EPA g-IO/R-99-003
United States
Envi'onmentai Protection
Agency
Region 10
1200 Sixth Avenue
Seattle WA 98101
Alaska
Idaho
Oregon
Washington
Office of Environmental Assessment Risk Evaluation Unit
May 1999
Asian & Pacific Islander
Seafood Consumption
Study in King County, WA
Exposure Information Obtained through a Community-
Centered Approach
Study Results and Education Outreach
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Asian and Pacific Islander Seafood Consumption Study
Ruth Sechena, MD, MPH1, Connie Nakano, BA, Shiquan Liao, Ph.D., Nayak
Polissar, Ph.D., Roseanne Lorenzana, DVM, Ph.D., Simon Truong, and
Richard Fenske, Ph.D., MPH
May 27,1999
Funded by:
EPA Environmental Justice Community/University
Partnership Grant EQ925003-01
Project Officer: Susan Morales
EPA 910/R-99-003 (Phase II)
EPA 910/R-96-007 (Phase I)
Address correspondence to:
'Ruth Sechena, MD, MPH
Director, NIEHS Center Community Outreach Programs
4225 Roosevelt Way NE, #100
Seattle, Washington 98105
e-mail: rsechena@u.washington.edu
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Address correspondence to:
Connie Nakano, BA
University of Washington
Box 356429
Seattle, WA 98195
Shiquan Liao, Ph.D.
StatPro Consultants
7127 NE167"1 Street
Bothell, WA98011
Nayak Lincoln Polissar, Ph.D.
The Mountain-Whisper-Light
Statistical Consulting
1827 23rd Avenue, East
Seattle, WA 98112-2913
Roseanne Lorenzana, DVM, Ph.D., DABT
U.S. EPA—Region 10
1200 Sixth Avenue
Seattle, WA 98101
Simon Truong
Social Services Director
The Refugee Federation Service Center
7101 Martin Luther King, Jr. Way S., #214
Seattle, WA 98118
Richard Fenske, PhD, MPH
Department of Environmental Health
University of Washington
Box 357234
Seattle, WA 98195
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Table of Contents
Executive Summary ', 1
I. Introduction 4
II. Background 6
III. Implementation of the Study (Phase II) 9
A. Methodology 9
1. Overview 9
B. Community Support, Study Design, Questionnaire
Development 9
1. Committee Guidance 10
2. Development of Survey Instruments 11
a. Survey Questionnaire 11
b. Visual Aids 11
c. Determination of seafood model weights 12
C. Survey Implementation and Data Analysis (Phase II) .14
1. Interviewer Recruitment, Training, and Quality
Assurance 14
a. Interviewer Recruitment 14
b. Training and Quality Assurance 14
2. Questionnaire Pilot Testing 15
3. Sampling Strategy. 15
a. Respondent Selection Criteria 15
b. Ethnic Representation 15
4. Subject Recruitment 16
a. Roster recruitment 17
b. Volunteer recruitment 18
5. Questionnaire Administration '_ 19
a. Re-interviews 20
b. Questionnaire editing 20
c. Double Key Data Entry 20
6. Data Analysis 21
a. Statistical Methods 21
IV. Survey Results (Phase II) 25
A. Participation Rate 25
B. Descriptive Statistics 25
C. Seafood Consumption Rates 27
1. Consumption rate for the API community 27
2. Consumption rate by ethnicity 29
3. Consumption rate by gender 30
4. Consumption rate by age 31
5. Consumption rate by income 31
6. Consumption rate by educational level 32
7. Consumption rate by roster category
and volunteer category 32
8. Consumption rate by fishermen and
non-fishermen 33
9. Consumption rate by generation 34
D. Fish Sources 35
E. Seafood Species and Parts Consumed 36
1. Seafood species consumed 36
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Table of Contents
2. Seafood parts consumed 37
F. Preparation Methods 38
G. Re-interviews 40
H. Educational Outreach Information .41
V. Education and Communication of Study Findings (Phase III) 44
A. Methods 44
1. Introduction 44
2. Selection of an Education/Communication Tool 44
3. Development of Education/Communication Tool 45
4. Translation and Focus Group Testing 46
VI. Results (Phase III) 47
Discussion ;.47
Participation Rates 47
Potential Biases 48
Per Capita Consumption Habits 50
Consumption Rates. 51
Seafood Sources 53
Seafood Species and Tissue Parts Consumed 53
Fishermen 55
Educational Outreach information 56
Conclusions 57
Acknowledgments • 58
References 62
Appendix A: Questionnaire 65
Appendix B-l: Picture of models 85
Appendix B-2: Table of Models and Model Weights Used 86
Appendix B-3: Calculation of edible meat percentage
for models A, B, D, and P 87
Table B-3-a (Model A) 87
Table B-3-b (Model B) 88
Table B-3-c (Model D). 88
Table B-3-d (Model P) ; .89
Appendix C: Species Manual 90
Appendix D: Interviewer Telephone Script .97
Appendix E: Record of Contacts. 100
Appendix F: Letter to roster organizations, Governor Locke's
letter of support for study, and Agreement
of Consent 102
Appendix G: Letter of Introduction to study participants,
and postcards—English, and translations 106
Appendix H: Posters—English and translations. Ill
Appendix I: Consent for future contact 123
Appendix J: Re-interview data and script 125
Appendix K: Types of Seafood Consumed/Respondents
Who Consume (%) 129
Appendix L: Outlier Table 131
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Table of Contents
Appendix M-l-a. Participation Rates by Participant
Category 134
M-l-b. Miscellaneous Seafood Consumers 135
M-2-a. Demographic & Seafood Preparation
characteristics: "higher" & "lower" 136
M-2-b. Demographic & Seafood Preparation
characteristics: "higher" & "lower" 137
M-3 Seafood consumption rates by ethnicity 138
M-4 Seafood consumption by ethnicity and gender 140
M-5. Seafood consumption by age 143
M-6. Seafood consumption by income 144
M-7. Seafood consumption by education 145
M-8. Seafood consumption roster versus volunteer 146
M-9. Seafood source by ethnicity 147
M-10. Comparison between original survey and
re-interview responses on selected questions 149
Appendix N: Phase III
N-l. CSC ranking of seafood health concerns 151
N-2. Draft brochure 152
N-3. Focus group Evaluation Questionnaire 155
N-4. Focus analysis of brochure 157
N-5. Reviewers comments of translation f the brochure 158
N-6. Revised brochure with incorporated comments 169
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List of Tables
Table M-l: Sample Size based on Population Proportionate Sampling Versus
Actual Sample Size based on Community Steering Committee's
Recommendation 16
Table R-l: Consumption Rate of API Community Members 28
Table R-2: Consumption Rate by Gender for All Asian and Pacific
Islander Community. 31
Table R-3: Consumption Rates by Roster and Volunteer 33
Table R-4: Consumption Rates by "Fishermen"
and "Non-fishermen" 34
Table R-5: Generation by Income 34
Table R-6: Seafood Consumption by Generation 35
Table R-7: Fish Sources !Z!!!!!."Z"ZZ"Z.""!"!"!"™"!!36
Table R-8: Parts of Finfish Consumed by Ethnicity. 37
Table R-9: Shellfish Consumption (Bivalves) ~"!!Z!!!!!Z!!!!!!!!!!!!!!!"!"Z!!38
Table R-10: Non-Bivalve Shellfish Consumption"l"ZZZ.!"...! "!!!!!!Z..Z~38
Table R-l 1: Fish Preparation Methods. 39
Table R-12: Seafood Cooking Water Usage
(Percentage of Time Used) 39
Table R-13: Comparison of Answers between Original Survey and Re-
Interview 41
Table R-14: Best/Most Reliable Sourcesi of Information Used by the API
Community _ 42
Table R-15: Preferred Learning Methods 42
Table R-16: Preferred Seafood Information 43
Table R-17: Fishing Safety Information Sources for
All Fishermen by Education 43
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EXECUTIVE SUMMARY
PURPOSE
The primary purpose of this study was to describe Asian and Pacific Islander
(API) seafood consumption rates, species, and seafood parts commonly
consumed and cooking methods. This information is needed to allow the
API community in the Pacific Northwest to determine what risks it may face
from seafood and to balance such risks with the significant health and
cultural benefits associated with seafood consumption. This study was a first
step towards gathering necessary information for such a risk assessment.
Study aims also included development of culturally appropriate health
messages related to seafood consumption and the field testing of this
information within the API community.
METHODS
This work was made possible only because of the willingness of API
community leaders and the Refugee Federation Service Center to work in
partnership with the University of Washington—National Institute for
Environmental Health Sciences (UW-NIEHS) Center for Ecogenetics and
Environmental Health, Community Outreach and Education Program.
Description and quantification of seafood consumption habits with the API
community was conducted in three phases. Phase I was considered a
planning phase, and focused on identifvinft-*afpet-ethnic_ groups and
developing an appropriate questionnaire. This work was accomplished prior
to the inltTatiorToTthe study reported here and was published as a U.S. EPA
Report (Asian and Pacific Islander Seafood Consumption Study, EPA 910/R-
96-007, August 1996).
Phase II, which is detailed in this report, focused on the characterization of
seafood consumption patterns of ten API ethnic groups (Cambodian, Chinese,
Filipino, Hmong, Japanese, Korean, Laotian, Mien, Samoan, and Vietnamese)
within King County, Washington. Participants were first or second
generation members of the above ethnic groups, 18 years of age or older, who
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lived in King County, Washington, and were seafood consumers. Data were
collected using a survey questionnaire that was developed in English and
later translated into the Respondents' native languages. The surveys were
administered by trained bilingual interviewers recruited fromjhe API__
community. The questionnaire solicited information about the types of
seafood consumed, the source of the seafood, the preparation of seafood, the
frequency and portion size of consumption by the respondents, demographic
information, and educational approaches preferred by the respondents. Two
hundred participants were sought, and two selection methods were used.
First, volunteers were recruited for a "Dietary Habits Study" and from those
volunteers participants were randomly selected. Second, religious and API
community organizations donated membership rosters from which potential
participants were randomly selected and contacted.
Phase III, also detailed within this report, focused on the development of
culturally appropriate health messages related to seafood consumption risks
and the dissemination of this information to the API community. The
technical expertise of the Advisory and Technical Committees was linked to
the cultural expertise of the Community Steering Committee to develop an
appropriate health education strategy. These efforts culminated in a multi-
lingual brochure that highlighted five key public health messages. The
brochure was then tested through an API focus group.
RESULTS
The majority of the 202 respondents (89%) were first generation (i.e., born
outside the United States). There were slightly more women (53%) than men
(47%), and 35% lived under the 1997 Federal Poverty Line. In general, the API
members consumed seafood at a very high rate. The average overall
consumption rate for all seafood combined was 1.891 grams/per kilogram
body weight/day (g/kg/day), with a median consumption rate of 1.439
g/kg/day. The predominant seafood consumed was shellfish (46% of all
seafood). Seafood consumption based on gender, age, income, and
"fishermen" status did not differ significantly.
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First generation APIs consumed more fish than the second generation APIs_
in all the fish categories, except pelagic fish - the consumption rates being
statistically different for freshwater fish and shellfish. In general, members of
the Vietnamese and Japanese communities had the highest overall
consumption rates of all seafood; and the Mien, Hmong, and Samoan
communities consumed the least amount of seafood.
The proportion seafood harvested (rather than purchased commercially) by
API community members varied from a low of 3% to a high of 21%,
depending on the seafood type. Differences were observed among the. ethnic
groups, with Japanese, Chinese, Filipino, and Korean groups consuming
more seafood that was purchased commercially. Members of the Mien,
Hmong, and Laotian communities seemed to harvest seafood more often
than other ethnic groups. Salmon, tuna, shrimp, crab, and squid were the
most frequently consumed seafood. Skin was consumed with fillets 55% of
the time, and crabs were eaten with their butter 43% of the time. Seafood
cooking fluids were commonly drunk or used in cooking. These customs
suggest that risk assessment methods include toxic chemical measurements
in these tissues.
The study results also indicated that members of the API community were
interested in learning more about health issues surrounding eating fish, the
safety of seafood from Puget Sound (the water body surrounding King
County), and the safe preparation methods of seafood. The learning methods
preferred by the APIs were book/pamphlets (69%), verbal communication
(55%), and video presentation (35%). Community newspapers/newsletters
were the most preferred information source (75%), followed by television
(65%) and word of mouth (60%).
The public health messages developed during Phase III of the study were
generally well received by API community focus groups. The brochure was
viewed as helpful in decision making, and the presentation was considered
clear and precise. Corrections and recommendations resulting from the focus
group process have been incorporated into the final version of the brochure.
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I. Introduction
Asian and Pacific Islanders (API), people having origins in the Far East,
Southeast Asia, the Indian subcontinent, or the Pacific Islands, represent one
of the most diverse and rapidly growing immigrant populations in the
United States. In 1997 API's (166,000 people) accounted for 10% of the King
County, Washington population, an increase from 8% in 1990. Between 1990
and 1997, the total population of King County increased 9% while the
population of API's increased 43% (State of Washington Population Trends,
1998).
API immigrants and refugees consider seafood collection and consumption as
healthy activities that reflect a homelike lifestyle and may fish for economic
necessity. For these reasons, API immigrants have been hypothesized to
consume greater quantities of seafood, differing species, and differing parts of
seafood than the general United States (U.S.) population. Such cultural
behaviors may increase their risk of toxic chemical exposure, especially
among subsistence fishermen who obtain seafood in polluted urban sites. Yet,
the API community has little information on the potential contamination in
seafood consumed. Cultural and economic factors may put recent API
immigrants at greater than expected risk from environmental exposures.
Seafood consumption risk assessments within ethnic groups require
specialized survey tools because of cultural and language differences, as well
as varying consumption and acquisition habits. Only a few cases in the
western United States for which reports are available: e.g., the Columbia
River Inter-tribal Fisheries Commission (CRITFC), the Tulalip and Squaxin
Island Tribes, and the Laotian Community of West Contra Costa County,
California (CRITFC, 1994; Toy et al, 1996; Chiang, 1998, respectively). The
CRITFC survey (1994) included selected tribes in Washington and Oregon and
estimated per capita consumption at the 50th and 90th percentile of 41.5g/day
and 127.2g/day, respectively. Fish consumption surveys were administered
and reported jointly for a total of over 200 members of the Tulalip Tribes and
Squaxin Island Tribe of the Puget Sound Region (Toy, 1996). The results
showed that the median daily per capita consumption rates for men were
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53 g/day and 66 g/day for the two tribes, while women consumed a median
rate of 34 g/day and 25 g/day, respectively.
Chiang (1998) surveyed the Laotian community (Laotian, Mien, Khmu,
Thaidum) residing in the eastside of San Francisco Bay, in West Contra Costa
County, California, using a "usual intake" consumption survey and
calculated a mean per capita seafood consumption rate of 18 g/day. Chiang
also reported that among 229 Laotian survey participants (87% of whom
consumed seafood at least one time per month), fish skin was "always"
consumed by 76% and "sometimes" by 23%; the head was "always" consumed
by 20% and "sometimes" by 47%; and organs were "always" consumed by 6%
and "sometimes" consumed by 41%.
Considerable uncertainty regarding seafood consumption rates among APIs
exists because studies reporting API seafood consumption and habits are few
and use different methodologies. However, these studies are valuable for
providing insight into the scope of potential exposures. Javitz used 1973-74
National Purchase Dietary data to calculate a mean per capita seafood
(fresh/estuarine/marine) consumption rate for "orientals" (21 g/day). Three
surveys conducted among API fishermen fishing in San Francisco Bay, Santa
Monica Bay, and Los Angeles reported median seafood consumption rates of
43 g/day, 21 g/day, and 71 g/day, respectively (Wong, 1996; Allen, 1996; Puffer,
1982). These studies documented self-harvested seafood consumption rates
only from specific fishing sites over varying periods of time (7 days, 4 weeks
and "usual intake" per year, respectively),
The U.S. EPA uses differing consumption rates depending on the regulatory
program for which the assessment is being developed. Fish and seafood
consumption rates are adopted only as U.S. EPA policy with varying degrees
of non-EPA review and input. The consumption rate which may have
received the most intense scrutiny due to publication in the Federal Register
and a subsequent comment period is the value included in EPA's ambient
water quality criteria (AWQC) recommendations developed under section
304(a) of the Clean Water Act. In 1980, a national average consumption rate
of 6.5 grams per day (g/day) of fish and shellfish from estuarine and
freshwaters was recommended. This is the currently used value. This rate
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was based on the mean per capita (both consumer and non-consumers)
consumption rate of freshwater and estuarine finfish and shellfish from 3-day
diary results that were reported in the 1973-74 National Purchase Diary
Survey (Javitz, 1980). Proposed revisions to the AWQC methodology include
a tiered approach for choosing an appropriate consumption rate (Federal
Register: August 14,1998). The results from local or regional seafood intake
surveys are preferred, while the last preference is use of defaults based, on the
1989-91 Continuing Survey of Food Intake by Individuals (CSFII, 1990) data:
17.8g/day for the general adult population and sport fishers, and 86.3/day for
subsistence fishers.
The U.S. EPA national Superfund program's policy is to assume an ingestion
rate of 54g/day for high consumers of locally caught fish (OSWER). Region 10
of the U.S. EPA, which includes the State of Washington, recommends the
use of results from local or regional seafood intake surveys for use in the
regional Superfund program (U.S. EPA, 1991).
The U.S. EPA Exposure Factors Handbook which can be used by any federal or
state program recommends a mean and 95th percentile for the general U.S.
population of 20.1 g/day and 63 g/day, respectively (U.S. EPA, 1997). For
Native American subsistence populations the recommended value for mean
intake is 70 g/day and the recommended 95th percentile is 170 g/day.
The Washington State Department of Ecology recently recommended a
statewide default or" 177g/day to protect all Washington residents including
the highest consumers, subsistence fishers (Washington Department of
Ecology, 1999).
fl. Background
Because of an increasing awareness in the risk of consuming certain seafood
in the API community, the API community in King County, Washington,
initiated a study to characterize seafood consumption patterns within their
community. The uniqueness of this evaluation included: 1) the community
based approach throughout the study; 2) the large number of ethnic groups
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participating; and 3) the partnership and interaction between the community
and the researchers.
