Fish Mercury Project: Stakeholder Involvement and Risk Communication

1
Fish Mercury ProjectStakeholder Involvement
and Risk Communication

• FMP Annual Meeting
• June 5-7, 2007
• California Department of Health Services (DHS)
• Environmental Health Investigations Branch

2
DHS Role in FMP

• Fishing Activities and Needs Assessments
• Ensure sampling plan reflects actual fishing
  activities and local input
• Stakeholder Involvement
• Incorporate stakeholder interests, concerns, and
  viewpoints
• Engage stakeholders in the project
• Outreach and Education (aka Risk Communication)
• Raise public awareness and reduce exposure to
  mercury
• Promote healthy fish consumption practices

3
FISHING ACTIVITIES NEEDS ASSESSMENTS
4
Fishing ActivitiesDHS Priorities for 2007
Sampling

• Priority 3 (highest)
• inside or bordering Calfed ERP areas with some
  fishing
• OR outside Calfed ERP areas with very high
  fishing activity (gt50) for species other than
  trout
• 16/17 sites selected for 2007 were sites DHS
  ranked highest priority (3)
• 17th site selected due to other considerations
  that DHS supported

5
Needs Assessments

• Key informant interviews
• 9 county HO or EHD
• DFG, fed/state agencies, irrigation districts,
  etc.
• Findings
• Low public concern--few inquires
• Counties appreciated learning about FMP and want
  to be kept informed
• Southeast Asian (esp. Hmong) and Latino are
  important fishing groups
• Provided additional contacts and ideas for
  outreach and collaboration

Stanislaus Merced Fresno Madera Mariposa Tuolumne
Calaveras Amador El Dorado
6
Focus Groups

• 16 focus groups, 160 people (primarily anglers),
  various ethnic groups
• Topics
• Fishing locations and species consumed
• Attitudes toward fishing
• Ways to provide fishing/health information
• Testing educational messages and activities

7
Focus Groups - Summer 2006

• Delta boat anglers, EcoVillage Farm Learning
  Center, Richmond

• Russian anglers, Slavic Assistance Center,
  Sacramento

• Vietnamese anglers, Vietnamese Voluntary
  Organization (VIVO), Stockton

8
Focus Groups - 2007

• 3 Hmong groups (Fresno)
• Anglers (men only)
• Women (consumers of local fish)
• Anglers (mixed, mostly men)
• 2 groups of pregnant women in Sacramento clinic

Focus Group with Hmong Anglers 4/07
9
Hmong Focus Groups

• Identified fishing locations and species consumed
• Reasons for fishing
• Relaxation (reflect on life, fresh air,
  relieve boredom)
• recreation (exercise, fun)
• family time
• like to eat fish (not starving)
• Most catch and eat fish 1/week or more
• Awareness low, except for radio program
• High concern about fish contamination

10
Hmong Focus Groups

• Feedback radio PSA mixed
• Several problems with Hmong translations
• Information sources
• Trusted community groups
• Hmong Radio
• Outreach at community events

Focus Group with Hmong anglers 5/07
11
Need Assessments and Focus GroupsNext Steps

• Keep need assessment contacts informed
• Continue follow up of needs assessment contacts,
  collaborations, and ideas
• Focus group with Latinos in Stockton planned for
  June or July 07
• Plan additional focus groups as needed to test
  materials or activities
• Focus group training

12
STAKEHOLDER INVOLVEMENT
13
Stakeholder Involvement

• Stakeholders on the FMP Steering Committee
• Local Stakeholder Advisory Group (LSAG)

14
FMP Steering Committee NGO Stakeholders

• Angler Groups
• Doug Lovell, Federation of Fly Fishers/EJ
  Coalition for Water
• Bob Strickland, United Anglers of California
• Environmental Groups
• Andria Ventura, Clean Water Action
• Community-Based Groups
• Henry Clark, West County Toxics Coalition
• LaDonna Williams, People for Childrens Health
  Environmental Justice
• Shyaam Shabaka, EcoVillage Farm Learning Center
• Tribal Groups
• Sherri Norris, California Indian Environmental
  Alliance
• Other Groups
• G. Fred Lee, G. Fred Lee and Associates

