix C-2. The Current Information Environment Influencing Seafood Choices Consumers have access to several different types of communication that form a complex information environment in which they make decisions. Each of these plays a role in their decisions, either as a source of information or as a facilitator of choice. A striking aspect of the information available to consumers is that it
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Seafood Choices: Balancing Benefits and Risks is not systematically coordinated. This lack of coordination would not be unexpected between public agencies and private organizations, or between groups who may have different interpretations of the evidence about what is a healthful eating pattern as well as different goals in giving advice. However, even within the federal government, guidance to consumers has not been systematically coordinated, either on a benefit-by-benefit or risk-by-risk basis, as illustrated by the differences between recommendations on portion sizes and frequency of consumption (see Table 1-2 and Appendix Table B-3). Elements of the information environment which government agencies can control include labels, other point-of-purchase information in the retail environment, and restaurant and fast-food outlet menus. Labels and Other Point-of-Purchase Information Ingredient and Nutrition Labeling Ingredient labeling gives consumers content information about packaged seafood products. In some cases, regulation also restricts use of terms in identifying products. For example, only albacore tuna can be labeled as “white tuna,” while “chunk light tuna” may include several species of tuna. Nutrition labeling in the form of the Nutrition Facts panel is mandatory in the United States for packaged products, while the use of voluntary nutrient content and health claims is also regulated. Fresh foods are exempt from mandatory labeling. In 1992, the US Food and Drug Administration (FDA) issued guidelines for a voluntary point-of-purchase nutrition information program for fresh produce and raw fish. The guidelines are scheduled to be revised in 2006 to make them more consistent with mandatory nutrition labeling requirements (Personal communication, K. Carson, Food and Drug Administration, April 1, 2006). To meet the guidelines, a retailer must include the following nutrition information on the point-of-purchase label for seafood that is among the 20 types most commonly eaten in the US: seafood type; serving size; calories per serving; protein, carbohydrate, total fat, cholesterol, and sodium content per serving; and percent of the US Recommended Dietary Allowances (RDA) for iron, calcium, and vitamins A and C per serving (FDA, 2004a). A serving is defined as 3 ounces or 85 grams cooked weight, without added fat or seasoning. Qualified Health Claims Labeling While the standard Nutrition Facts format informs consumers about several nutrition characteristics of seafood products, it does not list omega-3 fatty acid content. In 2004, the FDA announced the availability of a qualified health claim for reduced risk of coronary heart disease on conventional foods that contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Qualified health claims on
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Seafood Choices: Balancing Benefits and Risks foods must be supported by scientific evidence as outlined in the guidance document, Guidance for Industry and FDA: Interim Procedures for Qualified Health Claims in the Labeling of Conventional Human Food and Human Dietary Supplements (CFSAN, 2003). In addition, the FDA is conducting further consumer studies to make sure the language used in claims is well understood by consumers (FDA, 2004b). In the interim period, the FDA will prioritize health claims for review based on the potential significance of the product’s health impact on a serious or life-threatening illness, and the strength of evidence in support of the claim. The health claims that will be evaluated first include the benefits of eating foods high in omega-3 fatty acids, including certain fatty fish like ocean salmon, tuna, and mackerel, for reducing the risk of heart disease. Country of Origin and Other Labeling The 2002 Supplemental Appropriations Act amended the Agricultural Marketing Act of 1946 to require retailers to inform consumers of the country of origin of wild and farm-raised fish and shellfish. This information can be conveyed by label, stamp, mark, placard, or other clear and visible sign on the product, package, display, holding unit, or bin containing the seafood at the final point of consumption. Food service establishments are exempt, as are processed products. Box 6-1 describes an unresolved issue over which governmental sector has the authority to control the consumer’s access to certain information BOX 6-1 Challenge to California’s Proposition 65 In 2005, the Food and Drug Administration claimed that California’s action was a violation of federal law. On March 8, 2006, the House passed HR 4167, the National Uniformity for Food Act, which amends the Federal Food, Drug, and Cosmetic Act to “provide for uniform food safety warning notification requirements” and to supersede state legislation and practices on food-warning labels, including Proposition 65. At the writing of this report, the Act had not passed the Senate. An amendment to the Act included a clause to exclude mercury warnings: “Nothing in this Act or the amendments made by this Act shall have any effect upon a State law, regulation, proposition or other action that establishes a notification requirement regarding the presence or potential effects of mercury in fish and shellfish.” SOURCE: http://www.govtrack.us/data/us/bills.text/109/h/h4167.pdf.