The Refugee Federation Service Center (RFSC), which is the largest social aid
organization for recent immigrants and refugees in King County,
Washington, was established in 1982 by refugees for the provision of social
services with an initial budget of $60,000. Today, the agency is a thriving
organization and operates three facilities with a budget over $1 million. The
agency is managed and staffed by refugees and remains a community-based
organization through its affiliated seven Mutual Assistance Associations:
Coalition of Lao Mutual Assistance Association, East European Association,
Ethiopian Community Mutual Association, Khmer Community of Seattle-
King County, Vietnamese Friendship Association, Indochina Chinese
Refugee Association, and Eritrean Community of Seattle and Vicinity. The
agency's most unique aspect is that the bilingual/bicultural staff and
volunteers provide comfort that comes with speaking the native tongue and
true understanding of what it means to be a refugee and an immigrant. The
staff are familiar with the difficult transition to life in the U.S., culturally
specific coping mechanisms, and specific concerns of their communities. In
1995 the RFSC identified seafood consumption and subsequent
contamination as a chief environmental justice issue of the API community.
The study documented in this report involved ten API ethnic groups
(Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Laotian, Mien,
Samoan, Vietnamese) within King County, Washington. The community
played an important role in the study, from the initiation of the study to the
final report. During the study period, the researchers had frequent
interactions with the community because the researchers viewed the study as
"by the API community," instead of "for the API community." This
interaction and cooperation helped the study team in its understanding of
community concerns and therefore gained the support of the community,
which was vital for the completion of this study involving ten ethnic groups
with diverse cultural backgrounds.
The Refugee Federation Service Center and the University of Washington's
Environmental Health Department collaborated with three instrumental
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committees to develop the study. The planning, design, and development
were conducted by a Community Steering Committee comprised of members
representing each ethnic group. A Technical and an Advisory Committee
also shared responsibility in the design of the study. The Technical
Committee was responsible for providing technical assistance, while the
Advisory Committee provided recommendations to ensure the final study
would be relevant to regulatory agencies, the medical field, industry, and
businesses.
Description and quantification of seafood consumption habits among API's in
King County, Washington, was accomplished in three phases. The first,
Phase I, consisted primarily with identifying the target ethnic groups,
modification of the fish consumption and acquisition survey questionnaire
used in the Tulalip and Squaxin Island Tribes Fish Consumption study (Toy,
1996) to be culturally appropriate and accurate for the API community, and
the translation of the questionnaire into the native languages for the ethnic
groups being identified. The first phase of the study has been presented in the
technical report to U.S. EPA (EPA, 1996).
Phase II and Phase III of the evaluation, which were conducted jointly by the
Refugee Federation Service Center and the University of Washington
National Institute for Environmental Health Sciences (UW-NIEHS) Center
for Ecogenetics and Environmental Health, were funded by the U.S. EPA
Environmental Justice Community/University Partnership Grant No. 66-604,
and are described in this report. The specific purposes of Phase II were to: 1)
document the seafood consumption pattern and consumption rate of the API
community; 2) document the sources of fish consumed by API members; and
3) document educational approaches appropriate for the API community.
The goals of Phase III were to: 1) identify culturally acceptable health messages
related to seafood, 2) develop a brochure on seafood related health risks
jointly with the community, and 3) field test the brochure within the API
community for understandability and cultural appropriateness.
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Ill IMPLEMENTATION OF THE STUDY (PHASE II)
A. METHODOLOGY
1. Overview
This study characterizes seafood consumption patterns of ten API ethnic
groups (Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Laotian,
Mien, Samoan, Vietnamese) within King County, Washington. Participants
were first or second generation members of the above ethnic groups, 18 years
of age or older, who lived in King County, Washington. Data were collected
using a survey questionnaire that was developed in English and later
translated into the respondent's native language. The surveys were
administered by trained bilingual interviewers recruited from the API
community. The questionnaire solicited information about the types of
seafood consumed, the source of the seafood, the preparation of seafood, the
frequency of and portion size consumption by the respondents, demographic
information, and educational approaches preferred by the respondents.
The study was conducted in three phases. While this report mainly addresses
only Phases II and III, a brief discussion of Phase I is included for background
and will assist the readers in understanding the approach and results
contained in this report. To promote reading clarity, some aspects of this
study's methodology appear in appendices.
B. COMMUNITY SUPPORT, STUDY DESIGN, QUESTIONNAIRE
DEVELOPMENT (PHASE I)
The purpose of Phase I was: 1) to develop a framework which would interest
and involve API leaders in a seafood consumption and acquisition study; and
2) to develop a culturally acceptable survey instrument. To achieve these
goals, three committees were formed by the Study Coordinator (SC) at the
RFSC. The SC was a resident of the local API community and belonged to
one of the ethnic groups included in the study.
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1. Committee Guidance
The Community Steering Committee (CSC). This committee's function was
twofold: 1) to provide recommendations on specific cultural issues such as
how to approach the community, language, and key concerns of the
community; and 2) to provide community contacts that would enable the
networking and outreach efforts of the study's staff. The fifteen members of
the committee each belonged to at least one of the ethnic groups being
surveyed and had an affiliation with one or more community organizations
(e.g., health care, education, religious or social organizations) within his or
her respective community. Certain ethnic groups (e.g., Cambodian, Laotian,
Vietnamese, Hmong and Mien) felt a strong vested interest in this study and
sent more than one member.
Technical Committee. The Technical Committee was responsible for: 1)
advising the design of a scientifically sound questionnaire that took into
account the cultural and language characteristics identified by the CSC for the
ethnic groups involved; and 2) providing technical assistance to the CSC for
the feasibility and planning of the study. Members included representatives
from the U.S. EPA, King County Health Department, UW School of Fisheries,
UW School of Public Health and Community Medicine, Washington (WA)
State Department of Health, WA State Department of Ecology, and two
representatives from firms (Steven Gilbert, Ph.D., BioSupport, Inc. and
Gregory L. Glass, Environmental Consultant).
Advisory Committee. The Advisory Committee's function was to provide
recommendations to ensure that final documentation of the study would be
relevant and applicable to different interested agencies and ethnic groups.
Members of the Advisory Committee included representatives of industry,
health care, and regulatory agencies. Represented agencies included the
Boeing Company, U.S. EPA, Puget Sound Keepers Alliance, National Oceanic
and Atmospheric Administration, Washington State Department of Ecology,
and the Community Coalition for Environmental Justice.
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2. Development of Survey Instruments
a. Survey Questionnaire
The Community Steering Committee deemed the use of creel, mail, or
telephone surveys as culturally inappropriate and indicated that APIs would
be unlikely to participate. Therefore, a face-to-face interview survey
questionnaire was developed based on an earlier study by the Tulalip and the
Squaxin Island Tribes of Washington (Toy et. al., 1996). The modification of
this questionnaire was mostly completed in Phase I. The Community
Steering Committee was instrumental in guiding the selection of seafood
species most often consumed by API as well as usual preparation methods
and seafood tissue parts most frequently consumed. Minor modifications of
the questionnaire also occurred early in Phase II, for example, inclusion of 4
educational outreach questions. Appendix A contains the final questionnaire
used in this study.
The questionnaire was first developed in English and subsequently translated
into the languages of the ten ethnic groups. Focus groups tested the
questionnaire within six ethnic groups (Cambodian, Laotian, Samoan,
Korean, Filipino, Vietnamese) for content, format, wording, language,
accuracy of translation, presentation, and use of visual displays during the
development stage of the questionnaire. The focus group's feedback was used
to enhance the questionnaire before it was finalized.
The final questionnaire covered selected demographic information of the
respondents, the frequency and portion size for each seafood consumed by the
respondent, the sources of the seafood, the preparation methods, and specific
tissue parts consumed (for example, consumption of finfish skin,
hepatopancreas of crabs, etc).
b. Visual Aids
To maximize the recall reliability in the survey, visual aids for administering
the questionnaire were also developed during Phase I. One aid was plaster
models of seafood representing approximate portion sizes (pre-cooked) of the
different species. Appendix B-l contains a picture of these models, and
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Appendix B-2 describes the weight of each model used for calculation of
seafood consumption rates. A second aid was the species manual (Appendix
C), a collection of pictures of the different seafood species. The manual was
used to assist respondents in identifying partJaala£^p_ecigs-df-6eAfood. Pictures
were obtained mainly from the Washington State Department of Fish and
Wildlife, Fishing in Washington, 1996 pamphlet edition. A copy of this
booklet is provided with the purchase of every fishing or shellfish collecting
license. Pictures were available for most of the species, except snowfish and
moonsnail. For moonsnail, actual moonsnail shells were available and
therefore used. The species manual was especially important for the API
community because the names of some species (e.g., cockles, butter clams)
could not be precisely translated as they are not generally collected or
consumed in some respondents' native countries. The manual also included
a map of the Puget Sound area. Interviewers used the map to help
respondents identify seafood acquisition locations. Seafood "caught from
Puget Sound" was defined by interviewers as seafood caught within King
County, Washington which borders on Puget Sound; and seafood "caught
from outside Puget Sound" as defined as seafood from all other areas,
including non-King County Puget Sound locations. The expanse of Puget
Sound goes far beyond the confines of King County, therefore to avoid
confusion in this report, fishing areas will be referred to as: within King
County and outside of King County.
c. Determination of seafood model weights.
Plaster models were cast from fish purchased from markets. Individual
models could not be provided for the 21 finfish included in the survey.
Therefore, all 21 finfish were represented by four models (Models A through
D shown in Appendix B-l). The models represented the appropriate body
shape and preferred fish size for a group of finfish. The selection of models
and preferred fish size was determined by consensus of the CSC. Essentially,
their guidance was that a fish must fit on a serving plate and effective models
must be similar in body shape to the finfish in question, but did not have to
be exact replicas in order to evoke recognition. Model A was the broad-bodied
fish shape which was cast from a tilapia, and represented a serving of snapper,
snowfish, rockfish, crappie, perch, bass, or tilapia. Model B was the narrow-
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bodied fish shape which was cast from a trout, and represented salmon,
catfish, carp, sturgeon, and suckers. Model C, the skinned fillet model,
represented a typical serving of tuna, halibut, or cod. Model D symbolized
small, narrow-bodied fishes that the CSC advised were eaten whole or with
the head attached, and represented smelt, dogfish, and herring. Other
seafoods were individually represented by 16 models except that abalone and
scallop were represented in one model, and shrimp and lobster were
represented in one model.
The weights used in the consumption rate calculations are shown in
Appendix B-2. For models A, B, and D the measured weight in ounces of the
uncooked fish from which the model was cast was multiplied by an ounces to
grams conversion factor (28.35) and the percentage of edible meat in the
whole body. The edible meat percentage was determined by methods
described in Appendix B-3. The weight for model C was the measured weight
of the uncooked fillets of the same approximate size. The weight of the
shellfish (models J, K, L, M, N, O and T representing manila, macoma, horse,
razor, geoduck and butter calms, and cockles, oysters, mussels and
moonsnails, respectively) were the measured weights of the edible tissues
after cooking and removal from the shell. The weights for models I, E, F, R, S
and H (abalone/scallop, sea urchin, shrimp/lobster, squid, sea cucumber and
fresh sea weed/kelp, respectively) were the measured weights of uncooked
samples of the same size. The weight for model G (dried seaweed) was the
weight stated on the packaging. The weight for model F (crab) was determined
from cooked crab meat plus crab "butter". .(See Appendix B-3). Crab "butter"
consisted of the yellowish liquid and all of the easily removable soft tissue
when the carapace is gently removed from the crab body. The carapace is
removed by turning the crab body upside down or tipping it sideways. The
manner in which the carapace is removed intentionally captures as much of
the yellowish liquid as possible, and the carapace, itself, may be used as a bowl
to sip the liquid.
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C. SURVEY IMPLEMENTATION AND DATA ANALYSIS (PHASE II)
The implementation of the survey and the data analyses were carried out in
Phase II. Phase II included the recruitment and training of bilingual
interviewers, questionnaire pilot testing and revision, development of
sampling strategies, participant recruitment, survey administration, and the
data analysis.
1. Interviewer Recruitment, Training, and Quality Assurance
a. Interviewer Recruitment
The RFSC study coordinator recruited ten interviewers. The job openings
were announced in local API newspapers and social service organiaations
around King County. Job announcements were placed in API newspapers,
flyers, and posted on local college and university campuses. The Community
Steering Committee also recommended applicants. Each interviewer had to
have a cultural knowledge of at least one of the ten ethnic communities and
be fluent in both English and the respective native language.
b. Training and Quality Assurance
Prior to interview, all interviewers attended training on the skills of survey
questioning and probing and use of seafood models. The 9-hour training (3
hours daily for 3 days) was provided by an experienced consultant Glide
Ballard, Fred Hutchinson Cancer Research Center) who has directed many
survey studies. Issues addressed included interviewer tasks, familiarity and
proficiency with questionnaires, use of interview tools (e.g. models, maps),
and data collection consistency. After completing the training, interviewers
were required to practice interviewing relatives and friends over a two-week
period. Afterwards they conducted a simulated interview with the RFSC
study coordinator (SC) using the models and manuals. Once the SC deemed
the interviewers proficient in their interview and data recording techniques,
interviewers were allowed to begin interviewing survey participants. After
each interviewer had administered two questionnaires to survey participants,
the consulting statisticians reviewed the completed questionnaires for data
consistency and counseled interviewers to improve data collection.
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2 . Questionnaire Pilot Testing
Ten survey pilot tests were conducted by the trained interviewers to assess the.
format of the questionnaire and the effectiveness of the seafood models. The
test group had an equal number of males and females, at least one member of
each ethnic group, at least one person from three identified age groups (18-39,
40-64, 65+ years), at least 3 members who were first generation Americans
and 3 who were second generation, and at least 2 people who identified
fishing or collecting seafood as a major source of seafood consumed. Based
on this pilot testing, translations were modified as needed to improve clarity
and cultural appropriateness. Adjustments included translation corrections,
re-phrasing of the questions, and the addition of questions related to cultural
holidays.
3. Sampling Strategy
An interview _goalj)f 200 respondents was planned. All respondents needed
to meet pre-defined criteria to be included in the study. In this section, we will
describe the criteria and the selection process of the respondents.
a. Respondent Selection Criteria
Prospective participants of the study needed to meet the following
requirements:
1) Membership in one of ten API ethnic groups: Cambodian,
Chinese, Filipino, Hmong, Japanese, Korean, Laotian, Mien,
Samoan, or Vietnamese;
2) At least 18 years of age;
3) Resident of King County, Washington;
4) Seafood consumer (non-consumers were documented during
the recruitment process);
5) First generation (born outside US) or second generation
American (at least one of the parents was born outside US).
b. Ethnic Representation
The original sampling strategy specified that the ten API ethnic groups would
be represented in the sample proportionate to their composition as reported
in the 1990 US Census data for King County (see Table M-l). The Community
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Steering Committee, however, had concerns about this strategy. They felt
such an allocation of sample across ethnic groups purely based on the
population size would polarize the community because: 1) certain groups
appeared to be "preferred"; and 2) too few individuals would be interviewed
from the API groups they felt to be most at risk; i.e., Cambodian, Hmong,
Vietnamese, Laotian, Samoan, and Mien. The CSC considered Cambodian,
Hmong, Vietnamese, Laotian, Samoan and Mien to be less well-established
socioeconomically because most (except Samoans) had come to the United
States as refugees of war, and therefore, were at a higher risk for subsisting on
self-caught seafood. On the other hand, other groups (i.e., Korean, Chinese,
Japanese and Filipino) were viewed as relatively well-established in King
County, more affluent, and less likely to collect seafood in contaminated
waters, and therefore, more likely faced a "lower risk". Taking account of the
CSC's concern, the allocation of the number of respondents was modified to
their satisfaction, and it was decided to weight the results to reflect the API
ethnic group apportionment within King County when the final result was
presented for the whole API community. (Table M-l).
TABLE M-l. - SAMPLE SIZE BASED ON POPULATION PROPORTIONATE SAMPLING vs. ACTUAL SAMPLE SIZE
BASED ON CSC'S RECOMMENDATION
Ethnic Group
Cambodian
Hmong
Laotian
Mien
Samoan
Vietnamese
Chinese
Filipino
Japanese
Korean
Total
Sample size allocation
based on census data
7
1
6
*
3
19
52
47
44
22
201
# of actual interviews
(CSC
recommendation)
20
5
20
10
10
26 (25)
30
30
30 (29)
22
202
Allocation principle
less well established
less well established
less well established
less well established
less well established
less well established
more established
more established
more established
more established
•"Census data unavailable for this population.
4. Subject Recruitment
Because of the diversity of the ethnic groups covered in this study, no known
master list existed for all first and second generation Asian and Pacific
Islanders residing in King County. The lack of a complete sample frame
called for a special sampling approach in this study. Particularly, two
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recruitment methods, "roster" and "volunteer" approach, were employed
(described below). Both methods were used within each ethnic group, except
for the Hmong community, in which all five interviewees were from roster.
In the sampling design, the goal was to obtain one-half of the total
participants via each method. In an effort to reduce possible selection bias
based upon participants' knowledge that the study's focus was seafood
consumption, the study was advertised as a Dietary Habits Study for Asian
Pacific Islanders. A $25 check or grocery store gift certificate was offered as an
incentive for study participation.
Interviewers contacted respondents from a randomly constructed roster
and/or volunteer list by phone to arrange an interview appointment using a
prepared telephone script (Appendix D) that was also translated into ten
languages. Interviewers documented their attempts to reach respondents on
a record of contacts; dates, times, and results of calls were recorded
(Appendix E). Interviewers were instructed to contact respondents up to five
times, but not to leave messages on answering machines. If unable to speak
with the respondent in person by their fifth attempt, interviewers were to
proceed to the next respondent on their list. For a completed interview, the
respondent was paid for their participation.
Once the number of respondents for each ethnic group was determined, the
number of respondents was allocated equally between "rosters" and
"volunteers." To have a fair presentation of both genders, the percentage of
each gender in the 1990 census data was used to decide the number of female
and male respondents for each ethnic group. Similarly, the percentage of
people above and below the median age (1990 census data) of each gender
within a specific ethnic group was used to approximately reflect the age
composition of people in each ethnic group.
a. Roster Recruitment
Though no complete list of all API members existed in the community, a
variety of roster lists did exist within different API ethnic organizations.
These roster lists in the API community covered a portion of the API
members. It was planned to recruit about half of the respondents from
various roster lists in the API community. The SC contacted all known API
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religious and community organizations to determine the sizes of their
memberships. Based upon these size estimates, organizations with sixty or
more members were asked to share their membership rosters with the study.
Approximately 50% of these religious and community organizations agreed
to share their rosters after one introduction letter and a follow-up call from
the SC. To increase participation a second letter was sent out to those who
had initial reservations about providing an organizational roster, which
included a letter of support from Governor Gary Locke, the first Chinese
American to be governor in the United States. (Appendix F.) No additional
organizations agreed to participate. Membership rosters from organizations
that agreed to participate were used to randomly select potential study
participants based on the size of the roster list.