15
FMP Steering Committee Evaluation

• 14 SC members interviewed
• Goals
• Has SC met goals/objectives
• How to improve/enhance FMP
• Assess satisfaction with process/make
  participation more meaningful

16
FMP Steering Committee Evaluation

• Findings/Themes
• SC is meeting its purpose of guiding FMP
• Participation helpful to NGO stakeholders
• EJ concerns/diverse viewpoints some improvement
  but still room for more
• Stipends are very helpful and often necessary for
  participation
• Lack of participation
• Better clarity on meeting outcomes

17
Local Stakeholder Advisory Group (LSAG)
Groups attending meetings in the past year

• West County Toxics Coalition
• United Cambodian Families
• DeltaKeeper
• Senator Machados office
• UC Coop Extension
• Sacramento Regional Co Sanitation District
• Sacramento River Watershed Program
• State agency staff
• Staff from Solano, San Joaquin, Contra Costa,
  Sacramento, and Stanislaus Counties

• Maat Youth Academy
• EcoVillage Farm Learning Center
• Clean Water Action
• United Anglers of CA, Inc.
• Todos Unidos
• Vietnamese Voluntary Organization (VIVO)
• Lao Khmu Association
• People for Childrens Health Environmental
  Justice
• Lao Family Community
• Mechoopda Indian Tribe
• California Indian Environmental Alliance

18
LSAG Assessment of 2007 Goals
19
LSAG Assessment of 2007 Goals

• New activities for 07?
• Media campaigns/training
• Hosting fish forum
• LSAG resource book

LSAG meeting Oct 06, Oakland
20
Field Trips/Capacity Building Activities
June 06 Delta pumping plants/fish restoration,
Byron
Aug 06 DFG Fish sampling demonstration,
Sacramento River
21
Field Trips/Capacity Building Activities

• Dec 06 Nimbus Fish Hatchery American River
• April 07 Fishing activity California Aqueduct

22
Funding Support for SC/LSAG

• Stipends/travel reimbursements
• Calfed
• New consolidated grantnot funded
• funding of 2007 mini-grantsfunded
• CalEPA EJ Grants
• Public Health Trust grants
• Other funding opportunities
• Grant writing workshops

23
Stakeholder InvolvementNext Steps

• Continue convening SC as needed
• Continue convening LSAG through end of project
• Complete LSAG resource book
• Field Trips/capacity building
• DFG sampling demonstration
• Stakeholder fishing activity
• Reach out to groups in Sacramento River watershed
  to support forthcoming advisory

24
OUTREACH EDUCATION
25
Outreach and Education

• Mini-Grants
• Educational Materials/Activities
• Media
• Delta Warning Sign
• Training
• Other Activities

26
Mini-Grants

• Support community-based groups in
  outreach/education activities within
  hard-to-reach communities
• DHS provides technical support and training
• 2007 Grantees
• Vietnamese Voluntary Foundation (VIVO)
• Todos Unidos
• EcoVillage Farm Learning Center
• United Cambodian Families
• Lao Family Community of Stockton (new)
• CA Indian Environmental Alliance (new)
• Mechoopda Tribe (new)

27
Mini-Grants--Next Steps

• Complete 2007 projects
• mid-term reports (June 1)
• site visits this summer
• Provide technical support (training, materials,
  LSAG) to groups continuing with other funding
• Seek future funding for community-based group

28
Educational Materials

• Continuing to distribute materials through local
  partners
• Frequently Asked Questions booklet updated 10/06
  (3rd printing)
• 19,000 materials distributed in last year

29
New Educational Material

• Reformat OEHHA Safe Eating Guidelines for South
  Delta and San Joaquin River
• SJR - Laminated sign
• Two page flyer
• Six languages (Spanish, Hmong, Vietnamese, Lao,
  Cambodian, Russian)