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Seafood Choices: Balancing Benefits and Risks regarding food. In 2004, the Attorney General of California joined a lawsuit filed by the Public Media Center, a nonprofit media and consumer advocacy agency in San Francisco, against the nation’s three largest canned tuna companies to enforce Proposition 65, California’s 1986 law requiring warnings about exposure to contaminants, such as methylmercury. Restaurant and Fast-Food Menu Information The away-from-home sector is exempt from nutritional and country of origin labeling requirements. Further, many restaurants do not identify seafood products such as breaded fish sandwiches by species. Some of this information is provided voluntarily, and this may increase with consumer demand for specific types of seafood. In April 2003, the Attorney General of California filed suit against major restaurant chains in the state for violating Proposition 65 requirements to inform consumers of potential exposure to “substances known by the state to cause cancer or reproductive toxicity” by failing to post “clear and reasonable” consumer warnings about exposure to mercury in seafood (i.e., shark, swordfish, and tuna). The suit was settled in early 2005, when most of the restaurants agreed to put up warnings about the risks from mercury in seafood near the front door, hostess desk or reception area, or entry or waiting area (California Office of the Attorney General, [http://ag.ca.gov/newsalerts/2005/05-011.htm]). The information provided in this sector remains largely unregulated. The outcome of the lawsuit concluded that labeling under Proposition 65 was preempted for mercury in tuna, although the decision was specific to the circumstances in the case. All applications of Proposition 65 to food were not preempted by the decision. Moreover, this decision was by a state judge and specific to Proposition 65 and California—not other laws or other states. Regulated Point-of-Purchase Information Retailers may place nutrition information on individual food wrappers or on stickers affixed to the outside of the food. Compliance with point-of-purchase guidelines is checked by biennial surveys of 2,000 food stores that sell raw produce or fish and the results are reported to Congress. Additionally, every 2 years the FDA publishes, in the Federal Register, revised nutrition labeling data for the 20 most frequently consumed raw fruits, vegetables, and fish. Recent research suggests that the amount of information available on fresh seafood products in retail settings varies markedly, with counter staff frequently unable to provide additional information (Burger et al., 2004). In addition to the quantity and types of information available to consumers, the accuracy of information should also be considered. Limited tests indicate that seafood products may be misrepresented—for example, sold as wild when they are in fact farmed (Is Our Fish Fit to Eat, 1992; Burros, 2005).
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Seafood Choices: Balancing Benefits and Risks Advertising and Promotion Advertising and promotion may include nonregulated point-of-purchase information, which can be displayed on placards, shelf tags, or in pamphlets or brochures. In addition to regulated labeling and point-of-purchase information, several types of retail information are available to consumers making food choices. For processed foods, packaging information includes the brand, product name, and unregulated product claims and other information. It is estimated that $7.3 billion was spent on advertising food in 1999 (Story and French, 2004). As well, several other forms of point-of-purchase (e.g., signage, brochures) and other forms of information (e.g., websites) may be provided. Other means to convey this information to consumers may include live demonstrations, computer booths, or recorded presentations as adjuncts to the printed information. Web-Based Health Information Interactive Health Communication Much of the rapidly rising use of the Internet is devoted to seeking health information: four out of five Internet users (95 million Americans) have Internet access to look for health-related information; 59 percent of female users have used the Internet to look for information on nutrition (Fox, 2005). The promise of eHealth and, in particular, interactive health communication (IHC) (Eng et al., 1999; Eng and Gustafson, 1999; Wyatt and Sullivan, 2005), has captured the attention of health communicators, in part due to the ability to target and tailor communications, disseminate them rapidly, and engage the audience in an exchange of information, rather than a one-way message delivery (Gustafson et