Once selected, a letter of introduction was sent to each potential participant
containing two response postcards, one in their native language and the other
in English (Appendix G). A bilingual interviewer made a follow-up
telephone call approximately a week later to ascertain the potential
participant's qualifications (see Section IH.C3.a.), interest, age and gender. If
the qualified participant agreed and fit the needed age and gender profile, an
interview was arranged.
b. Volunteer Recruitment
Study planners anticipated problems obtaining a sufficient number of
participants through the roster method, as well as possible selection bias based
on the membership in a religious organization or community group.
Therefore, a second pool of participants, volunteers, was sought from which
to randomly select the remaining half of the participants needed for the study.
This second group of potential participants was referred to as/'volunteers."
Recruitment of volunteers was achieved in a number of ways. Between
March and April 1997, press releases were published in API newsletters, local
newspapers, and community organizations' and UW newsletters. Shortly
afterwards, approximately 1000 posters (Appendix H) in the ten ethnic
languages and English were posted within King County in areas believed to
be frequented by API members: e.g., groceries, community organizations,
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churches, UW campus, and area parking lots. Attached to the posters were
bilingual postcards (e.g., if the poster was displayed in a Korean establish-
ment, the postage-paid postcards would be in Korean and English), deliver-
able to the UW. In addition, word of mouth, solicitation from various
community and church leaders, and the RFSC staff encouraged and increased
the participation in the study. The volunteer category (from post cards and
lists submitted by the RFSC) identified 476 individuals for the dietary habit
survey.
As the postcards were received at the UW, the information provided on the
postcard (names, addresses, phone numbers, ethnicity, age, and gender) was
entered into a database maintained in a secure area at UW. The consulting
statisticians then randomly selected volunteers from the database and
transmitted the names to interviewers. Letters indicating selection for study
participation were mailed to the selected volunteer category participants, and
a bilingual interviewer contacted them one week later to set up an interview.
As the study progressed, it was discovered that some minor adjustment was
necessary to enable timely completion of the data collection phase.
Particularly, the preset age and gender sampling allocations could not be
strictly met within some ethnic groups because of insufficient names on
either volunteer or roster lists. Among Japanese and Cambodian participants,
five people from the volunteer category were substituted when sufficient
roster members of the needed gender and age were not available, respectively.
Also, within the Japanese and Filipino groups there was difficulty locating
individuals between the ages of 18-37. Therefore, relatives of roster selectees
within the same age group were recruited, though only one study participant
per family participated in the survey.
5. Questionnaire Administration
Interviews were conducted during the spring and summer of 1997 at
convenient locations preferred by the study respondent (e.g., residence,
church, restaurants, respondents' work location, RFSC office). In some cases,
the interviews were conducted in the respondent's native language. During
the interviews, interviewers showed participants seafood models and pictures
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of seafood to help respondents identify types of seafood and the portion sizes
consumed. Interview duration averaged 59 minutes (range: 25-120 minutes).
Respondents who were interviewed received monetary compensation of
$25.00.
a. Re-interviews
During the initial interview, respondents were given the option of signing a
"Consent For Future Contact" form (Appendix I) for a potential re-interview.
From these, twenty survey respondents were randomly selected, 10%
proportionately from each ethnic group, e.g. three each from the Chinese,
Japanese and Korean groups, one from the Mien group, etc. for re-interview
via telephone using the re-interview questionnaire, which was a subset of the
questions contained in the main survey questionnaire (Appendix J). This re-
interview was used to check the reliability of responses on the earlier survey
and participants were selected as soon as all 202 surveys were completed.
Respondents who were re-interviewed received an additional $10
compensation.
b. Questionnaire Editing
Completed surveys were subjected to an editing process between the SC and
the interviewer. This editing process was used to screen and verify answers
that were ambiguous or inconsistent. In the editing process, logic validation
of answers (within field checks for values in the possible range and between-
field checks for relationships) was also carried out. The editing was completed
before the questionnaires were sent for data entry.
c. Double-key Data Entry
To minimize the data entry error, a "double key-entry" procedure was
employed. The data entry was done initially for all questionnaires. After the
first data entry, the data entry program was set as the "verification" mode and
a second round of data entry was done for all data fields and for all
questionnaires. This "verification" mode of the data entry prompted the data
entry staff with an on-screen error message if any inconsistency occurred for
the data field being entered.
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6. Data Analyses
When the data entry was completed, the data were transferred to the
consulting statisticians for data analysis. For each seafood species, the answers
of each respondent were converted into a consumption rate based on the
frequency and the portion size as reported in the survey.
a. Statistical Methods
1) Consumption Rate. Seafood species were categorized into seven groups:
anadromous, pelagic, freshwater, bottom, shellfish, sea weed/kelp, and
miscellaneous seafood (see Appendix K) for surveyed species within each
group. Anadromous, pelagic, freshwater and bottom fish were further
combined into the "finfish" category. Finfish, shellfish, and miscellaneous
seafood were used to compute the "all fish" category. "All fish" and
"sea weed/kelp" were aggregated into "all seafood."
The reported total amount consumed per year was computed for each of the
above seafood groups. The daily consumption amount for each person was
then calculated by dividing the annual amount by 365 days. The daily average
amount was further adjusted for the body weight of the respondent (based
upon self-reported body weight), yielding a common daily consumption rate
across all respondents (grams/per kilogram body weight/per day, or
g/kg/day).
Consumption Rate = (# annual servings x portion size in grams)/
(365 days x kg body weight)
The adjustment was necessary for comparison across different ethnic groups
and across other demographic characteristics. All results will be reported
using this common unit of g/kg/day, unless otherwise stated. This unit of
"g/kg/day" has been used and reported in other fish consumption studies as
well (Toy, 1996). Non-consumers of a specific fish species were assigned a
consumption rate of zero and were included in the data analysis and
reporting.
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2) Treatment of outliers. A number of respondents reported unusually large
consumption rates in this study. For example, the largest consumption rate
reported for shellfish was approximately 11.83g/kg/day (see table of Outliers
and Substitution in Appendix L). Values such as these represent large but
uncertain consumption rates. Generally, these unusually large values are
referred as "outliers."
Because outliers may have profound influence on the average and potentially
other summary statistics, special treatment for them is warranted. In this
study, the outliers were identified as those with an observed value greater
than 3 standard deviations above the mean for consumers of the specific
seafood group of interest. All outliers were identified within each fish
category and substituted by a smaller value that equals to the mean plus 3
standard deviations.
The treatment of outliers involved three steps. Firstly, all observed values in
individual seafood category (anadromous, pelagic, freshwater, bottom,
shellfish, seaweed/kelp, miscellaneous) that were greater than three standard
deviations (SD) above the mean of all consumers were identified as outliers,
and these outliers were then substituted by mean-f 3SD (the rule of "mean
plus three standard deviations").
Secondly, after the treatment of outliers for each of the individual seafood
categories, the "all seafood" consumption rate was computed as the sum of all
individual seafood sub-categories. Using the same principle as applied in
individual seafood sub-categories, the outliers in the "all seafood" category
was also adjusted downward to a value of mean+3SD.
The last step in the treatment process of outliers involved a re-adjustment of
consumption rates of sub-categories for these respondents who were outliers
in the "all seafood" category. To reflect the fact that the overall "all seafood"
rate was the sum of the individual seafood categories, all the individual
seafood categories (the components used in the computation of "all seafood")
were re-adjusted proportionately using the percentage of each sub-category in
the "all seafood" multiplied by the re-adjusted "all seafood" rate.
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All results in this report are based on values after the substitution of the
outliers. Appendix L lists specific values that were receded based on the rules
of treatment of outliers. These values, along with the means and standard
errors reported in the tables, are sufficient statistics for recalculation should
the reader wish to recalculate means, standard errors, and confidence
intervals, with outlier values as originally reported.
3) Hypothesis testing and statistical significance. Analyses of consumption
rates (g/kg/day) are presented in terms of mean, standard error, median (the
50th percentile), and percentiles. The 95% confidence interval on the mean is
also presented for the consumption rates for each ethnicity group. The
statistical significance of difference in consumption rates by ethnicity, gender,
age, income level, and fishing activity was also calculated. Due to the
occurrence of right skewed distribution (because of a few fairly large values)
in the observed consumption rates, nonparametric methods, which are based
on the ranked data and are more robust against skewness than parametric
tests, were used in the assessment of the statistical significance. When
comparing consumption rates between or across groups, either the Wilcoxon-
Mann-Whitney test or the Kruskal-Wallis test was used, depending on the
number of groups being compared (Fisher and Van Belle 1993). In this report,
p<0.05 is considered statistically significant. Since there are many hypothesis
tests and associated p-values, some results may be significant by chance alone.
Readers are encouraged to note that no formal methods of adjusting this
"multiple testing problem" were used in this report. Interpretation of
statistical significance should take into account the number of tests (p-values)
performed in the area of comparison to the reader.
4) Calculation of means, standard errors, confidence interval, and percentiles
of consumption rates. The arithmetic mean (average) consumption rate
(g/kg/day) was calculated for each ethnic group. All 202 survey respondents
were used in the computation. However, if a respondent did not consume a
specific seafood species, the consumption rate of zero was assigned for the
seafood species. The observed standard error was also calculated. The 95%
confidence interval on the mean for each ethnic group was constructed based
on the Student t-distribution. The median (50th percentile) and other
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percentile were also presented for the ethnic groups with at least ten
respondents.
The arithmetic mean, standard error, median, and other percentiles were also
calculated for all 202 respondents by gender, by source of respondents (roster
list vs. volunteer), by age group, and by income level.
5) Calculation of means, standard errors, confidence interval and percentiles
for API community using weighted methods. Ten ethnicity groups of the
Asian and Pacific Islander community were included in this survey. When
the survey results were aggregated into the average consumption rate for the
whole API community, different weights were applied to the mean for each
ethnic group. The weighting was necessary to adjust for the composition
(proportion) of the ethnic groups in the API community. When the mean
consumption rate was computed for the API community, the proportion (P,)
of each ethnicity of the API community was used as the weight for mean of
each ethnicity. This weighting scheme by population percentage took into
account the underlying population structure of the API community.
Specifically, the average consumption rate for the entire API community was
calculated as
where x, is the average for the /'* group, and P, is the population percentage of
that ethnic group in the API community. The standard error of the average
consumption rate for API was then computed as
where var(.v,)is the observed variance for the ith group.
A different weighting scheme was used when the median and other
percentiles were calculated for the entire API community. All observed
consumption rates in a specific ethnic group are applied the same weight --
the ratio of the population proportion (P,) of the corresponding ethnicity and
the number of the surveys (P, / //,), with P, the population percentage of that
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ethnic group in the API community and n,the number of survey respondents
for the i'h group. This weighting scheme for the percentiles took into account
both the population proportion and the number of surveys in the sample.
The median was then calculated as the sorted rates (from the lowest to the
largest) that corresponded to the 50th percentile on the accumulated weights
across all respondents (all weights add up to 1). Other percentiles were also
obtained in the same manner as the median, using the combination of the
sorted consumption rates and the accumulated weights.
The weighting was only applied in the calculation in the consumption rates
for all 202 respondents combined. No weighting was used for the
computation of rates by ethnicity, gender, age, income, education, participant
category (roster versus volunteer), fishing status, generational status or
consumption category (high versus low).
IV Survey Results (Phase II)
A. PARTICIPATION RATE
Survey participation rates differed between the volunteer and roster
categories. Those in the volunteer category had already indicated their
willingness to participate by sending in a postcard. Within this group (n=462),
interviewers attempted to contact 150 individuals. Of these, 16% could not be
contacted. Of those contacted, 13% were disqualified because they did not
meet all of the selection criteria outlined in Section Ill.C.S.a. or did not fit into
needed age and gender categories. Excluding the disqualified, the
participation rate within the volunteer group was 96%. Within the roster
category 365 contacts were attempted. Of these, 54% could not be contacted,
and 14% did not meet selection criteria. Excluding the disqualified, the
participation rate in the roster group was 67% with 33% refusing
participation. See table in Appendix M-l-a. Non-consumption of fish was
considered a disqualifier for 0% of the volunteer category and 2% of the roster
category.
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B. DESCRIPTIVE STATISTICS
The majority of the 202 respondents (89%) were first generation who were
born outside the United States. The remaining 11% of the respondents were
born in the United States, but at least one of their parents was born outside
the United States. Forty percent (40%) of the respondents had completed
college, and 13% had an education level less than high school.
As described in Table M-l, the 202 respondents in this study came from ten
ethnic groups. Of these 202 respondents, there were slightly more women
(n=107, or 53%) than men (n=95, or 47%). The average body weight for men
and women in the sample was 70kg (SD=12kg) and 57kg (SD=13kg),
respectively. However, the sampled Samoans weighed more than other API
groups. The average weight was 99kg for Samoan men (n=5, SD=19kg) and 95
kg for Samoan women (n=5, SD=16kg). The body weight for other ethnic
groups was more homogeneous. The average body weight ranged from 52kg
to 63 kg for women in the other 9 ethnic groups, and from 60kg to 73kg for
men in the other ethnic groups. Ninety-six (or 48%) of the respondents were
recruited from the community roster lists, and the remaining 106
respondents (or 52%) were from the volunteer category. The majority of the
respondents were under age 55 (n=163, or 81%), and people 55 years or over
accounted for 19%.
Household income, reported as income intervals, was provided by 187
respondents. The mid-point of the household income intervals was adjusted
for the number of people in the household and compared with 1997 Federal
Poverty Level (FPL). Overall, 35% of the 202 respondents in the sample lived
under the 1997 poverty line. However, the percent of respondents living
under the FPL was not uniform among the ethnic groups. A greater
percentage of people living under FPL was observed for the Samoan
community and those ethnic groups with the majority members being
refugees: Mien, Laotian, Cambodian, and Vietnamese. Samoan (90%) had the
highest percentage of respondents under FPL, followed by Vietnamese (62%),
Mien (60%), Cambodian (50%), Laotian (45%), Korean (32%), Chinese (26%),
Filipino (21%), Japanese (6%) and Hmong (0%). In 1990, the percentage of all
API in King County living under the FPL was 14.8%. Respondents recruited
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from community rosters had a slightly higher percentage of people living
under FPL than the volunteer category respondents (39% versus 32%) did.
C. SEAFOOD CONSUMPTION RATES
1. Consumption rate for the API community
The main object of this study was to estimate the seafood consumption for
the entire Asian Pacific Islander community in King County, Washington.
The consumption rates for API were aggregated for the ten ethnic groups
included in this study using the weighting methodology as described in the
methods section.
All 202 respondents were fish consumers. Only one person (0.5%) did not eat
shellfish. The percentages of consumers of anadromous, pelagic, freshwater,
bottom fish, and sea weed/kelp were 96%, 97%, 86%, 81%, and 57%,
respectively. The relatively low percentage of the respondents eating
seaweed/kelp was due to the fact that seaweed and kelp were primarily
consumed by the Chinese, Japanese, and Korean communities. Only a few
members of other API ethnic groups ate seaweed and kelp.
In general, the API members consumed seafood at a very high rate (see Table
R-l). The average overall consumption rate for all seafood combined was
1.891 g/kg/day (median 1.439 g/kg/day). The predominant seafood consumed
by API was shellfish (45.9% of all seafood consumed by APIs). The API
community consumed more shellfish (average consumption rate of 0.867
g/kg/day) than all finfish combined (an average rate of 0.819g/kg/day).
Within the category of finfish, pelagic fish were most consumed by the API
members, averaging 0.382 g/kg/day (median 0.215 g/kg/day), followed by
anadromous fish with an average consumption rate of 0.201 g/kg/day
(median 0.093 g/kg/day). The average consumption for freshwater fish was
0.110 g/kg/day (median 0.043 g/kg/day), and bottom fish was 0.125 g/kg/day
(median 0.047 g/kg/day).
In addition, to the seafood specifically listed in the questionnaire, survey
respondents were asked if they consumed other types of seafood. For this
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report, these seafood were classified as "miscellaneous seafood". A
substantial quantity of "miscellaneous seafood" was consumed by the API
members, much of which was canned or preserved fish. On the average,
respondents reported a consumption rate of 0.121 g/kg/day of miscellaneous
seafood (median 0.056 g/kg/day). See Appendix M-l-b for the listing of
miscellaneous seafood by percentage of study participants who consume
them. Fish consumption rates were skewed considerably for all fish groups.
The skewed distribution indicates that a few respondents had a larger
consumption rate than other respondents. Because outliers had already been
adjusted within each fish group (see Methodology section), these large
consumption rates reflected the fact that some API members were, indeed,
"higher" consumers of seafood.
TABLE R-l. CONSUMPTION RATES OF API COMMUNITY MEMBERS
1 Category N
Anadromous 202
Fish
Pelagic Fish 202
Freshwater 202
Fish
Bottom 202
Fish
Shellfish 202
Fish
Seaweed/Kel 202
P
Miscellaneo 202
us Seafood
All Finfish 202
All Fish 202
All Seafood 202
Median
g/kg/d
0.093
0.215
0.043
0.047
0.498
0.014
0.056
0.515
1.363
1.439
Mean
g/kg/d
0.201
0.382
0.110
0.125
0.867
0.084
0.121
0.818
1.807
1.891
Percentage of
consumption
10.6%
20.2%
5.8%
6.6%
45.9%
4.4%
6.4%
43.3%
95.6%
100.0%
S.E.
0.008
0.013
0.005
0.006
0.023
0.005
0.004
0.023
0.042
0.043
95% LCI
g/kg/d
0.187
0.357
0.101
0.113
0.821
0.075
0.112
0.774
1.724
1.805
95%UCI
g/kg/d
0.216
0.407
0.119
0.137
0.913
0.093
0.130
0.863
1.889
1.976
90%tile
g/kg/d
0.509
0.829
0.271
0.272
1.727
0.294
0.296
1.638
3.909
3.928
95%LCI = 957c lower confidence interval bound; 95%UCI=95% upper confidence interval. The
confidence interval was computed based on the Student's t-distribution. Rates were weighted
across ethnic groups.
To better characterize individuals consuming large quantities of seafood,
survey participants were classified as "higher" (n=44) or "lower" (n=158)
consumers of shellfish or finfish if their consumption rates were > 75th or <
API Seafood Consumption Study
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28
EPA9IO/R-99-003
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75th percentile, respectively. Appendix M-2 shows demographic and seafood
preparation characteristics of each group. For finfish, a greater percentage of
women fell into the "higher" finfish consumers (24%) than men (19%).