30
New Educational Materials

• Low literacy brochureunder development

31
New Educational Materials

• Examples of formative evaluation
• Input from several sources in development
• EHIB health educators
• LSAG
• Medical clinic staff
• Tested at medical clinic in educational session
  with patients
• Evaluated use of brochure
• Interviews with clinic staff
• Interviews with patients
• Focus groups with patients

32
Educational Activities/MaterialsNext Steps

• Safe Eating Guidelines for S. Delta/San Joaquin
  River
• Distribution/posting
• Finish translations
• Revise, translate, distribute low-literacy
  brochure
• Hmong outreach with new CBO (CARE)
• Testing of advisory messages
• Color categories (avoid, caution, good choices,
  best choices)
• Portion size
• Evaluate whether we are discouraging fish
  consumption

33
Educational Activities Fish Forum

• One day Forum Nov. 7, 2007 in Sacramento
• Forum Objectives
• Promote collaboration and networking
• Strengthen local capacity to address fish issues
• Share FMP information (lessons learned and next
  steps)
• Celebrate accomplishments to date

34
Media

• Hmong radio interview KBIF AM (Fresno)

35
Media Training

• Understanding the media
• Framing messages
• Creating media materials/packets
• Handling interviews
• Leveraging media on a low budget
• Media activity plans

36
Media

• Radio PSAs Eat Fish Safely under review
• Fish is a healthy and delicious food.
• But some fish we catch come from contaminated
  areas where chemicals have been found in the
  fish.
• Do you know how much fish is safe to eat each
  week?
• It all depends on the type of fish and where it
  comes from.
• Some lakes, rivers and bays in California have
  fish advisories that give advice about what fish
  are okay to eat.
• Visit www.oehha.ca.gov and click on Fish to
  learn more
• This is a message from the State of California.

37
MediaNext Steps

• 2nd Hmong radio interview (Sept 07?)
• Sacramento Bee newspaper tabloid insert
• Cable TV interview Latinos en California
• Complete radio PSA evaluation

38
Delta Warning Sign

• Developed with LSAG input
• Languages English, Spanish, Cambodian, Hmong,
  Lao, Russian, Vietnamese, Chinese
• 300 large signs (outdoor)
• 500 small signs (indoor)
• Posting began 4/06
• Posting done by counties, CBOs, DHS, others

Rio Vista Pier, Solano Co.
39
Delta Warning SignEvaluation Summary
40
(No Transcript)
41
Sign Content

• New South Delta advisory issued in March 07
• Less restrictive than previous advisory
• Interim solution
• South Delta Sticker

42
Sign Evaluation with Anglers (n21)

• Impression of sign?
• Favorable 16
• Neutral 2
• DK 1

• Did angler plan to eat fish caught?
• Yes 13
• Maybe 3
• No 5
• Did angler see the sign?
• Yes 17
• No 4
• Is angler aware of the advisory
• Yes 16
• No 5

Antioch Pier, Contra Costa Co., May 07
43
Sign Evaluation with Anglers

• Many could recall main messages
• Limit fish to once a month/dont eat too much (6)
• Pregnant women be careful, mercury in fish (3)
• Throw the big ones away/Larger fish have
  chemicals (2)
• Comprehension issues
• Several thought size limits referred to legal
  size, not health advice
• Little awareness of difference between red and
  green categories

Antioch Pier, Contra Costa County May 07
44
Sign Durability and Placement

• Signs holding up well in weather
• Vandalism/signs torn down
• Placement issues
• Negative feedback on some posting locations
  (i.e., stop signs, private fences)
• Lack of suitable posting location

Fourteen Mile Slough, San Joaquin County
45
Delta Sign - Next Steps

• Continue to take GPS coordinates at each site
• Be more selective about posting locations and/or
  get permission
• Increase outreach to businesses and private
  marinas
• Post at more bait shops and indoor venues
• Explore erecting posts, building kiosks, using
  plexiglass fronts
• Use plywood backing

