Awake at the switch: improving fish consumption advisories for at-risk women.

Eating fish provides health benefits; however, nearly all fish contain at least some methylmercury which can impair human health. While government agencies have been issuing fish consumption advisories for 40 years, recent evaluation efforts highlight their poor performance. The benefit of an advisory can be measured by its ability to inform consumers as to both the positive and negative attributes of their potential choices, leading to appropriate changes in behavior. Because of the health benefits, fish advisories should not reduce fish consumption, even among at-risk individuals, but should lead consumers to switch away from highly contaminated fish toward those less contaminated. Although studies document how advisories reduce fish consumption (a negative outcome), no study indicates whether they lead to switching behavior (a positive outcome). We explore the effects of Maine Center of Disease Control and Prevention's advisory aimed at informing women who may become pregnant, nursing mothers and pregnant women about the benefits and risks of fish consumption. We examine how the advisory changes consumption, especially related to switching behavior. We demonstrate such changes in behavior both during and after pregnancy and compare the advisory-induced changes with those induced by other information sources. Although we find the advisory reduced some women's consumption of fish, we find the decrease is short-lived. Most importantly, the advisory induced appropriate switching behavior; women reading the advisory decreased their consumption of high-risk fish and increased their consumption of low-risk fish. We conclude a well-designed advisory can successfully transform a complex risk/benefit message into one that leads to appropriate knowledge and behavioral changes.