Japanese had a greater percentage of "higher" finfish consumers. More
individuals >55 years (36%) were in the "higher" consumer category for all
finfish. Cambodian (10%), Mien (10%), Korean (9%), Hmong (0%) and
Samoan (0%) participants tended to be "lower" consumers of finfish. Each
consumption group had similar preparation and procurement practices for
finfish. Frequency of finfish skin or heads/bones/organs consumption did
not differ between groups. For shellfish, more women were "higher"
shellfish consumers (29%) than men (21%) were. A greater percentage of
Vietnamese (50%) were in the "higher" consumer category for shellfish. Mien
(10%), Hmong (0%) and Samoan (0%) participants tended to be "lower"
consumers of shellfish. Only 7% of "higher" consumers harvested (by self,
family members or friends) shellfish.
2. Consumption rate by ethnicity
The study was designed to include the participation of members of ten API
ethnic groups. Because of the small number of respondents for some ethnic
groups in the study, it is not feasible to estimate the consumption rates for
each ethnic group accurately. Nevertheless, differences in the pattern of
seafood consumption can be observed from the data.
The detailed Seafood Consumption Rates by Ethnicity Table in Appendix M-3
suggests that the ten ethnic groups did not consume seafood uniformly.
There was a statistically significant difference (Kruskal-Wallis test) in all
consumption rates (anadromous, pelagic, freshwater, bottom fish,
sea weed/kelp, miscellaneous seafood, shellfish, and the aggregated categories
of finfish, all fish, and all seafood) among the ten API ethnic groups.
In general, members of the Vietnamese and Japanese communities had the
highest overall consumption rate of all seafood, averaging 2.627 g/kg/day
(median 2.384 g/kg/day) and 2.182 g/kg/day (median 1.830 g/kg/day),
respectively. On the other end of the spectrum, the Mien, Hmong, and
Samoan communities consumed the least amount of seafood. The overall
API Seafood Consumption Study 29 EPA 910/R-99-003
5/27/99
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consumption rate of all seafood for Miens was 0.580 g/kg/day (median 0.288^
g/kg/day), less than one-third of that of Vietnamese community. Hmong
people consumed 0.587 g/kg/day on the average (median 0.521g/kg/day). The
Samoan community ate about 0.850 g/kg/day of all seafood on the average
(median 0.879g/kg/day).
For specific seafood categories, the amount consumed differed among the
communities. The Japanese community reported the largest consumption of
anadromous fish,'pelagic fish, and miscellaneous seafood. Members of
Vietnamese community had the largest consumption of shellfish and
freshwater fish of the ten ethnic groups. The Korean community consumed
the most seaweed and kelp, followed by the Japanese and the Chinese groups.
3. Consumption rate by gender
Of the 202 respondents, 107 were women and 95 were men. The survey data
showed that in general women ate slightly more seafood after adjusting for
body weight. However, there was no statistically significant difference in the
consumption rates between men and women for all the fish groups and the
combined categories, after adjusting for body weight. The average
consumption rate for all seafood for women was 1.807 g/kg/day (median
1.417g/kg/day), and 1.710g/kg/day (median 1.257g/kg/day) for men. Results in
Table R-2 indicate that women had a slightly greater average consumption
rate for all fish groups, except for anadromous and freshwater fish. Appendix
M-4 shows seafood consumption rates by ethnicity and gender.
API Seafood Consumption Study 30 EPA 910/R-99-003
5/27/99
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TABLE R-2 CONSUMPTION RATES BY GENDER FOR ALL ASIAN AND PACIFIC ISLANDER COMMUNITY
Female
Category
g/kg/d
SE Median n
g/kg/d
g/kg/d
SE Median
g/kg/d
Anadromous Fish (p=0.8)
Pelagic Fish (p=0.4)
Freshwater (p=1.0)
Bottom Fish (p=0.6)
Shellfish (p=0.8)
Seaweed/Kelp (p=0.5)
Miscellaneous Seafood (p=0.5)
All Finfish (p=0.8)
All Fish (p=0.5)
All Seafood (p=0.4)
107
107
107
107
107
107
107
107
107
107
0.165
0.349
0.131
0.115
0.864
0.079
0.105
0.759
1.728
1.807
0.022
0.037
0.021
0.019
0.086
0.018
0.013
0.071
0.135
0.139
0.076
0.215
0.054
0.040
0.432
0.005
0.061
0.512
1.328
1.417
95
95
95
95
95
95
95
95
95
95
0.169
0.334
0.137
0.087
0.836
0.044
0.104
0.726
1.666
1.710
0.024
0.045
0.023
0.017
0.104
0.010
0.015
0.072
0.149
0.152
II _ .!...»__.. ^
0.080
0.148
0.054
0.034
0.490
0.002
0.055
0.458
1.202
1.257
P-values are based on Mann-Whitney test.
4. Consumption rate by age
Respondents were classified into three age groups: 18-29, 30-54, and 55 and
over. Overall, people in the 55 and over age group ate more seafood than
people did in the other two age categories. The average consumption rate for
the 55 and over age group was 2.065g/kg/day, compared with 1.752 and 1.631
g/kg/day for the age groups of 18-29 and 30-54 age groups, respectively. The
same pattern was observed for all other fish groups, except for pelagic and
miscellaneous seafood. However, the differences in the consumption rates of
fish by age were not statistically significant except for anadromous fish. (See
Appendix M-5).
5. Consumption rate by income
Household income along with the number of people depending on the
reported income was used to compare with the 1997 Federal Poverty Level
(FPL). One hundred eighty-seven (93%) of the 202 respondents provided the
income information in the survey. These respondents with known
household income and number of people in the household were grouped
API Seafood Consumption Study
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EPA910/R-99-003
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into four income levels: under the FPL, 1-2 times FPL, 2-3 times FPL, and
more than 3 times FPL.
There was no clear pattern of consumption rates across income levels for the
API community. (See Appendix M-6). The difference in the average
consumption rate of all seafood was about 20% across the 4 income levels,
indicating people in all the income levels consumed approximately same
amount of seafood. People in the lowest income level (under FPL) ate more
in the categories of all seafood, all fish, and shellfish, but none of the
difference was statistically significant.
6. Consumption rate by educational level
Seafood consumption was cofnpared by educational level achieved (high
school or less versus more than high school). (See Appendix M-7). No clear
pattern was observed except seaweed/kelp, and miscellaneous seafood
consumption were significantly higher in those with greater than a high
school education, and more freshwater fish was consumed by those with less
than a high school education. The higher consumption of sea weed/kelp
among those with more education probably reflects its consumption
preference among the "more established" API groups (e.g., Japanese, Chinese
and Korean).
7. Consumption rate by roster category and volunteer category
Respondents in this study were recruited from volunteers and community
roster lists. Ninety-six of the interviews were from roster lists, and the
remaining 106 participants were volunteers from the ten different
participating communities. Eighty-eight percent of volunteer participants
and 90% of roster participants were first generation.
The consumption rates from the volunteer category were similar to those of
the roster list participants (Table R-3). The overall consumption rate of all
seafood for volunteer category was slightly higher than that for people from
roster lists (average 1.811 vs. 1.707 g/kg/day). Participants from the volunteer
category ate more fish than the respondents recruited from roster category in
all finfish, all fish, and all seafood. Nevertheless, none of the differences was
statistically significant. Appendix M-8 shows roster and volunteer
API Seafood Consumption Study 32 EPA 910/R-99-003
5/27/99
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consumption rates for all seafood categories, e.g. andromous fish, pelagic fish,
etc.
TABLE R-3. CONSUMPTION RATES BY ROSTER AND VOLUNTEER
Category
Shellfish Fish (p=0.4)
All Finfish (p=0.4)
All Fish (p=0.5)
All Seafood (p=0.5)
Resource
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
n
96
106
96
106
96
106
96
106
Mean
g/kg/d
0.873
0.831
0.698
0.785
1.662
1.733
1.707
1.811
SE
0.109
0.081
0.070
0.072
0.149
0.135
0.152
0.139
Median
g/kg/d
0.422
0.494
0.452
0.494
1.129
1.409
1.206
1.477
P-values are based on Mann-Whitney test
8. Consumption rate by fishermen and non-fishermen
Respondents in this study were also asked if they fish. Overall, 66 (33%) of the
202 respondents indicated that they "fish". For simplicity, we will refer these
66 people as "fishermen" and the remaining 136 respondents as "non-
fishermen." The income level (as measured by 1997 FPL) did not show
significant difference between the "fishermen" and "non-fishermen" groups.
Twenty-four percent of female and 42% of male participants were fishermen.
The overall consumption rate (Table R-4) of all seafood for "fishermen" was
slightly greater than that for "non-fishermen" (average 1.971 vs. 1.660
g/kg/day). "Fishermen" consumed more fish than "non-fishermen" in all
finfish, all fish, all seafood, and all sub-fish categories, except freshwater fish
and seaweed/kelp. However, the difference in the consumption rate between
"fishermen" and "non-fishermen" was not statistically significant in the
three aggregated fish categories: "all finfish," "all fish," and "all seafood."
API Seafood Consumption Study
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TABLE R-4. CONSUMPTION RATES BY "FISHERMEN" AND "NON-FISHERMEN"
Category
••••••••••
Shellfish Fish (p=0.4)
All Finfish (p=0.2)
All Fish (p=0.3)
All Seafood (p=0.2)
Resource
i^mmmmmm
Fishermen
Non-fishermen
Fishermen
Non-fishermen
Fishermen
Non-fishermen
Fishermen
Non-fishermen
mmm*
66
136
66
136
66
136
66
136
Mean
g/kg/d
0.889
0.833
0.879
0.678
1.879
1.612
1.971
1.660
SE
0.116
0.082
0.101
0.056
0.188
0.117
0.192
0.120
Median
g/kg/d
0.498
0.428
0.616
0.437
1.357
1.254
1.531
1.254
P-values are based on Kruskal-Wallis test.
9. Consumption rate by generation
First (people born outside U.S.) or second (people born inside U.S. but who
have at least one parent born outside U.S.) generation APIs were eligible for
this study but only 11% of participants were second generation. Participants
from South East Asian countries (Cambodian, Laotian, Mien, Hmong and
Vietnamese) were all first generation. Among the remaining ethnic groups
60% of Samoan, 69% of Japanese, 83% of Chinese, 87% of Filipino, and 95% of
Korean were first generation. Table R-5 shows a trend toward higher incomes
among second generation participants.
TABLE R-5 GENERATION BY INCOME
Income Level
Under FPL
1-2 FPL
2-3 FPL
>3FPL
Total
Second Generation (born
n in US)
71
39
38
39
187
9%
8%
13%
18%
11%
First Generation (born
outside US)
91%
92%
87%
82%
89%
In general, first generation APIs consumed more fish than the second
generation API in all the fish categories, except pelagic fish. The consumption
rates are statistically different between the first and second generation for the
following seafood categories: freshwater fish and shellfish (Table R-6).
API Seafood Consumption Study
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EPA910/R-99-003
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TABLE R-6 SEAFOOD CONSUMPTION BY GENERATION
Second Generation
(n=23)
Mean SE
g/kg/d ;
First Generation
(n=;179>
• Mean'-X-^wSE:
g/kg/d 7'
Anadromous Fish (p=0.1)
Pelagic Fish (p=0.08)
Freshwater Fish (p<0.001)
Bottom Fish(p=0.1)
Shellfish (p=0.043)
Seaweed/kelp (p=0.055)
Miscellaneous Fish(p=0.9)
All Finfish (p=0.8)
All Fish (p=0.2)
All Seafood (p=0.3)
0.132
0.377
0.020
0.088
0.445
0.068
0.097
0.616
1.158
1.226
0.018
0.058
0.005
0.018
0.070
0.025
0.025
0.074
0.126
0.135
0.171
0.338
0.148
0.103
0.903
0.062
0.106
0.760
1.769
1.830
0.018
0.032
0.017
0.014
0.074
0.012
0.010
0.056
0.111
0.114
P-value is based on Mann-Whitney test.
D. FISH SOURCES
Respondents were asked to report the sources [grocery stores/street vendors;
restaurants; harvested (by self, family member or friend) in King County,
Washington; harvested outside King County] where they acquired the
seafood they consumed. The main source of all forms of fish consumed by
API community was purchased from grocery stores, street vendors, or
restaurants, ranging from a low of 79% to a high of 97% across types of
seafood (see Table R-7). Eighty-five percent of anadromous fish consumed
were purchased from grocery/street vendors or restaurants. Ninety-three
percent pelagic fish, 79% freshwater fish, 83% bottom fish, 88% shellfish, and
97% seaweed/kelp were purchased as well.
The harvested portion of the consumed seafood by API community members
varied from a low 3% to a high of 21%, depending on the seafood type. The
main harvest sites tended to be in King County. Questioning about other
harvest sites was not pursued because the Community Steering Committee
felt that more explicit questioning about harvest sites was culturally
intrusive.
Overall, the harvested portion of the fish consumed by the API community
was less than a quarter of the total consumption; nevertheless, differences can
API Seafood Consumption Study
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35
EPA910/R-99-003
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be observed among the ethnic groups. Respondents in the Japanese, Chinese^
Filipino and Korean groups tended to consume purchased seafood. Members
of the Mien, Hmong and Laotian communities seemed to harvest seafood
more often than other ethnic groups (See Appendix M-9). Laotians, for
example, harvested 43% of bottom fish. Miens harvested more than half of
anadromous fish, 100% of bottom fish, and 34% of shellfish. However, only
ten Mien respondents were selected for this survey, and their overall seafood
consumption rate was the lowest among all ethnic groups.
Category
Anadromous Fish
Pelagic Fish
Freshwater Fish
Bottom Fish
Shellfish
Seaweed/Kelp
n
194
196
173
163
201
116
(^••OTVMBMBBimM
Total
Purchased
Seafood
55%
95%
79%
83%
88%
97%
Purchased
**m******mmimammmm
Groceries
/Street
Vendors
69%
77%
62%
61%
67%
81%
I^BB^BBUBBBBHqMRBVIMBH
Restaurants
16%
16%
17%
22%
21%
16%
Total
Harvested
Seafood
16%
7%
21%
17%
11%
3%
Harvested
Caught in
King County,
Washington
7%
4%
15%
8%
9%
3%
J
Caught
outside King
County, WA.
9%
3%
6%
9%
2%
0% _
E. SEAFOOD SPECIES AND PARTS CONSUMED
1. Seafood species consumed
The percentage of survey participants who consumed each finfish species,
shellfish species, and seaweed/kelp are listed in Appendix K. Salmon and
tuna were the most frequently consumed finfish. Of the shellfish species,
more than 75% of respondents consumed shrimp, crab, and squid. Appendix
M-l lists the percentage of survey participants consuming "miscellaneous
seafood/' These seafood were identified when participants were asked if there
were "other seafoods which you eat that were not mentioned earlier" (in the
questionnaire). The most frequently consumed miscellaneous seafood was
the octopus (11%). This low percentage suggests that information provided by
the Community Steering Committee provided accurate guidance for reducing
the number of species questions on the questionnaire.
API Seafood Consumption Study
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EPA910/R-99-003
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2. Seafood parts consumed
For all survey participants, when finfish were eaten, the head, bones, eggs,
and other organs were consumed twenty percent (20%) of the time.
(Table R-8). Fillet with skin was eaten 55% of the time. Forty-two percent of
the respondents reported they eat fillet with skin "sometimes" (more than 0%
but less than 100% of the time) and 30% "always" (i.e. 100%) eat fillet with
skin. Thirty-six percent reported they "sometimes" eat head, bone, eggs,
and/or organs, and 8% said they "always" eat head, bones, eggs, and organs.
However, the consumption pattern of fish parts was not uniform among the
ten ethnic groups. Vietnamese, Hmong, and Mien reported eating the fillet
with skin a greater percentage of the time than other API ethnic groups.
Caution should be exercised when using these data to describe habits by ethnic
group because of the small numbers surveyed.
TABLE R-8. PARTS OF FINFISH CONSUMED BY ETHNICITY
••
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
••
20
30
29
29
15
18
9
5
10
25
190
Fillet with skin
64%
55%
59%
30%
50%
42%
67%
100%
45%
78%
55%
Fillet without skin
36%
45%
41%
70%
50%
58%
33%
0%
55%
22%
45%
Head, bones, eggs, organs
34%
27%
26%
10%
1%
4%
23%
90%
11%
18%
20%
The consumption pattern of shellfish parts varied depending on the specific
shellfish (Tables R-9 and R-10). Most of the time, clams were eaten without
removing the stomach. For example, manila/littleneck clams were eaten only
10% of the time with the stomach removed. Sixty-three percent of the time
macoma clams were eaten whole. This clam ingests sediment and does not
filter feed like littleneck clams. Crabs were eaten whole (includes the meat
and hepatopancreas) 43% of the time.
Seafood Consumption Study
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TABLE R-9. SHELLFISH CONSUMPTION (BIVALVES)
m^;'ftv;V^^
Shellfish
Maniia/littleneck clams
Oysters
Mussels
Scallops
Butter clams
Geoduck clams
Cockles
Razor clams
Abalones
Horse clams
Macoma clams
•nHHHH|
I i on 5i i mprQ
V_- U 11O U L 1 It 1 .3
72% (145)
71% (142)
62% (125)
57% (115)
39% (78)
34% (68)
21% (42)
16% (33)
15% (30)
13% (27)
9% (1 9)
PJUIHH
|
i
77%
88%
89%
71%
76%
24%
64%
58%
53%
48%
63%
•E933D9HB
wYstomach > 'Sip
removed |
10%
5%
6%
4%
14%
40%
12%
21%
23%
22%
26%
3J3BHES1
hon removed
4%
4%
4%
1%
3%
2%
9%
0%
2%
0%
0%
Whole with
stomach and
siphon removed
9%
3%
1%
24%
6%
35%
14%
21% !
22%
30%
11%
TABLE R-10 NON-BIVALVE SHELLFISH CONSUMPTION
;: , Species ;
Shrimps
Crabs
Squids
Lobsters
Sea Cucumbers
Sea Urchins
Moon snails
% Consumers v
(n)
98% (196)
96% (192)
82% (165)
65% (131)
15% (31)
14% (29)
4% (8)
Whole
21%
43%
22%
16%
26%
24%
38%
Body/meat/ ;
eggs/ :' !:
muscles only
78%
57%
78%
84%
74%
76%
62%
Tissue parts consumed
-.':-:; ./•:••:' ', .'• .'.<". : '. •' .'.. '. '•"'
body and head versus meat only
crab meat and butter* versus meat only
whole squid versus body and tentacles only
whole body and head versus body only
whole body versus muscle only
whole body versus eggs only
whole body versus muscle only __
*The "butter" a crab is defined as yellowish liquid and soft tissue compromised of the cooked
gastrointestinal tract which includes the hepatopancreas and stomach.