al., 1999); compared with Griffiths et al., 2006. Evaluation of IHC, which falls under the category of eHealth, remains challenging (Eysenbach and Kummervold, 2005). While ethical issues such as unequal access to the Internet and maintaining confidentiality of information pose challenges, IHC has become an important tool for health communicators. Online Seafood Information and Advocacy There are currently several examples of online seafood consumption information and advocacy available, as illustrated in Table 6-1. For example, Oceans Alive, a nongovernmental organization (Environmental Defense Network), offers “Buying Guide: Becoming a Smarter Seafood Shopper,” on its website (http://www.oceansalive.org/eat.cfm). Other sites offer nutrition information about seafood; however, a cursory glance suggests that some sites may not be updated frequently, and so may provide out-of-date nutritional and other guidance. Updating is likely to be a challenge for any interactive guidance
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Seafood Choices: Balancing Benefits and Risks TABLE 6-1 A Sampling of Online Consumer Information and Advocacy Sites Which Include Mercury Calculators Website Organization Type of Organization/Project Input http://www.ewg.org/issues/mercury/20031209/calculator.php Environmental Working Group (EWG) Public health and environmental action organization Consumer’s weight (lbs) Consumer’s gender http://www.fishscam.com/mercuryCalculator.cfm FishScam.com A project of the Center for Consumer Freedom A nonprofit organization supported by restaurants, food companies, and individuals, created by Berman & Co., a public affairs firm which has represented various animal production industries Consumer’s weight (lbs) Fish of choice (dropdown menu provided) http://gotmercury.org/english/advanced.htm Got Mercury? A project of Turtle Island Restoration Network Public education and campaign to reduce exposure to methylmercury from seafood Consumer’s weight (lbs) Type of fish consumer has eaten in a week Amount (oz) of up to three different fish consumer has eaten in a week (dropdown menu provided)
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Seafood Choices: Balancing Benefits and Risks Output Notes/Quoted Extracts Amount of canned albacore and canned light tuna you can safely eat (g/kg of weight/day) Based on FDA’s health standard (i.e., safe dose) Assumes that you do not eat any other seafood. Assumes that every can of tuna has an average amount of mercury. The FDA recommends up to 12 ounces a week of a variety of fish. If you eat other seafood, the amount of tuna that you can eat safely will be less than calculated here. EWG recommends that women of childbearing age and children under 5 not eat albacore tuna at all, because a significant portion of albacore tuna has very high mercury levels. People eating this tuna will exceed safe exposure levels by a wide margin. Amount (oz) of each fish you can eat weekly without introducing new health risks from mercury Based on the US EPA’s Reference Dose Links the US EPA’s “Reference Dose” and the theoretical harm threshold (a number ten times greater, called the “Benchmark Dose lower limit”) to the Glossary section of this website The EPA knows the level of exposure that represents a hypothetical risk, but it adjusts it by a factor of 10 in order to arrive at its “Reference Dose.” It’s this smaller, hyper-cautionary number that environmental groups use to scare Americans into thinking that tiny amounts of mercury in fish represent a real health hazard. According to fishy math from EWG and SeaWeb, for instance, your health is in grave danger if you consume just 12 ounces of tuna (canned chunk light) in a given week. This trickery is responsible for a great deal of needless fear. And food-scare groups ignore the fact that health risks from mercury take an entire lifetime to accumulate. It’s simply not possible to get mercury poisoning from eating a week’s worth of any commercially available fish. Mercury exposure (% of EPA limit) Based on the US EPA’s reference dose Please be aware that these values are averages. The concentration of mercury in seafood can be significantly higher or lower than what is represented here. As a precautionary approach, we recommend that women (especially of childbearing age) avoid seafood species that contain higher average levels of mercury. Mercury information for many shellfish species is currently unavailable. Data source: FDA website (http://www.cfsan.fda.gov/~frf/sea-mehg.html). Two exceptions are the troll-caught albacore data which come from an Oregon State University study and canned albacore data, which come from an FDA dataset that is not yet published on its site.