Georgiana Slough, Sacramento County
46
Delta Sign - Next Steps

• Continue to support posting efforts of counties
  and others
• Continue to evaluate
• Posting success
• Durability
• Awareness/comprehension
• Revise sign after North Delta and striped bass
  advisories are issued

Stans Yolo Marina, Yolo County
47
Training

• 5 module training curriculum
• Two approaches
• Direct training for groups
• Training for trainers

48
Direct Trainings
Mini-grant groups and CBOs, Stockton 4/07
Feather River Tribal Health, Oroville 8/06
49
Training Evaluation
50
Training for Trainers Evaluation

• Evaluation of all (40) trainees who have taken
  the Training-for-Trainers Program
• Goals
• Qualify training experience
• Measure self-efficacy of trainees
• Evaluate use of materials and activities
• Update/change training module

51
Training-for-Trainers Evaluation Results

• T4T Program provided CBOs, clinics, Food Stamps
  educators, Tribal groups, counties and schools
  with the resources needed to train others on fish
  contamination issues in settings such as
• Prenatal education classes (1,000 pregnant
  women/year at Kaiser Permanente)
• Tribal community meetings (100 youth, adults and
  elders)
• Community health fairs (targeted to Russian,
  Hmong, Spanish and other Asian-language speakers)

52
Training-for-Trainers Evaluation Results,
continued

• Majority of those interviewed said T4T program
  greatly raised their level of confidence to
  take what you know about fish contamination
  issues and customize a training to meet the needs
  of your community.
• All of those interviewed said T4T program
  enabled you to become the point-person in your
  organization on fish contamination.

53
Training--Next Steps

• Future trainings
• San Joaquin River advisory?
• Sacramento River/North Delta
• Forum breakout sessions (media, educational
  tools, grant writing)
• Expand health benefits discussion in training
  curriculum
• Spanish translation

54
Other Activities

• WIC clinic evaluation of educational activities
• Dr. Brode Clinic Study
• Food Stamp Nutrition Education Program (FSNEP)

55
WIC Clinic EvaluationDelta Health Care, Stockton

• 2004 Fish consumption survey and education at
  WIC clinic
• June 2005 State WIC distributes WIC fish card
  to all clinics in state
• Aug 2005 Stockton clinic begins distribution of
  WIC fish card to all clients
• 2004, 2005 Trainings for Stockton clinic staff
• 2006
• Observations of clinic staff
• Interviews of clinic staff
• Interviews of 97 clients in waiting room

56
WIC Clinic Evaluation--Conclusions

• WIC intervention with participants is very short
• Effective at raising general awareness,
  especially among Spanish speakers
• Less effective at increasing specific knowledge
  on advisory information
• This type of intervention needs reinforcement
  through other means to be most effective

Front Desk at Delta Health Care WIC Clinic,
Stockton
57
Dr. Brode Clinic Study - Goals

• Characterize mercury exposure among pregnant
  women in medical clinic
• Assess feasibility of incorporating blood mercury
  test into clinical practice, and the extent to
  which Medi-Cal will pay for these tests.
• Through training and education, increase
  knowledge among clinic staff and patients about
  health risks and benefits of fish and ways to
  reduce exposure to mercury.

Front desk, Dr. James Brode, M.D
58
Dr. Brode Clinic Study

• Private OB/GYN in south Sacramento serves
  primarily low income women of color
• 180 women were interviewed about fish consumption
  practices
• 165 provided blood samples
• Clinic staff provided targeted educational
  counseling to patients

59
Dr. Brode Clinic Study

• Evaluation goals
• Feedback on low-literacy educational brochure
• Retention of educational counseling
• Overall experience of patients participating in
  study
• How study impacted clinic staff
• Next Steps
• Finish analysis and write up results
• Explore integration of study activities into
  ongoing medical care for low-income pregnant women

60
DHS Fish Team Staff

• Tivo Cheatham-Rojas
• Lori Copan
• Ilinisa Hendrickson
• Jessica Kaslow
• Diana Lee
• Elana Silver
• May Lynn Tan
• Alyce Ujihara