F. PREPARATION METHODS
The survey covered two categories of preparation methods (Table R-ll):
"baked, boiled, broiled, roasted, or poached," and "canned, fried, raw, smoked,
or dried." The respondents reported that they prepared both finfish and
shellfish more often using the method of "baked, boiled, broiled, roasted, or
poached," averaging 65% and 78% of the time, respectively. The second
method of "canned, fried, raw, smoked, or dried," was also used substantially
in the API community, ranging from 35% for finfish and 22% for shellfish.
API Seafood Consumption Study
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1 TABLE R- II FISH PREPARATION METHODS
Finfish
^^^^—
\
Baked, boiled,
broiled, roasted,
i or poached
Cambodian 20 54%
Chinese 30 79%
Filipino 30 58%
Japanese 29 78%
Korean 15 57%
Laotian 19 59%
Mien 8 74%
Hmong 5 50%
Samoan 10 52%
Vietnamese 25 67%
All Ethnicity 191 65%
Canned, fried,
raw, smoked, or
dried r
Shellfish
Baked, boiled,
broiled, roasted,
i or poached
46% 20 65%
21% 30 82%
42% 30 77%
22% 29 68%
42% 15 89%
41% 19 79%
26% 8 88%
50% 5 60%
48% 10 50%
Canned, fried,
raw, smoked, or
dried
35%
18%
. 23%
32%
11%
16%
13%
40%
50%
33% 25 92% 8%
35% 200 78%
22%
VVhen finfish were prepared (Table R-12) with boiling, 33% of the time the
boiled water was thrown out, and 54% of the time the boiled water was re-
used either in cooking (36%) or simply in drinking (18%). Boiled water in
preparing shellfish was thrown out at a rate of 57% of the time. The re-use of
the boiled water in preparing shellfish was evenly distributed between
"drinking" and "cooking," at a rate of 21% of the time. Mien and Hmong
survey participants drank the cooking water from both finfish and shellfish a
survey higher percentage of the time.
TABLE R-12. SEAFOOD COOKING WATER USAGE (PERCENTAGE OF TIME USED)
Finfish: Water Usac
^^^—
n
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
20
30
30
29
22
20
10
5
10
26
202
Throw Out
18%
58%
47%
41%
19%
14%
28%
0%
60%
12%
33%
Use in
Cooking
67%
15%
20%
38%
45%
31%
0%
0%
23%
80%
36%
]e* Shellfish
. Drink It
0%
42%
34%
0%
0%
3%
62%
100%
27%
0%
18%
Throw Out
88%
68%
46%
52%
31%
74%
38%
0%
73%
60%
57%
: Water lisa
Use in
Cooking
13%
15%
24%
11%
51%
10%
0%
0% .
16%
36%
21%
ae*
Drink It
0%
39%
30%
32%
5%
3%
53%
80%
14%
0%
21%
*Mean percentage.
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G. Re-interviews
Since the study is a recall survey of the fish consumption, the reliability and
consistency of the answers provided by the respondents was tested by re-
interviewing. To assess the reliability of the responses, 20 respondents were
selected for a follow-up re-interview via telephone after the completion of
their survey interviews. A subset of the questions in the survey questionnaire
were selected and used in the re-interview. These questions were: the
frequency of consuming salmon, halibut, shrimps, the sources of
anadromous fish and shellfish, and the parts of finfish consumed. Since the
re-interview was conducted by telephone and no model display was available,
no questions regarding portion sizes were asked. Re-interviews occurred
within one to four months after the initial interview. The interval variation
was due to participant recruitment delays encountered because of specific
ethnic group, gender, and age requirements.
The table in Appendix M-10 indicates that substantial difference exists
between the answers provided by the 20 respondents who participated in the
re-interview process. This difference in inter-individual paired results
suggests that consumption rate for each individual can not be consistently
estimated. In this study, our focus is to provide an assessment of the seafood
consumption rate for API community. Table R-13 shows the group results of
the original survey and the re-interview on the same questions. The
Wilcoxon ranked test indicates that the answers provided in the original
survey and the re-interview were not significantly different for most of the
re-interview questions, except for the percentage of anadromous fish caught
outside King County, Washington (p=0.043), shellfish caught in King County
(p=0.027), shellfish consumed at restaurants (p=0.023), and consumption of
head, bone, eggs, and organs of finfish (p=0.036). This result suggests that the
difference in the means between the original and re-interview for all 20
respondents as a group indicates that the estimated consumption rates for the
whole API community in this study can be viewed as generally reliable.
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TABLE R-13 COMPARISON OF ANSWERS BETWEEN ORIGINAL SURVEY AND THE RE-INTERVIEW
r—
• •
Salmon: #of servings per year
Halibut: # of servings per year
Shrimp: # of servings per year
Anadromous fish: purchased from groceries
Anadromous fish: caught in King County
Anadromous fish: caught outside King County
Anadromous fish: eat at restaurants
Shellfish: purchased from groceries
Shellfish: caught in King County
Shellfish: caught outside King County
Shellfish: eat at restaurants
Finfish: fillet with skin
Finfish: fillet without skin
Finfish: head, bone, eggs, organs
Original
mean(SE)
17(4)
6(2)
24(4)
80% (6%)
7% (4%)
4% (3%)
8% (3%)
82% (5%)
6% (3%)
!%(!%)
11% (3%)
53% (9%)
42% (9%)
24% (8%)
Re-Interview
mean(SE)
14(4)
7(2)
41 (16)
76%'(7%)
6% (2%)
9% (4%)
10% (4%)
77% (6%)
0% (0%)
3% (3%)
21% (5%)
44% (8%)
56% (8%)
9% (4%)
Two-sided
••'• p-valua
(Wilcoxon)
0.3
0.9
0.7
0.5
0.7
0.043
0.7
0.4
0.027
0.3
0.023
0.4
0.2
0.036
H. Educational Outreach Information
The educational outreach information was evaluated in two ways. First, by
educational status (high school or less, n=69; and greater than high school,
n=98); then by fishing status (fishermen, n=66; and non-fishermen, n=136).
preferred sources of reliable information about the API community, preferred
learning methods, and types of information desired about seafood were
compared for these groups. The fishermen (n=66) were also queried about
fishing safety information sources.
Table R-14 shows the most reliable sources of information used by the API
community by fishing and educational status. There were no appreciable
differences based upon fishing or educational status. Radio in native
language appealed to relatively few, though radio broadcasts at the time of the
study were available only in the following languages: Cantonese, Vietnamese,
Tagalong, Laotian/Mien, Korean, and Samoan and may not have used the
preferred dialect of the survey participants. For example, radio in native
language was deemed reliable by 40% of Mien and 0% of Laotian respondents.
Radio broadcast in native language was deemed a reliable source of news by
17% of Chinese, 13% of Filipino, 36% of Korean, 0% of Samoans and 39% of
Vietnamese.
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TABLE R-14. BEST/MOST RELIABLE SOURCES OF INFORMATION USED BY THE API COMMUNITY.
Source of Best/Most Reliable
Information
Fisherman Non- All Survey HSor
fisherman Responde Less
(n=66) (n=136) nts (n=202) (n=69)
thanHS
Community Newspapers/Newsletters
Television
Word of mouth
Temple/mosque/church
Community Center
Radio in English
Radio in own language
Bulletin Boards
85%
64%
65%
36%
30%
29%
24%
11%
70%
66%
60%
37%
28%
28%
13%
19%
75%
65%
62%
37%
29%
28%
16%
16%
70%
64%
54%
39%
38%
25%
28%
22%
82%
64%
68%
36%
26%
32%
11%
15%
Survey participants were asked to indicate which two of the learning methods
listed in Table R-15 they preferred. Sixty-one percent of the fishermen and
74% of non-fishermen preferred learning with the use of books/pamphlets,
and 55% of all survey respondents preferred listening to someone. Less than
10% preferred to learn through the use of tape recordings, slide shows, and
comic book presentations. Findings were similar using the educational status
categories.
TABLE R-15. PREFERRED LEARNING METHODS
Preferred Learning Methods Fisherman
(n=66)
Non- All Survey
fisherman Respondent
(n=136) s(n=2Q2)
HSor
Less than HS
(n=69) (n=98)
Book/pamphlets
Listen to someone
See video
Learn on Computer
Tape recording
i See slide show
Read comic book
61%
55%
41%
18%
9%
6%
3%
74%
55%
32%
15%
7%
3%
5%
69%
55% '
35%
16%
8%
4%
5%
58%
51%
44%
13%
16%
6%
9%
74%
55%
32%
15%
2%
4%
3%
Survey participants were asked to indicate what information about seafood
would be of interest to them (Table R-16). Most participants wanted health
information about eating fish (82%) as well as the safety of Puget Sound
seafood (69%). Somewhat fewer fishermen wanted information about safe
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preparation methods compared to non-fishermen (58% versus 72%,
respectively), and more fishermen than non-fishermen wanted information
about safety of specific fishing location in Puget Sound.
TABLE R-16. PREFERRED SEAFOOD INFORMATION
Information Desired About Seafood Fishermen
(n=66)
Non- All Survey
fishermen Respondents
(n=136) (n=202)
HSor
thanHS
(n=69) (n=98)
Health info about eating fish
Safety of Puget Sound Seafood
Safe preparation information
Safety of specific fishing locations in PS
Type/amounts of Seafood eaten by API's
83%
73%
58%
53%
33%
817o
67%
72%
29%
27%
82%
69%
67%
37%
29%
78%
71%
64%
33%
29%
86%
69%
69% >
38%
32%
Fishermen were asked to cite useful information sources to find out about the
safety of fishing in a particular site (Table R-17). Word of mouth (65%) was
the most frequently cited useful information source followed by posted
warning signs (59%). Less than one-half found State and County sources
useful. More fishermen with >HS education indicated that posted warning
signs, Washington State Shellfish Information, and the red tide hotline are
useful information sources than those with
-------
V. EDUCATION AND COMMUNICATION OF STUDY FINDINGS (PHASE III)
A. METHODS
1. Introduction
Phase III of the Seafood Consumption Study was intended to serve as a
vehicle to develop and field test culturally appropriate educational materials
to convey information about seafood. While Phase II described and
quantitated seafood acquisition, consumption, and preparation habits, such
technical information obtained in Phase II is more useful to the regulatory
agencies and risk assessors than the API community. Community leaders
indicated that the quantitative information was of little interest to them, and
among survey respondents, only 29% of indicated that they would like to
know the amount of the fish that was consumed by API community.
However, 82% of survey respondents desired health information about eating
fish, 68% information about safety of Puget Sound seafood, and 67%
information about safe seafood preparation methods. Therefore, a strategy
was developed to link the technical expertise of the Advisory and Technical
Committees with the cultural perspectives of the Community Steering
Committee to develop health messages for the API community about seafood
related health issues, safe acquisition information, and safe preparation
methods.
These efforts resulted in a draft brochure that was translated into ten
languages and focus group tested. Based upon comments from community
focus group reviewers, and the Advisory and Technical Committee members,
modification of the English version of the educational materials was
accomplished. Funding for the pilot translation was available, but not to
finalize the translation or distribute the brochure.
2. Selection of an Education/Communication Tool
The original study design called for the development of a slide show;
however, this idea, with concurrence from the U.S. EPA grant manager, was
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discarded for several reasons. First, data collected from the Phase II study
survey (see table R-12) showed that only 4% of survey participants considered
slide shows a preferred learning method while 69% preferred books or
pamphlets. Secondly, members of the Community Steering Committee
indicated to the RFSC Study Coordinator that they preferred brochures
because they are easier to distribute than slide shows and can be referred to as
reference material over a longer period of time. They also felt that translators
are more willing to translate a pamphlet than a slide show and that slide
shows are considered "old technology" with videos being preferred, however
the cost of video production was not covered by the grant funding.
3. Development of Education/Communication Tool
The UW asked members of the Technical and Advisory Committees to
brainstorm and name five most important public health risks associated with
seafood consumption and acquisition. Eight of the fourteen committee
members (both committees combined) responded by identifying fifteen
general concerns. These were ranked by citation frequency. From this list,
CSC members (n=16) were then asked to select five concerns they felt to be
most important for the API community (Appendix N-l). The goal was to
incorporate the top five health messages into the brochure; however, seven
were ultimately included because three health messages received the same
rating from the CSC for the fifth position. The CSC was concerned about the
issue of "seafood from foreign markets and restaurants", but this was not
included because of the topic's complexity and scope.
Using these topics, the UW developed the text (health and preventive
behavior messages) of the brochure, which then was edited by the RFSC Study
Coordinator. The CSC reviewed these messages to ensure cultural
appropriateness and understandability. The UW and the RFSC also
developed a list of resources for obtaining further information (e.g., Red Tide
Hotline, etc.) to include in the brochure. The resources included were based
jn part on recommendations made by members of the Technical and
Advisory committees, and the SC.
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Other sources of community input included discussion with the director of
the Seafood Consumption Information Project with Save San Francisco Bay
Association, to advise in the planning and development of the educational
brochure. The San Francisco project had also developed an educational
brochure to raise awareness of safe cooking preparations, sensitive
populations, etc. The SC also met with the director of the Wilderness-Inner
City Leadership Development Youth Programs of the International District
Housing Alliance in Seattle, Washington, to exchange strategy and
development ideas since that organization was also in the midst of
developing an educational brochure on seafood consumption.
From the acquired information, the RFSC Study Coordinator developed a
basic layout for the brochure that was transformed into a brochure format by a
graphic artist with the U.S. EPA Region X (Appendix N-2).
4. Translation and Focus Group Testing
RFSC Study Coordinator recruited ten translators from the community to
translate the brochure. Translators were required to be bilingual in English
and one of ten languages: Cambodian, Chinese, Filipino, Japanese, Laotian,
Korean, Hmong, Mien, Samoan, and Vietnamese.
RFSC study coordinator recruited eight focus group members from the API
community to review the brochure (both English and translated version) for
format, content, translation, and presentation; each was compensated with
$25. Focus group members were recruited from health clinics, educational
institutions, libraries, and community organizations. Due to unexpected and
unavoidable time conflicts experienced by the RFSC study coordinator, focus
group members from the Hmong and Samoan communities were not
recruited. For the same reason, the focus group did not meet as a whole
group; rather, members completed a self-administered questionnaire
(Appendix N-3) which evaluated the content, accuracy of translation,
effectiveness, and format of the brochure.
RFSC Study Coordinator also mailed the English brochure translation to the
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Technical, Advisory, and Community Steering Committees for their general.
comments and recommendations.
Comments and recommendations from the Focus Group, Technical,
Advisory, and Community Steering Committees, as well as other interested
parties were incorporated into the English translation of the educational
brochure. Translation of the final edited version was outside the scope of the
grant study plan.
VI Results (Phase III)
Overall, with the exception of the Mien review, the health risk messages,
graphics, and effectiveness of the brochure were rated, generally, good to
excellent by the focus group reviewers (see Appendix N-4). The brochure was
felt to be useful for decision making. Except for Laotian and Mien
translations, the translations were above average, and the presentation clear
and precise. Reviewers made corrections to translation on the brochures
themselves (see Appendix N-5), which will be useful when the final version
of the brochure is published (funding to be obtained).
Comments from the focus group reviews, the CSC, the Technical and
Advisory Committees, as well as other interested parties, were incorporated
into the brochure where appropriate. An English version of the brochure,
which incorporated all of the editorial comments, is contained in (Appendix
N-6).
DISCUSSION
PARTICIPATION RATES
expected, participation rates among volunteers were high (96%), and
somewhat lower in the roster group (67%). Within the roster group, 67%
elected to participate. Reasons for refusal are unclear. Though community
leaders were involved through membership on the Community Steering
Committee and urged community organizations to participate, they were not
involved in person to person recruitment. Chiang (1998) achieved a 79.8%
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participation rate in her study of the Laotian community, which was made_up
of the following ethnic groups: Khmu (13%), Laotian (32%), Mein (45%), and
Thadum (10%). Her success may reflect community leader involvement; e.g.
they made first contact with all study participants. In addition, Chiang's study
focused on only one ethnic community which happened to be closely knit,
unlike the King County study which targeted ten groups which were
dispersed throughout the area. The roster method of recruitment also had
the drawback that churches and community groups may not have resources
to update their membership rosters. Interviewers were unable to contact 54%
of the individuals selected for interview. Despite the differing participation
rates between the volunteer and roster groups, the seafood consumption rates
between the two groups did not differ significantly.
POTENTIAL BIASES
This study covers ten ethnic groups in the Asian and Pacific Islander
community who reside in a large metropolitan, area. A complete numeration
and a random sampling of the targeted population was not feasible. To reduce
potential coverage bias in the recruitment of respondents, a two-tier approach
was employed by the study team - "roster" and "volunteer" selection. This
two-tier approach may not be theoretically optimal for the coverage and
selection of an unbiased sample of the targeted population; it was designed to
minimize possible bias in the selection of respondents.
While the study team made every effort in soliciting as many rosters as
possible from organizations in the API community, nevertheless, some
organizations in the API community refused to share their membership
rosters with the study team. Reasons generally involved confidentiality
concerns. It is difficult to assess what bias, if any, exists by using the roster lists
provided by the community organizations.
The survey was advertised as a "dietary habits study" to reduce the possibility
that potential lower seafood consuming participants would de-select
themselves. It is difficult to determine this strategy's success because an
undetermined number of the community members were aware that a
seafood consumption study had been funded for Phase I (completed in 1996).
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This bias would be expected to be most evident within the volunteer group
which represented individuals who actively volunteered for the study versus
the roster group which was randomly selected from preexisting lists. This
effect, if present, is probably small because comparison of roster and volunteer
consumption rates showed no significant difference between these two
groups.
Thirty-eight percent of survey participants who responded to questions about
their income (n=187) lived below the Federal Poverty Limit (FPL). These rates
are also considerably higher than the 14.8% observed among all API's residing
in King County in 1990 (1990 U.S. Census). This difference may be due to the
recent immigration status of the study group when compared to the
multigenerational composition of API's in King County, or economic
patterns shifting since the 1990 census. The relatively high percentage of
individuals living below the FPL also may have been influenced by
calculation procedures. Because income was considered a culturally sensitive
question, survey respondents were asked to check income range categories
instead of providing exact income information. Calculation of FPL used the
midpoint of the range, e.g. $5000 for survey participants who marked the $0 -
$10,000 income level. This method may have underestimated incomes.
A slightly greater percentage of the roster than volunteer respondents
interviewed in this study were living under the federal poverty level (39%
versus 32%, respectively), but roster participants were not more likely than
volunteers to be first generation. People.in the lowest income level (under
FPL) ate more in the categories of all seafood, all fish, and shellfish, but none
of the differences were statistically significant. First generation consumed
significantly more freshwater fish and shellfish than second generation
participants.