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Seafood Choices: Balancing Benefits and Risks Qualified Health Claims Eating foods high in omega-3 fatty acids to decrease risk of heart disease Producers On products/menus All consumers These claims increase the perceived healthfulness of functional foods (Bech-Larsen and Grunert, 2003; Williams, 2005) Web-based Health Information Nutrition information (although often not updated), risk, mercury, Dioxin-like Compiounds, ecological Environmental Non-govenmental Organizations Internet, interactive Internet users, environmentally concerned Committee unaware of any evaluations. Advice is given in a limited number of categories; limited quantitative information; very limited info on benefits of seafood consumption Mercury Intake Calculators Risk focus: mercury Various organizations (public health, environmental action, nonprofit, education/campaign, research advocacy) Internet, interactive Internet users, concerned consumers (inferred) Misuse of RfD, committee unaware of any evaluations Northern Contaminants Program Benefits, balancing choices Health Canada Mixed media, participative program Northern communities Program limited to Northern Canada (Kuhnlein et al., 2000; Mos et al., 2004; Willows, 2005), evaluations suggest program effectively prevents substituting low nutrition foods for seafood; questions about costs
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Seafood Choices: Balancing Benefits and Risks of point-of-purchase information. Notably, federal and state government agencies are not currently providing interactive online guidance. SETTING THE STAGE FOR DESIGNING CONSUMER GUIDANCE Seafood is a complex commodity, with a very wide range of individual products with varying price levels, and nutrient and contaminant profiles. The availability and affordability of seafood products is changing (see Chapter 2); this is likely to influence the ability of consumers to implement the seafood choices that they want to make to balance benefits and risks. The market context in which consumers make choices should be kept in mind when designing guidance. For example, information accompanying the guidance could point to lower-cost alternatives for increasing intake of seafood rich in EPA and DHA. Seafood choices, like all consumption choices, entail value trade-offs; for example, seafood higher in EPA and DHA may cost more than seafood that is lower. Other seafood may be more economical but contain higher levels of contaminants. Some individuals will accept high risks to achieve what they value as high benefits (e.g., consume raw seafood because of its pleasurable taste), while others may prefer to “play it safe.” Individual differences in tastes, preferences, beliefs and attitudes, and situations complicate the task of informing and supporting benefit-risk trade-off decisions. Food choices may be predicated on different objectives—a healthy baby for the pregnant woman, or weight loss for someone who is overweight. Audience segmentation and targeting is essential for effective communication (see above), not only because decision objectives and risk attitudes vary, but because people’s knowledge and interest varies. Tailored communications are more effective than general advice (de Vries and Brug, 1999; Rimer and Glassman, 1999). For example, access to appropriate, science-based information on both the benefits and risks of seafood consumption is particularly critical for pregnant women to enable them to adhere to health guidance messages (Athearn et al., 2004). Therefore, constructing information on balancing the benefits and risks of seafood consumption during pregnancy must address pregnant women separately from other consumers. A recent multi-state focus group study (Athearn et al., 2004) revealed that most but not all women were aware of and followed the recommendation to avoid undercooked or raw seafood during pregnancy. In contrast, the recommendation not to serve smoked fish cold without heating was less familiar, which was reflected in higher reported consumption levels (25.8 percent for smoked fish vs. 14.5 percent for undercooked or raw seafood consumption). This appeared to be related to lack of exposure to this recommendation (especially from participants’ doctors) and lack of publicized
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Seafood Choices: Balancing Benefits and Risks evidence of risk (in terms of outbreaks, case studies, or risk assessment measures). It was also related to the lack of clarity as to whether “smoked” fish included lox and hot-smoked and/or cold-smoked fish. The authors concluded that it is critical for pregnant women to understand why the information is being targeted to them, and to make certain to entitle food safety information as “applicable to pregnant women” specifically. Consumer messages about diet and nutrition need to be understandable, achievable, and consistent across information sources. They must also “address sources of discomfort about dietary choices; they must engender a sense of empowerment; and they should motivate both by providing clear information that propels toward taking action and appeals to the need to make personal choices” (Borra et al., 2001). Consumers need access to information that is in a clear and easy-to-understand format, that is structured to support decision-making, and that allows consumers access to additional layers of information when they want them (Morgan et al., 2001). It is important for those designing consumer guidance to conduct an empirical analysis of the decision-making process. Part of this assessment is understanding consumers’ decision context when they are presented with guidance suggesting changes in food choice behavior. One way to gain such understanding is to construct an empirically based scenario reflective of the consumers’ world, rather than that of the scientist, as described in the Family Seafood Selection Scenario shown in Appendix C-4. This should be based on the best available evidence from consumer research. Pre-implemention and post hoc evaluation of the impact of consumer guidance must control for differences, as well as changes in factors including incomes and prices, that occur during the period studied in order to isolate the effect of the guidance itself. Otherwise, the effect of the guidance on changes in consumption may be over- or underestimated. These types of controls have been lacking in previous evaluations, making the effect of the guidance unclear. FINDINGS Consumers are faced with a multitude of enablers and barriers when making and implementing food choices. Dietary advice is just one component in making food choices. Advice to consumers from the federal government and private organizations on seafood choices to promote human health has been fragmented. Benefits have been addressed separately from risks; portion sizes differ from one piece of advice to another. Some benefits and some risks have been addressed separately from others for different physiological systems and age groups. As a result, multiple pieces of guidance—sometimes conflicting—exist simultaneously for seafood.