The impact of the relatively more low-income respondents in the study may
not warrant major concern. The results of this study have indicated that there
vvas no significant difference among the income levels in terms of overall
fish consumption rates among the API community, and income was not
related to "fishermen" status. Respondents in the "more-established" ethnic
Croups (for example, Japanese, Chinese, Filipino, Korean) seemed to consume
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more fish by purchasing from groceries/street vendors and restaurants, the
other groups reported more self-harvested fish for consumption.
The reliability of participant responses was assessed using a subset of 14
questions from the survey. Of these, 3 queried seafood consumption
frequency, 3 tissue parts consumed, and 8 source of seafood. The retest of ten
questions showed no significant response differences and that responses were
generally reliable. Two of the four questions for which answers differed
significantly were related to fishing locations. During face-to-face interviews
a map visually clarified the definition of "inside Puget Sound" versus
"outside Puget Sound" to be "inside" versus "outside" of King County. Such
visual clarification could not be accomplished via telephone interview, and
without the map, misinterpretation was likely because Puget Sound, while
within King County, is much more extensive then just King County,
Washington. The other two questions were source of shellfish (restaurants)
and finfish tissue parts consumed (head, bone, eggs, organs). Reasons for
these differences are unclear.
PER CAPITA CONSUMPTION ESTIMATION
This study was designed to quantitate usual intake among API seafood
consumers. Because participants had to be seafood consumers, the study was
not designed to determine per capita rates; so the percentage of non-
consumers were estimated from interviewer screening logs. The study
recruitment protocol required that prospective participants answer a series of
qualifying questions; e.g., their county of residence, ethnic group, age,
generation in the U.S., and seafood consumption status. Of all prospective
participants willing to participate in the study, only 1.5% were disqualified
because they did not eat seafood, 0% in the volunteer group, and 2% in the
roster group. These data suggest that seafood consumption is almost
universal within the API community and that per capita rates are probably
similar to those calculated here. Chiang (1998) also did not quantitate the
number of non-consumers, but found that 87% of the Laotian community
surveyed in West Contra Costa County, California, ate seafood at least one
time per month. A survey of 500 Native Americans from the Umatilla, Nez
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Perce, Yakima, and Warm Springs tribes found that -9% did not consume
fish (CRITFC, 1994).
CONSUMPTION RATES
This study was intended to evaluate the fish consumption rates of the API
community members in King County, Washington. The 202 respondents
were from ten different ethnic groups. While the observed consumption rates
have been reported for each ethnic group in this study, it is important to note
that the estimate of consumption rate for any specific ethnic group should not
be considered accurate because of the small sample size for the individual
ethnic groups.
The median seafood consumption rate was 89g/day for the average weight
(62kg) of all survey participants. A consistent difference was noted between
mean and median seafood consumption rates. As discussed above, this
difference persisted even when consumption rates for the highest consumers
(outliers) were corrected to 3 standard deviations above the mean. These data
suggest that there are APIs who have very high rates of seafood consumption.
For example, consumption at the 90th percentile rate would be 242g/day or 7.8
ounces seafood per day. Even at the 10th percentile, consumption was 32g/day
which is above the 21g/day per capita rate estimated by Javitz (1980). The API
ethnic groups with the highest seafood consumption rates were Vietnamese
(median: 148g/day) and Japanese (median: 113g/day).
These high rates may be explained by the more recent immigration status of
g9% of participants and possibly the lower income status of many participants,
though the higher fish consumption rates observed in the lowest income
group were not statistically significant. There are no published studies
available which estimate seafood consumption rates in API countries of
origin, e.g. Japan, China, etc.
Survey methods may also overestimate consumption rates. Our survey
specifically queried "in" and "out of season" consumption rates for a total of
40 finfish and shellfish species, and participants could add additional species if
consumed. Several models were used for species types as outlined in the
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methods. Multiple estimations of consumption by a single respondent may
overestimate consumption rates. The timing of survey administration
(Spring and Fall) may have influenced consumption reporting for certain
species, however, the survey was structured to query seafood consumption
both "in" and "out" of season.
In contrast, Chiang found markedly lower consumption rates (median
9.2g/day) in the Laotian immigrant population in California. This may reflect
several factors. First, there is a high-profile Superfund site which has
contaminated the Bay near this community, and the lower consumption rates
may reflect the effectiveness of the public awareness program regarding
contaminated fish in local waters. Second, survey instrument differences
may account for some of the disparity. In Chiang's survey, a single model was
used to estimate usual seafood portion size for both finfish and shellfish
species together, and then grouped usual consumption frequencies into
imprecise categories(e.g. more than once/day, 3-4 times/week, a few times a
month, etc), which may have resulted in consumption rate underestimation.
Finally, our study used models portraying uncooked weights except for crab
and bivalve shellfish, whereas Chiang referred to cooked weight. Jacobs
(1998) indicates that an uncooked fish portion is -22% heavier than cooked
fish.
Studies, using similarly structured questionnaires to that in our study, of
Pacific Northwest Native Americans who fish for subsistence have also
documented high rates of fish consumption. Men in the Tulalip and Squaxin
Island Tribes (Toy, 1995) consumed a median of 53 g/day and 66 g/day for the
two tribes respectively, while women consumed a median rate of 34 g/day
and 25 g/day. Among the Umatilla, Nez Perce, Yakama and Warm Springs
Tribes of the Columbia River Basin, median seafood consumption was 40
gram/d among tribal members who eat fish (mean=63g/d), and 32 g/d (mean
=58.7g/d) among all tribal members (n=500). Easy access to marine waters as
well as fresh water may account for the higher consumption rates among the
Tulalip and Squaxin Island Tribes.
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SEAFOOD SOURCES
Our study showed that the majority of seafood is obtained at grocery stores,
street vendors, or from restaurants, with harvesting by self, family or friend
being used less often. While these numbers appear to suggest that the
majority of seafood consumed is from "commercial" sources, locally caught
fish, possibility from contaminated sources, may be sold by vendors trying to
cut costs. Chiang's study suggests that smaller markets and street vendors may
be the source of a large percentage of seafood. She reported that 50% of the
Laotian community used large markets (e.g., Lucky, Costco, Safeway), 57%
small markets, 55% a fisher person/fish truck/farmer's market, and 54%
harvested (self/family/friend).
In our study, harvested seafood comprised less than one quarter of the total
consumption; nevertheless, differences were observed among the ethnic
groups. Members of the Mien community seem to harvest seafood more
often than other ethnic groups. The percentage of time Miens consumed
harvested fish were: 100% for bottom fish, 84% for freshwater fish, 54% for
anadromous fish, 35% for pelagic fish, and 34% for shellfish. However their
total seafood consumption was the lowest of all surveyed ethnic groups.
Cultural traditions may play a role because Miens immigrated from the rural
highland areas of Laos (Gilrnan, 1992) where harvested fish may have not
been readily available and therefore consumption might not be as customary.
In addition, 60% of Mien participants lived below the FPL. Even though the
Mien community does not consume as much seafood as other APIs, they may
have greater risks for seafood contaminant exposure because they harvest
more for subsistence. Chiang's study determined the number of fishermen
(n=95) and their main reason for fishing, of whom 53% fished "for food"
compared with 37% for "recreation", 1% for "traditional" reasons, and 10%
"no answer". Despite the small sample size, these pilot data warrant follow-
up study.
SEAFOOD SPECIES AND TISSUE PARTS CONSUMED
APIs consume a wide variety of seafood species, the most frequently
consumed being shellfish. These seafood, depending on their feeding and
habitat characteristics, and the tissue parts consumed pose varying chemical
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contaminant risks to APIs. For example, certain fat soluble chemicals, e.g.
PCB's are concentrated in the fat layer between the meat and skin, potentially
exposing such consumers to higher contaminant levels than those who
simply eat the fillet. Eating the fillet with skin is clearly a common practice in
the API community. Chiang (1998) determined that of Laotian community
members who had ever fished in San Francisco Bay (n=88), 76% "always" ate
the fillet with skin, 23% "sometimes" ate the skin, and 1% "never" ate the
skin. Among all our study participants 30% "always" ate the fillet with skin,
42% "sometimes", and 28% "never". Overall, skin was consumed with the
fillet 55% of the time. Consumption of fillet with skin appeared to vary with
ethnicity, but interpretation is difficult because of the small numbers. Among
the Hmong (n=5), Vietnamese (n=25), and Mien (n=9), and Laotian (n=20) the
fillet with skin was consumed 100%, 78%, 67%, and 42% of the time,
respectively.
In addition to concern about consuming fillets with skin, information about
contaminant levels in other fish tissues may be insufficient for culturally
appropriate risk assessment (e.g., head, bone, eggs, and/or organs) because risk
assessors have not felt that they are commonly eaten. In this study, these
parts were eaten 20% of the time, (8% said they "always", and 36% reported
they "sometimes" eat head, bone, eggs, and/or organs). Unfortunately our
data cannot determine which of these body parts are eaten more frequently.
Salmon eggs were consumed by 27% of participants, and other types of fish
eggs by 10%. This is similar to Chiang's findings that 'organs' were "always"
consumed by 6% and "sometimes" consumed by 41%. Wong (1997) found
that 98% of 228 mixed race fishermen residing near San Francisco Bay (36%
Asian, 24% Caucasian, 14% Latino, 12% African American, 7% mixed race, 2%
Pacific Islander) consumed 'non-fillet parts' (e.g., skin, eggs, heads, guts) when
perch was eaten. Similar rates were found for striped bass (84%) and white
croaker (77%).
API community members appear to eat shellfish parts that are thought to
contain higher concentrations of chemical contamination, e.g. clam stomachs
or the hepatopancreas of crabs (Faigenblum, 1988; Matter, 1994). Bivalve
shellfish were consumed whole by 24% (geoduck) to 89% (mussels) of the
respondents depending on the species. The "butter" as well as the meat of
API Seafood Consumption Study 54 EPA 910/R-99-003
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crabs were consumed 43% of the time, and though moon snails are not eaten
by most respondents, 38% of the time the entire moonsnail is eaten. Finally,
cooking water, both for finfish and shellfish are commonly used in cooking
or directly consumed.
Cost considerations frequently preclude chemical contaminant analyses for
these tissues. Certainly for the API's, seafood related risk assessment should
include chemical analyses of all consumed tissue parts for the most frequently
consumed species. For instance, crabs were commonly consumed (96% of
API's), and 43% of the time the "butter" of the crab, including the
hepatopancreas was consumed. Selection of seafood species and tissue part
contaminant testing should reflect the cultural consumption habits of specific
"at risk" populations.
FISHERMEN
Fishermen have been reported (Allen 1996, Puffer 1982, Wong 1997) to
consume greater quantities of fish than non-fishermen. These data are
generally derived from creel studies and may have surveyed biased groups,
e.g. the "10% of fishermen who catch 90% of the fish". Our study was not
advertised as a fish consumption study and was expected to have captured a
cross-section of fishermen. So, while this study showed that fishermen
consumed greater quantities of seafood than non-fishermen in all seafood
categories, these differences were not significant. In addition, the "higher"
consumers (individuals who had seafood consumption rates >75th percentile
for finfish or shellfish) were no more likely to be fishermen than those with
lower consumption rates. Decreased opportunity for fishing is an unlikely
reason because King County, Washington's geographic proximity to Puget
Sound and multiple lakes and rivers, which provide easy access to fresh and
salt water fishing and shellfish collection both in urban (assessable by public
transportation) and rural settings. This observation may be explained by
cultural traditions which incorporate seafood into daily diets of most first and
second generation API's.
Seafood Consumption Study 55 EPA 910/R-99-003
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EDUCATIONAL OUTREACH INFORMATION
Many recent API immigrants are refugees from war torn countries and
understandably distrust government officials or those in authority. Some
local efforts to establish communication with APIs have emphasized active
support and involvement of local API community service organization, as
well as information conveyance through API community members and
organizations (Clifford, 1998; Tebaldi, 1999).
Our survey examined the educational preferences and fishing information
sources of APIs. Respondents expressed a preference for written material as a
way of learning. The preferred media were API community
newspapers/newsletters, while bulletin boards were deemed reliable by only
16% of respondents. Audio-visual communication; e.g. television and word
of mouth were also preferred, but videos (35%) and slide shows (4%) were less
favored. Radio broadcasts in API languages were used by a relatively small
percentage (16%), but multiple dialects may be a factor, and for specific groups
may be effective. Wong (1997) successfully used both a seafood cooking
demonstration and pamphlet to educate children and adults about
minimizing exposures to chemically contaminated San Francisco Bay fish.
The API respondents were very concerned about health. They wanted health
information about eating fish, as well as safety information about Puget
Sound seafood. Very few fishermen said they were not concerned about the
safety of fish (6%) or that they never try to find out about fishing safety (3%).
Among fishermen, fishing safety information is mainly obtained by word of
mouth (65%) and posted warning signs (59%). Education beyond high school
appeared to play a positive role in utilization of posted warning signs,
pamphlets, and telephone information services, e.g. Washington State
shellfish information and Red Tide Hotline. Information from API
community centers and API radio broadcast were more frequently deemed
reliable by those with < high school, and may be effective for disseminating
information to specific groups.
API Seafood Consumption Study 56 EPA 910/R-99-003
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CONCLUSIONS
API community members consume greater amounts of seafood, as well as
differing species and tissue parts than the majority of U.S. citizens and
residents. These consumption patterns, while having significant general
health benefits, may pose a health risk if consumed seafood is contaminated
with toxic chemicals. Evaluation of existing seafood toxicity data is warranted
to determine if sufficient data exist for the tissue parts described in this report.
API-specific risk assessments that take into account these higher consumption
rates, species consumed, tissue parts consumed, and the sources of seafood
acquisition need to be completed. API-specific risk assessments will help the
API community determine if a risk exists, what activities increase risk, and
which community members have the highest risk. Such an analysis should
also focus on the benefits of consuming seafood and on culturally acceptable
ways of reducing what risks may exist. Health messages should be designed
and delivered by API community members (including those of the first
generation who may have the highest risks) through partnership
relationships with public health agencies.
The ethnic group specific data generated in this study is useful to identify
information needs, but it is based upon relatively small group numbers. It
should be used with caution for regulatory or risk assessment purposes
without additional verification. Further study of API community seafood
acquisition habits, specific tissue parts consumed, and preparation methods
are important, particularly for members of the Hmong, Laotian, Mien and
Vietnamese communities because our pilot data suggest that they may have
higher health risks if seafood is contaminated with toxic chemicals.
API Seafood Consumption Study 57 EPA 910/R-99-003
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ACKNOWLEDGMENTS
This study would not have been possible without the generosity of the
Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Laotion, Mien,
Samoan, and Vietnamese communities. We especially thank the participants
from these communities for their willingness to provide the authors with the
data needed to understand how Asian and Pacific Islanders acquire, prepare,
and consume seafood. Their contributions to this study has provided
invaluable information for their respective communities, the scientific
community, and the community at large.
The collaboration between the Community Steering Committee (CSC)
and the authors was a groundbreaking experience. Without the CSC
members' time and effort, this study would not have materialized.
Moreover, their knowledge and experience of the communities of focus, as
well as their advice on interviewing strategies and communication tools,
assured a positive outcome for all involved. We are most grateful for their
contributions to this study.
Community Steering Committee
Ms. Bee Chang, Hmpng community
Mr. Chanthone Chin, Program Coordinator, The Coalition of Lao Mutual
Assistance Association of Washington State
Ms. Regina Chae, Korean community
Mr. Paul Egashira, Japanese community
Mr. Ngy Hul, President, Khmer Community of Seattle-King County; Acting
Executive Director, Refugee Federation Service Center
Mr. Nisay Nuth, Program Coordinator, Khmer Community of Seattle King
County
Ms. Luningning Murro, Filipino community
Mr. Edwin Obras, Director of Development Operational Emergency Center
Mr. Stan Shikuma, Japanese community
Ms. Oanh Tran, Case Manager, Refugee Federation Service Center
Mr. Simon Truong, Social Services Director, Refugee Federation Service
Center; President, Indochina Chinese Refugee Association
Mr. Yaochien Sirisisangpha, Case Manager, Refugee Federation Service
Center
Ms. Lynna Song, Seattle-Washington State Korean Association
Mr. Savieng Soukhaphonh, Laotian community
Ms. May Wong, Beacon Hill Driving School
Ms. Benling Wong, Seattle Public Library
We would like to thank the Taiwanese Association of Seattle for its
endeavors to involve people from Taiwan in the study as a part of the
Chinese community. We understand that many in the Taiwanese American
community recognize Taiwan as a separate nation from China, and we
API Seafood Consumption Study 58 EPA910/R-99-003
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respect their position. Our study focused on cultural consumption habits
only and does not reflect a political position.
Additionally, we thank the Fujinkal Association with the Seattle
Betsuin Temple as well as other API community religious organizations for
helping to recruit participants.
We are grateful to the following scientists and community activists for
their participation and technical guidance. We appreciate their expertise as
well as their concern for populations who may be impacted by environmental
contaminants.
Technical Committee
Dr. Kenneth Chew, Director, Administrative Office, Western Region
Aquaculture Center
Mr. Gregory Glass, Environmental Consultant
Dr. Steven Gilbert, Director, Institute for Neurotoxicology
Ms. Leslie Keill, Toxicologist, Washington State Department of Ecology
Dr. Marsha Landolt, Dean and Vice Provost, UW Graduate School
Dr. Roseanne M. Lorenzana, Toxicologist, US EPA, Region 10
Mr. Craig McCormack, Senior Toxicologist, Washington State Department of
Ecology
Mr. Jonathan Sheilds, Water Quality Planner, Dept. of Natural Resources
Dr. Juliet Van Eenwyk, Director, Non-Infectious Conditions Epidemiology,
Washington State Department of Health
Advisory Committee
Dr. Elizabeth Evans, Rainier Center Clinic
Mr. Joseph Johnson, Boeing
Ms. Marcia Lagerloef, Water Quality Standards, US EPA, Region 10
Ms. Roberta Gunn, Executive Director, Puget SoundKeeper Alliance
Dr. Laura Weiss, Washington State Department of Ecology
Dr. John Wekell, Research Chemist, US Dept. of Commerce, NOAA
The interviewers and translators were recruited from the ten
participating communities. They provided the vital link in the success of this
study: obtaining data from the study participants and recording it in a way the
statisticians could accurately measure. Their patience and diligence in
interviewing the participants was remarkable, as was their accurate recording
of data.
API Seafood Consumption Study 59 EPA 910/R-99-003
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Bilingual Interviewers and Translators
Ms. Helen S. Barber, Filipino interviewer
Ms. Regina Chae, Korean interviewer
Mr. Pang Chang, Hmong interviewer
Mr. Jeff Dang, Vietnamese interviewer
Ms. Alison Doungphouchan, Laotian interviewer
Ms. Chenda Eng, Cambodian translator
Ms. Jeanie Li, Chinese interviewer
Ms. Mia Matsubara, Japanese interviewer/translator
Ms. Luningning Murro, Filipino translator
Mr. Chet Ouch, Cambodian interviewer
Mr. Ton Saechao, Mien interviewer/translator
Mr. Robert Tausili, Samoan interviewer/translator
Ms. Jenny Wong, Chinese translator
We thank the University of Washington—National Institute for
Environmental Health Sciences (UW-NIEHS) Center for Ecogenetics and
Environmental Health for providing technical experts and facilities required
to help bring this study and report to completion.
This was truly a multi-cultural, multi-disciplinary community study.
Many individuals from the focus communities, Washington State
governmental agencies, grassroots community groups, as well as the
University of Washington, have contributed to the success of this endeavor.
Following are listed those who have helped us realize this project.
Editor
Ms. Anne B. Harrington, Information Specialist II, UW-NIEHS Center for
Ecogenetics and Environmental Health
Mr. Michael Antee, Washington State Dept. of Health, Office of Shellfish
Programs
Ms. Jude Ballard, Fred Hutchinson Cancer Research Center, Seattle, WA
Ms. Audrey Chiang, Asian Pacific Environmental Network, Oakland, CA
Ms. Angela Chung, US EPA, Washington, D.C.
Mr. Wayne Clifford, Washington State Dept. of Health, Office of Shellfish
Programs
Mr. Floyd Davis, Accountant, Refugee Federation Service Center
Dr. David L. Eaton, Director, UW-NIEHS Center for Ecogenetics and
Environmental Health
Ms. Sharon Elliott, Manager, UW-NIEHS Center for Ecogenetics and
Environmental Health
Mr. Seng Nguon Eng, Social Services Coordinator, Refugee Federation
Service Center
Ms. Joan Hardy, Washington State Dept. of Health, Environmental Health
Assessment Services
API Seafood Consumption Study 60 EPA910/R-99-003
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The Honorable Gary Locke, Washington State Governor
Ms. Virginia McFerran, UW-NIEHS Center for Ecogenetics and
Environmental Health
Mr. Christopher Moffett, Graphic Designer, US EPA, Region 10
Mr. Long Kim Nguyen, President, Vietnamese Association of Greater Seattle
Dr. Raphael A. Ponce, Research Scientist, UW Department of Environmental
Health
Ms. Frances Robinson, UW-NIEHS Center for Ecogenetics and
Environmental Health
Mr. Jim Simmonds, Water Quality Planner II, King County Water and Land
Resources Division
Ms. Yolanda Sinde, Director, Community Coalition for Environmental
Justice
Mr. Chin Tan, Case Manager, Refugee Federation Service Center
The Honorable Kip Tokuda, Washington State Representative
Doc Thompson, Manchester Lab, US EPA, Region 10
Dr. Margaret Tudor, Washington State Department of Fish and Wildlife
Ecosystem Education
The Honorable Velma Veloria, Washington State Representative
Ms. Kristine Wong, Community Coalition for Environmental Justice
Ms. Cissie Van, Administrative Assistant, Indochina Chinese Refugee
Association
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REFERENCES
Allen JM, Velez PV, Diehl DW, McFadden SE, Kelsh M (1996). Demographic variability
in seafood consumption rates among recreational anglers of Santa Monica Bay,
California, in 1991-1992. Fishery Bulletin. 94:597-610
Bloom, NS (1992). On the chemical form of mercury in edible fish and marine invertebrate
tissue. CanJ. FishAquatSci,49, 1010-1017
CRITFC (Columbia River Inter-Tribal Fish Commission). 1994. A Fish Consumption
Survey of the Umatilla, Nez Perce, Yakama, and Warm Springs Tribes of the
Columbia River.Basin CRITFC Technical Report 94-3. Portland, Oregon.
Chiang A, A Seafood Consumption Survey of the Laotian Community of West Contra
Cost County, California. Asian Pacific Environmental Network, March 1998.
Clean Water Act, Section 304 (a). Appendix C - Guidelines and methodology used in the
preparation of health effects assessment chapters of the consent decree water criteria
document, 45 FR 79347, November 28, 1980.
Clifford W. (1998) "Barriers to Reducing High Risk Recreational Shellfish Harvesting",
conference presentation at the 5th Annual Joint Conference on Health, Yakima,
Washington.
Faigenblum J (1988). Chemicals and Bacteriological Organisms in Recreational Shellfish;
Final Report Co-operative Agreement; U.S. EPA, Region X; State of Washington
Department of Health 6B ML87AOOO.
Federal Register: August 14, 1998, Volume 63. Number 157, Page 43755-43828.
Fisher, L.D., van Belle, G. 1993. Biostatistics: A Methodology for Health Sciences. New
York: John Wiley & Sons.
Oilman SC, Justice J, Saepharn K and Charles G. (1992) "Cross-cultural Medicine A
Decade Later" Western Journal of Medicine. Sep; 157-310-315.
Jacobs, et. al, "Estimates of per capita Fish Consumption in the U.S. Based on the
Continuing Survey of food Intake by Individuals (CSFII), Risk Analysis, vol. 18.
no. 3, 1998,283-291.)
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Javitz H. 1980. Seafood consumption data analysis. U.S. EPA Contract 68-01-3887.
Prepared by SRI International for the Office of Water/Regulations and Standards,
Washington, D.C.)
Kendall, M.G., Stuart, A. 1963. The Advanced Theory of Statistics, vol. 1. New York:
Hafner Publishing Co., 236-237.
Landolt, M.L., Hafer, F.R., Nevissi A., van Belle G., van Ness K., and Rockwell, C.
1985. Final Report, "Potential Toxicant Exposure among Consumers of
Recreationally Caught Fish from Urban Embayments of Puget Sound." NOAA
Technical Memorandum No. OMA 33. National Oceanic and Atmospheric
Administration. Rockville, MD.
Landolt, M.L., Hafer, F.R., Nevissi A., van Belle G., van Ness K., and Rockwell, C.
1987. Final Report, "Potential Toxicant Exposure among Consumers of
Recreationally Caught Fish from Urban Embayments of Puget Sound." NOAA
Technical Memorandum No. OMA 33. National Oceanic and Atmospheric
Administration. Rockville, MD.
Leikin JB and Paloucek FP. (1996-1997) Poisoning & Toxicology Handbook. 2nd Edition,
Lexi-Comp, Hudson, Ohio.
Matter, AL. (1994). Paralytic Shellfish Poisoning: Toxin Accumulation in the Marine
Food Web, With Emphasis on Predatory Snails: U.S. EPA, Region X; U.S. EPA
910/R94-005.
McCallum, M. 1985. "Seafood Catch and Consumption in Urban Bays of Puget Sound."
Washington State Division of Health, Epidemiology Section.
Nakano C & Lorenzana R (1996) Asian and Pacific Islander Seafood Consumption Study:
Exposure Information Obtained through a Community-Center Approach., U.S.
EPA 910/R-96-007, August 1996).
OSWER directive 9285.6-03.
Pierce, D., Noviello D., and Rogers, S. (Dec. 1981) "Commencement Bay Seafood
Consumption Study." Tacoma-Pierce County Health Department. Seattle, WA.
Puffer HW, Azen SP, Duda MJ Young DR (1982) Consumption Rates of Potentially
Hazardous Marine Fish Caught in the Metropolitan Los Angeles Area. University
of Southern California School of Medicine. Departments of Pathology and
Preventive Medicine. Los Angeles, CA: Report No. U.S. EPA-600/3-82-070. June
1982.
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State of Washington Population Trends, October, 1998. Office of Financial Management,
State of Washington.
Tebaldi J, Memo to Juliet Van Eenwyk, Acting State Epidemiologist regarding API
Seafood Consumption Survey Study Review, May 19, 1999.
Toy K, Gawne-Mittelstaedt G, Polissar N and Liao S. 1996. A Fish consumption survey
of the Tulalip and Squaxin Island tribes of the Puget Sound region. Tulalip Tribes,
National Resources Department, Marysville, Washington
United States Census Bureau, "King County, Washington" (1990).
United States Department of Agriculture, Continuing Survey of Food Intakes by
Individuals, Data Set and Documentation (Agriculture Research Service, Beltsville
Human Nutrition Research Center, Beltsville, Maryland 20705, 1990).
U.S. EPA, Supplemental Guidance for Superfund Risk Assessment in Region 10, 1991.
U.S. EPA, Exposure Factors Handbook, U.S. EPA/600/P-95/002Fb, August 1997.
Washington Department of Ecology, Analysis and selection offish consumption rates for
Washington State risk assessments and risk-based standards, external review draft,
March 1999.
Wong K, Fishing for Food in San Francisco Bay: Part II. Save San Francisco Bay
Association, 1997).
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64
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Appendix A
65
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APPENDIX A
Questionnaire Number I I I I
ON
ASIAN PACIFIC AMERICAN SEAFOOD CONSUMPTION STUDY
DATE CALLED
1) 1 1 1 1
mo day yr
INTERVIEW APPT. TIME
1 ) : PI i am 1 1 2 pm
RESULT CODES
1 ) completed interview 1 li
2) 1 1 1 1
mo day yr
2) : l~| iam [~| 2pm
2) missed appointment;
reschedule db
3) 1 1 1 1
mo day yr
3) : fljam l~l 2pm
3) other Da
INTERVIEW LOCATION Q Respondent's house
EL Other
Q? RFSC Da Eatery
RESPONDENT'S INITIAL
INTERVIEWER'S CODE I I I I
-------
APPENDIX A
a.
\N1RODUCI\ON
Hello. My name is_
and I am (ethnicity). We are conducting a study to understand the seafood
eating patterns of (ethnicity) in the King County area. The information given in response to this questionnaire will
help the Asian Pacific American community to understand the rates of seafood consumption, ways in which
meals are cooked and prepared, and the types of seafood regularly consumed. A!l information provided in this
interview is voluntary and confidential. Your answers will be combined with those of others so that no person's
answers can be identified.
DATE OF INTERVIEW I I I I TIME INTERVIEW BEGINS : Qam CJ2 pm
I am going to ask you some questions which will determine whether you are in the group we wish to study.
a) Do you live in King County? Yes Q No Ck (IF NO, TERMINATE INTERVIEW)
b) Do you eat seafood at all? Yes Q NoD* (IF NO. TERMINATE INTERVIEW)
c) Which of the following ethnic groups best describe you. Check one only.
Filipino Qi Japanese D? Korean Q Chinese D<
Lao di Mien D? Hmong Da Samoan D?
Vietnamese DS
Cambodian dl
d) Were you born in the United States?
Yes
NoD
(If no, how many years have you been in the United States?) 0-5 D i 6-10
e) Is at least one of your parents born in the United States?
f) Were both of your parents born in the United States?
(TERMINATE INTERVIEW IF BOTH "D", "F" ARE YES)
11-20 Da 21+D4
Yes
YesD.
NoD?
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APPENDIX A
ON
oo
g) Are you at least eighteen years old? Yes Di No D? (IF NO, TERMINATE INTERVIEW)
I. I am going to ask you what types of seafood you eat, the amount you eat, and how often you eat each one.
The amount of seafood you eat and how often you eat it may depend on the time of year. For example, if there
are seasonal differences in how often you eat seafood. Please answer 2 different ways: when it is fresh and
readily available and when it has been frozen, dried, canned, stored, etc. Please answer these questions in a
way that's most familiar to you. Remember to include breakfast, lunch, dinner, and snacks. Do not include
seafood you eat at special celebrations (holiday celebrations, Chinese New Year, Japanese New Year,
weddings, community or cultural events, etc.) They will be asked later.
—FILL OUT CONSUMPTION FORM—SHOW PORTION MODEL, PICTURE CARD-
GROUP A
A1. How often do you eat the following...
NUMBER OF...PER YEAR
PORTION SIZE CODE
NUMBER OF PORTIONS EATEN
TYPE OF FISH
Model-#'-f;S
rest of the year
SALMON EGGS
rest of the year
in season
rest of the year
rest of the year
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APPENDIX A
A2. For the following categories, please tell me approximately what percentage of the fish in Group A you get
from: —READ ALL CATEGORIES— Answers must total 100%.
1) Grocery stores/street vendors %
2) Fish caught from Puget Sound by yourself, family members or friends %
3) Fish caught from outside of Puget Sound by yourself, family members or friends %
4) Restaurants %
—SHOW PORTION MODEL. PICTURE CARD—
GROUP B
B1. How often do you eat the following...
ON
TYPE OF FISH
in season
rest of the year
DOGFISH
in season
rest of the year
SNAPPER
in season
rest of the year
in season
rest of the year
in season
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
PORTION SIZE CODE
m&%&w-;
rest of the year
-------
APPENDIX A
{continualion 61)
TYPE OF FISH
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
PORTION SIZE CODE
Weiaht Un t
rest or the year
ROCKFISH
in season
rest of the year
in season
rest of the year
B2. For the following categories, please tell me approximately what percentage of the fish in Group B you get
from: —READ ALL CATEGORIES—Answers must total 100%.
1) Grocery stores/street vendors %
2) Fish caught from Puget Sound by yourself, family members or friends: ^
3) Fish caught from outside of Puget Sound by yourself, family members or friends 7<.
4) Restaurants 5?
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APPENDIX A
—SHOW PORTION MODEL, PICTURE CARD-
GROUP C
C1. How often do you eat the following...
TYPE OF FISH
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
PORTION SIZE CODE
I MONTHS
MONTH YEAR
rest or the year
CRAPPIE
rest of the year
CARP
rest of the year
PERCH
rest of the year
rest of the year
BASS
in season
rest of the year
C2. For the following categories, please tell me approximately what percentage of the fish in Group C do you
get from: —READ ALL CATEGORIES—Answers must total 100%. I j
1) Grocery stores/street vendors %
2) Fish caught from Puget Sound by yourself, family members or friends %
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APPENDIX A
3) Fish caught from outside of Puget Sound by yourself, family members or friends
4) Restaurants
—SHOW PORTION MODEL, PICTURE CARD—
Group D
Dl. How often do you eat the following...
rest of the year
SOLE/FLOUNDER
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
PORTION SIZE CODE
WEEKS
MONTHS
D2. For the following categories, please tell me approximately what percentage of the fish in Group D you get
from: - - -READ ALL CATEGORIES - - -Answers must total 100%.
1) Grocery stores/street vendors %
2) Fish caught from Puget Sound by yourself, family members or friends % j
3) Fish caught from outside of Puget Sound by yourself, family members or friends <%
4) Restaurants %
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APPENDIX A
D3. I'm going to ask you about what parts of the fish in Group A-D you eat. Please tell me what percentage of
the time you eat the following categories when you eat fish in Group A-D. —READ ALL CATEGORIES FIRST—Please
answer 0-100%. Answers 1 & 2 must total 100%.
1) Fillet with skin:
2) Fillet without skin:
3) Head, bones, eggs, organs:
_%(l&2total 100%)
% (0-100%)
D4. I'm going to ask you how the fish you eat in Group A-D is prepared. For the following 2 categories please tell
me what percentage of the time you eat fish in Group A-D prepared this way. —READ ALL METHODS FOR EACH
CATEGORY FIRST—Answers must total 100%.
1) Baked, boiled, broiled, roasted, poached, or steamed:
2) Canned, fried, raw, smoked, or dried:
_%(! & 2 must total 100%)
D5. If you boil, steam, poach any of the fish in Group A-D. what do you do with the water it is prepared in?
1) Throw it out % 2) Use it in cooking % 3) Drink it %
—SHOW PORTION MODEL. PICTURE .CARD-
GROUP E
E1. How often do you eat the following...
TYPE OF SHELLFISH
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
PORTION SIZE CODE
WEEK
MONTH
YEAR
WEEKS
MONTHS
: Weight Unit
CLAMS
(manila/littleneck)
wm^-^'s-
in season
rest of the year
-------
(continuation of E
APPENDIX A
TYPE OF FISH
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
PORTION SIZE CODE
Model # Weight Unit
HORSE CLAMS
rest of. the year
S^R: .v'-w'yfSn-
RAZOR CLAMS
rest of the year
BUTTER CLAMS
in season
rest of the year
GEODUCK CLAMS
rest of the year
MACOMA CLAMS
rest of the year
COCKLES
in season
rest of the year
in season
rest of the year
rest of the year
-------
(continuation of El)
APPENDIX
1YPE OF SHELLFISH
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
PORTION SIZE CODE
WEEK
MONTH
YEAR
WEEKS
MONTH
Model #
Weight Unit
ABALONE
^ttt^-.-.f.
'Z--*ftss?>tfx&f<&.\\
in season
rest of the year
SCALLOPS
in season
rest of the year
—SHOW PORTION MODEL, PICTURE CARD—
E2. How often do you eat the following
PORTION SIZE CODE
NUMBER OF...PER YEAR
NUMBER OF PORTIONS EATEN PER
TYPE OF SHELLFISH
rest of the year
n season
rest of the year
SEA URCHIN
n season
rest of the year
-------
APPENDIX A
ON
(continuation of E2)
FYPE OF SHELLFISH
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
PORTION SIZE CODE
Weiaht Unit
SEA CUCUMBER
in season
rest of the year
MOONSNAIL
in season
rest of the year
in season
rest of the year
—SHOW PORTION MODEL and PICTURE CARD-
E4. I'm going to ask you about which parts of the following you eat. Percentages for each species must total
100%.
SPECIES
CLAM
(manila/littleneck)
HORSE CLAMS
BUTTER CLAMS
RAZOR CLAMS
WHOLE
WHOLE
W/STOMACH
REMOVED
WHOLE
W/SIPHON TIP
REMOVED
WHOLE
W/SIPHON TIP
AND STOMACH
REMOVED
TOTAL 100%
TOTAL 100%
TOTAL lOCj^
TOTAL '100%
TOTAL 100%
11
-------
(continuation of E4)
APPENDIX A
SPECIES
GEODUCK CLAMS
MACOMA CLAMS
COCKLES
OYSTERS
MUSSELS
ABALONE
SCALLOPS
WHOLE
WHOLE
W/STOMACH
REMOVED
WHOLE
W/SIPHON TIP
REMOVED
WHOLE
W/SIPHON TIP
AND STOMACH
REMOVED
TOTAL 100%
TOTAL 100%
TOTAL 100%
TOTAL 100%
TOTAL 100%
TOTAL 100%
TOTAL 100%
TOTAL 100%
SHRIMP
CRAB
SQUID
SEA URCHIN
SEA CUCUMBER
MOONSNAIL
LOBSTER
WHOLE BODY (body and head)
WHOLE BODY (crab meat and
butter)
WHOLE SQUID
%
WHOLE BODY
To
WHOLE BODY
To
WHOLE BODY
To
WHOLE BODY {body and head)
BODY ONLY
MEAT ONLY
MEAT ONLY
(hirwlv nnd t^ntoolp^l
EGGS ONLY
/o
MUSCLE ONLY
MUSCLE ONLY
/o
BODY ONLY
HEAD ONLY
CRAB BUTTER
ONLY
^iSfeife-:
- . - ..-,(} -4 ;»-,V.> i:-..--. -•
'
:,;!.• - « :.",.. "v.''<»- . • il .