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Seafood Choices: Balancing Benefits and Risks The existence of multiple pieces of advice, without a balancing of benefits and risks, may lead to consumer misunderstanding. As a result, individuals may under- or overconsume foods relative to their own health situations. There is inconsistency between current consumer advice in relation to portion sizes. For example, the FDA/US EPA fish advisory uses a 6-ounce serving size whereas nutritional advice from some government agencies uses a 3-ounce serving size. Evidence is insufficient to document changes in general seafood consumption in response to the 2001 or 2004 methylmercury advisories. It is apparent that messages about consumption often have to be individualized for different groups such as pregnant females, children, the general population, subsistence fishermen, and native populations. Involving representatives of targeted subpopulations (e.g., Arctic Circle campaign) in both the design and evaluation of communications intended to reach those subpopulations can improve the effectiveness of those communications. There are models for designing guidance, e.g., using full programs, that some individual communities (e.g., Arctic Circle campaign) have contributed to understanding the effects of different modes of health communication and modifying messages to achieve the desired community and/or individual response. RECOMMENDATIONS Recommendation 1: Appropriate federal agencies should develop tools for consumers, such as computer-based, interactive decision support and visual representations of benefits and risks that are easy to use and to interpret. An example of this kind of tool is the health risk appraisal (HRA), which allows individuals to enter their own specific information and returns appropriate recommendations to guide their health actions. The model developed here provides this kind of evidence-based recommendation regarding seafood consumption. Agencies should also develop alternative tools for populations with limited access to computer-based information. Recommendation 2: New tools apart from traditional safety assessments should be developed, such as consumer-based benefit-risk analyses. A better way is needed to characterize the risks combined with benefit analysis. Recommendation 3: A consumer-directed decision path needs to be properly designed, tested, and evaluated. The resulting product must undergo methodological review and update on a continuing basis. Responsible agencies will need to work with specialists in risk communication and evaluation, and tailor advice to specific groups as appropriate.
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Seafood Choices: Balancing Benefits and Risks Recommendation 4: Consolidated advice is needed that brings together different benefit and risk considerations, and is tailored to individual circumstances, to better inform consumer choices. Effort should be made to improve coordination of federal guidance with that provided through partnerships at the state and local level. Recommendation 5: Consumer messages should be tested to determine if there are spillover effects for segments of the population not targeted by the message. There is suggestive evidence that risk-avoidance advice for sensitive subpopulations may be construed by other groups or the general population as appropriate precautionary action for themselves. While emphasizing trade-offs may reduce the risk of spillover effects, consumer testing of messages should address the potential for spillover effects explicitly. RESEARCH RECOMMENDATIONS Recommendation 1: Research is needed to develop and evaluate more effective communication tools for use when conveying the health benefits and risks of seafood consumption as well as current and emerging information to the public. These tools should be tested among different communities and subgroups within the population and evaluated with pre- and post-test activities. Recommendation 2: Among federal agencies there is a need to design and distribute better consumer advice to understand and acknowledge the context in which the information will be used by consumers. Understanding consumer decision making is a prerequisite. The information provided to consumers should be developed with recognition of the individual, environmental, social, and economic consequences of the advice. In addition, it is important that consistency between agencies be maintained, particularly with regard to communication information using serving sizes. SUMMARY Mass communication has inarguably changed the world, using a one-size-fits-all model. There are health messages that everyone of a certain generation has heard (“Just Say No”). But like shoes, advice is more helpful if it is sized appropriately and designed appropriately for the intended use. As communications technologies have advanced, the communicator’s ability to tailor communications to reach large audiences rapidly, and interact with them, has also advanced.
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