.. .:-.lslifA?-»'>]f' -'i*---^ - • 'i •>
, •: . -
-------
APPENDIX A
E5. I'm going to ask you how the shellfish you eat in Group E is prepared. For the following 2 categories please
tell me what percentage of the time you eat shellfish in Group E prepared this way. —READ ALL METHODS FOR
EACH CATEGORY FIRST —Answers must total 100%.
I) Baked, boiled, roasted, poached or steamed %
2) Canned, fried, raw, smoked, or dried %
E6. If you boil or steam any of the shellfish in Group E. what do you do with the water it is prepared in?
1) Throw it out % 2) Use it in cooking % 3) Drink it %
E7. For the following categories, please tell me approximately what percentage of the shellfish in Group E do you
get from: —READ ALL CATEGORIES— Answers must total 100%.
1) Grocery stores/street vendors
o^ 2) Shellfish caught from Puget Sound by yourself, family members, or friends
3) Shellfish caught from outside of Puget Sound by yourself, family members, or friends
4) Restaurants
—SHOW PORTION MODEL and PICTURE CARD-
GROUP F
Ft. How often do you eat the following:
07
TYPE OF SEAFOOD
NUMBER OF PORTIONS EATEN PER
NUMBER OF.. .PER YEAR
PORTION SIZE CODE
WEEK
MONTH
YEAR
WEEKS
SEAWEED
in season
MONTHS
rest of the year
KELP
in season
rest of the year
13
-------
APPENDIX A
F2. For the following categories, please tell me approximately what percentage of the seafood in Group F you
get from: —READ ALL CATEGORIES—Answer must total 100%.
1) Grocery stores/street vendors %
2) Seafood caught from Puget Sound by yourself, family members, or friends %
3) Seafood caught from outside of Puget Sound by yourself, family members, or friends %
4) Restaurant %
Are there other seafoods which you eat that were not mentioned earlier? Qi Yes
G 1 . How often do you eat. . .
No (If no, go to H
TYPE OF
SEAFOOD
^^^^^t^_
NUMBER OF PORTIONS EATEN PER
WEEK
MONTH
YEAR
NUMBER OF.. .PER YEAR
•WEEKS
MONTHS
PORTION MODEL CODE
fWBSRHtfit1^^
—SOCIAL EVENTS-
HI. The following questions will ask about your eating patterns at social events. In the last 12 months, how often
did you attend special celebrations (holiday celebrations, Chinese New Year, Japanese New Year, cultural or
community events, weddings, etc.): times in last 12 months (If 0, go to no. I 1)
H2. At what percentage of these events do you eat seafood? Please answer from 0-100%. %t
answer Is 0, go to I 1)
14
-------
APPENDIX A
—SHOW PORTION MODEL and PICTURE CARD-
MS. At these events, how much seafood do you usually eat each time? oz.
H4. How often do you eat the following seafoods at these events? You may answer from 0-100%.
SHELLFISH (crab, clam, shrimp...) % SEAWEED/KELP % FISH
11. Please indicate your age . If you choose not to, please select your age category.
18-29D1 30-54 D2 55+D3
12. Indicate your weight: pounds OR kilogram.
o 13. Indicate your height: feet inches
14. What is your household income per year?
D10-10,000 D 210,001-15,000 D 315,001-20,000 D < 20.001-25,000
D 5 25,001-35,000 D 6 35,001-45,000 0/45,001 +
15. How many people are supported by this total income?
16. Indicate the level of formal education. (~li completed high school CL did not complete high school
completed college Ch did not complete college Ds other
15
-------
APPENDIX A
17. We want to thank you for your answers to these questions because they will give us valuable scientific
information about seafood consumption in the Asian Pacific American communities. We also want to make this
information available in a useful form to Asian Pacific American community members and families through
educational materials.
To understand community needs and concerns we would like to ask your opinion on several topics.
What are the sources that give you the best/most reliable information about what is going on in the Asian Pacific
American community? —CHECK ALL THAT APPLY—
community newspaper/newsletters
community centers
bulletin boards
radio broadcasts in English
radio broadcasts in your own language
television
temple/mosque/church
word of mouth_
of her, please specify.
The following are ways people learn about things. Please select the two that you prefer. If there are others that
you prefer which are not on the list, please tell us what they are.
Read in books or pamphlets
listen to someone in person
listen to a tape recording
learn it on computer
see it on video
see it in a slide show
read in comic book
other
16
-------
APPENDIX A
What kinds of information would you like to have about fish and other seafood? If there are other items that are
not on the list, please tell us what they are. —CHECK ALL THAT APPLY—
Health information about eating fish
information on safe preparation of fish
safety of eating fish and other seafood from Puget Sound
types and amount of fish eaten by members of the Asian Pacific American community
safety of fishing from specific locations in Puget Sound
others
The following are sources for people who fish to find out about the safety of fishing in a particular site. If you fish,
which of the following are most useful to you? —CHECK ALL THAT APPLY. INDICATE "NOT APPLICABLE" FOR THOSE
WHO DO NOT FISH—
not applicable
°° word of mouth (friends, acquaintances)
posted warning signs on docks and other fishing places,
pamphlets
Washington State Dept. Shellfish Information
Red tide hot line
County Health Department
not concerned about the safety of fish
never try to find out
other, please specify
17
-------
APPENDIX A
CONCLUSION
Thank you for your cooperation in participating in this study. Your participation will contribute important
information needed to help protect your natural resources and provide guidance for public health programs for
your community.
NOTE TIME INTERVIEW ENDS: : Pi AM Da PM
—INTERVIEWER REMARKS—
Jl. Respondent's cooperation was: Di Very good [IkGood Da Fair D« Poor
J2. The quality of respondent's answers were: Qi High quality {_}* Generally reliable
Os Questionable O< Unreliable
00
J3. What was the main reason for the questionable or unreliable quality of the
interview? ;
J4. Respondent's Gender Female Qi Male D*
J5. Further
comments:.
-------
Appendix B
84
-------
00
•o
•o
re
D
0.
-------
Models and Model Weight used in the Computation of the API Survey
^^B^T«T^TH i-T^*i
Group A
Group B
Group C
Group D
Group E1
Group E2
Group F
ateoorv Seafood Species
Salmon
Salmon Eggs
Trout
Smelts
Cod
Dogfish
Snapper
Snowfish
Mackeral
Tuna
Rockfish
Herring
Catfish
Crappie
Carp
Perch
Tilapia
Bass
Halibut
Sole/Flounder
Sturgeon
Suckers
Clams (manila/macoma)
Clams (horse/razor/geo'
Clams (butter)
Cockles
Oysters
Mussels
Abalone/Scallop
Shrimp/Lobster
Crab
Squid
Sea Urchin
Sea Cucumber
Moonsnail
Seaweed (dried)
Seaweed/kelp (fresh)
Model Code
B
E .V.
B
D
C
D
A
A
B
C
A
D
B
A
B
A
A
A
C
C
B
B
J
L
K
M
N
6
1
F
P
R
E
S
T
G
H
Weiqht used
: 14.502*28.35*0.562=231.02 g
0^02*28.35=14/18 g"
14.502*28.35*0.562=231 .02 g
..• .-- --. • _ -•-**,
2.5oz*28.35*.876-62.09 g
255.15 g
2.5oz*28.35*.876=62.09 g
16.5oz*28.35*.49=229.21 g
16.5oz'28.35*.49=229.21 g
14. 5oz*28.35*0. 562=231 .02 g
255.15 g
16.5oz*28.35*.49=229.21 g
2.5oz*28.35*.876=62.09 g
1 4. 502*28^35*0^562=231 .02 g ./
16.502*28.35*.49=229.21 g^ -
1 4.502*28.35*0.562=231 .02 \ g
16.502*28.35*.49=229.21 g
1 6.502*28.35*.49=229.21 g-
1 6.5ozt283&.49=229.21 f £
255.15 g
255.15 g
14. 5oz*28. 35*0.562=231. 02 g
14. 5oz*28.35*0. 562=231 .02 g
28.35Tg "
' 92 g
56.70 g
^55 g\
"237 g
56.70,g'
25.52' g
127.58 g
334.07 g
226.8 g
14.18 g
99.23 g
40 g
8^51 g
56.7V
One Portion = Note 1
1 fish
1 container
1 fish
1 fish
3 fillets
1 fish
1 fish
1 fish
1 fish
3 fillets
1 fish
1 fish
1 fish
1 fish
1 fish
1 fish
1 fish:
1 fish-' :
3 fillets
3 fillets
1 fish
1 fish
6 clams
1 clam
6 clams-
3 'clams -^
3 oysters
4 mussels
1 container
3 shrimps
one crab (analyzed) Butter+Meat only
3 pieces
1 container
1 cucumber
1 shell
1 package
1 container
-------
Appendix B-3-a
Calculation of edible meat percentage for Models A, B, D, and P.
To determine accurate weight of serving sizes for Models A, B, D and P (crab), the
models were used to purchase nine or ten additional fishes or five crab of approximately
the same size for each of the four model species and the crab model. Two purchases of
fish or crab each were made two weeks apart to increase the likelihood that the fish or
crab were not from the same catch. The intention was to characterize potential variability
in size of fish or crab. The uncooked fishes were cleaned by five volunteers from the API
community using typical methods. Both the volunteers and the CSC said that sometimes,
but not always the head, gut, brain and eyeballs were eaten. Therefore, weights for these
tissues as dissected by the volunteers were also obtained. A variety of volunteers were
used with the intention to characterize potential variation in cleaning methods. The crabs
were cooked and edible portions removed from the shells by two API volunteers. Crab
meat and crab "butter" were separated from individual crab by the volunteers in the
manner in which they would be eaten. Cleaned fish, fish parts, crab meat and crab butter
were weighed by a trained person using an electronic balance. Tables B-3-a-d show the
data from which the percentage of edible meat were determined for each model.
B-3-a. (Model A)
Model A ( lilapia
Fish
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
Mean
sb H
95% Cl
Whole
(entire)
447.48
584.20
459.14
431.16
516.92
674.20
694.30
659.90
437.33
657.90
555.95
109.38
67.79
Body Meat
(without gut, (skin-t-desh)
fins, tail, head)
329.51 251.39
420.14 274.66
315.94 239.89
308.57 236.98
368.92 208.99
498.01 323.85
497.84 317.29
433.21 322.81
271.34 203.19
414.48 267.38
385.80 266.58
79.44 45.62
49.23 28.28
••••
Head
without gills)
59.93
83.52
83.80
56.40
94.20
77.59
58.87
94.57
92.39
133.78
83.47
- 23.08
14.31
••••
Gut
15.43
45.42
42.72
22.81
39.65
48.36
72.75
72.25
32.95
36.99
I 42.93
| 18.53
11.49
^^••1
Eyes& Brain
5.96
4.28
6.64
5.71
6.45
6.58
5.40
5.84
5.34
7.54
: 5.97
0.89
i 0.55
87
-------
B-3-b. (Model B)
Model B (Trout)
Appendix B-3-b/B-3-c
Fish Whole Body Meat Head ; Gut Eyes & Brain
#1
#2
#3
#4
#5
#6
#7
#8
#9
Mean
SD
95% Cl
(entire)
572.26
515.32
595.20
553.65
694.60
510.64
537.45
598.13
572.16
59.47
43.21
(without gut, ^skin+flesh)
fins, tail, head)
328.03
276.03
311.90
378.79 297.95
412.07 337.61
467.76 357.13
332.62 280.17
345.65, 297.94
404.37i 343.71
388.54 1 314.50
42.14 27.08
33.72 17.69
(without gills)
83.70
105.22
105.21
98.34
118.20
69.09
67.19
71.48
76.47
88.66
17.66
11.54
65.89
49.70
54.33
44.44
63.87
110.01
63.71
69.63
77.73
66.59
18.14
11.85
6.60
4.38
6.11
6.55
8.91
9.12
6.79
7.69
6.79
6.99
1.36
0.89
B-3-c. (Model D)
Model D (Herring)
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
Mean
SD
95% Cl
(entire)
231.15
246.55
227.60
149.67
229.12
252.33
211.18
230.32
243.52
256.46
227.79
29.20
17.99
(with head; i
without gut & '
Kills
205.02
219.10
201.69
129.37
203.80
214.51
183.97
200.88
213.04
225.73
199.71
25.88
16.04
-------
Appendix B-3-d
B-3-d. (Model P)
Model P (Crab) Whole Body Cooked Weights 1
crab
#1
#2
#3
#4
#5
Average
SD
95% Cl
Upper 95% Cl
Lower 95% Cl
Pre-cooked
(grains)
758.30
643.50
626.20
823.90
699.60
710.30
81.94
71.82
782.12
638.48
Cooked
(grams)
649.00
586.82
594.84
738.80
605.70
635.03
62.78
55.02
690.06
580.01
Butter
;§rams)
118.42
111.56
97.56
122.52
124.64
114.96
10.88
9.54
124.50
105.42
Meat
(grams)
254.54
208.27
193.91
227.28
211.54
219.11
23.09
20.24
239.34
198.87
89
-------
Appendix C
90
-------
SPECIES MANUAL
GROUPA
APPENDIX C
SALMON
SALMON EGGS
TROUT
SMELT
-------
SPECIES MANUAL
GROUP B
APPENDIX C
COD
DOGFISH
SNAPPER
MACKERAL
92
-------
SPECIES MANUAL
GROUP C
APPENDIX C
CATFISH
CRAPPIE
CARP
93
-------
SPECIES MANUAL
GROUP D
APPENDIX C
HALIBUT
SOLE
STURGEON
SUCKERS
94
-------
SPtCliib MANUAL
GROUP E
MANILA LITTLENECK CLAM
RAZOR CLAM
HORSE CLAM
MACOMA CLAM
BUTTER CLAM
GEODUCK CLAM
95
-------
Group F
APPENDIX C
SEAWEED N/4
KELP N/A
96
NEKEOCYSTIS
-------
Appendix D
97
-------
APPENDIX D
Interviewer's Telephone Script
Hello, my name is
afternoon OR evening?
How are you this morning OR
I'm with the
community, and I am working with the Asian Pacific
American Dietary Habit Study. Do you remember sending a post card saying you are
interested in learning more about the study?
As you know, this study will help make health recommendations that are specifically for
Asian Pacific American communities, especially for families and children. A!!
information provided in this interview is voluntary and confidential. Your answers will be
combined with those of others so that no person's answers can be identified.
One of the challenges we have in this study is that we cannot interview everyone in the
community, so we have to rely on a smaller group to represent the larger group. To
ensure that we represent the larger group we need to ask you the following five short
questions.
1. Do you live in King County?
2. Do you eat seafood?
3. What is your age?
4. What generation are you?
If yes: go to #2.
If no: I'm sorry, our study is targeting residents
living within King County only. Thank you for your
interest.
If yes: go to #3.
If no: I'm sorry, a very important part of our survey
addresses seafood consumption and we are
targeting people who consume at least a little
seafood. Thank you for your interest.
If yes: go to #4.
If no: a. I'm sorry, this study is only interviewing
those older than 18 years and older
b. I'm sorry, we have enough respondents for that
age group.
If yes: go to #5.
If no: I'm sorry- this study is targeting only 1" and
2nd generation Asian Pacific American groups.
Thank you for your interest.
5. Could you verify your ethnicity? If yes: see page 2
If no: I'm sorry, this study is targeting the following
groups: Cambodian. Chinese. Korean. Filipino.
Japanese, Samoan. Vietnamese, or Lao (Mien,
Hmong).
98
-------
APPENDIX D
If accepted:
Thank you for your patience and cooperation. You are eligible to participate trrthe
Asian Pacific American Dietary Study. The next step is a 45 minute face to face
interview with me at a location convenient to both of us (your home, your office, e~tc.)
where I will read you a number of questions and record your answers. You will be
reimbursed with $25.00 check or grocery certificate equivalent to $25.00 for a full
interview. Again, all information provided in this interview will be kept confidential and
voluntary. Your answers will be combined with those of others so that no person's
answers can be identified.
When would you like to arrange an interview appointment? And where would you like
to be interviewed?
99
-------
Appendix E
100
-------
APPENDIX E
nucono or CONTACTS
SUUJEC7 10 I:
L\\f£
.
-I
D
_t
.
i
DAY or
V/EEK
TIME
.
TYPE Ol: CONTACT (/)
I'EnsOtiAI.
lEltl'ilOMC
MESUI.T Ol:
CONTACT
Ct/ifi)/ CCK/O;
•
.. . _...... _. . — _ — ,-T,._-_ ^ .-_.
COMMENTS
'IKTERVIEV/EII
ID NUM5UII 1
i
i
i
i
1
•
-• — — • • • —••"•> — —•
RESULT COOES
01 -lMiurvi<™comnioiu O-l-U.iav.UU.lilu 0» - llos|iofulom Movu.l IU - Ca« l»cli. no apfiolninuml nindo
0? • Holujal 05 - Larvouso" I'lohlorn W - OHw 1 > - No answoi. r»o polnlmont M;ulo Vf - l.kra D«sy (mlaplrana)
•FINAL OUTCOME CODE (EntoiodbySupoivitQi): l_|_l
OutcomoCwlov 01 - C«nplolo 03 - Oocrtasecl 05 - LiuWwflo OS -Too II OT - l'«i,ich«l
U C ^ '• o-» - l\olu!i.l O-l - Uiinvaaahl- riolihin, O/ - MOVMCI h«n A,.,;, yri - Oil.o,
_Tr---..-r--v~ — ------- ^ =— ; •" ' " '
-------
Appendix F
102
-------
UNIVERSITY OF WASHINGTON APPENDIX F
Name of Religious Organization
Address
City, State Zip Code
Dear
Several weeks ago, we contacted your organization to help us identify individuals within your
community. We would like to take this opportunity to re-contact you to explain how the Asian
Pacific American Dietary Habit Study may meet your organization and community's needs. We
feel that we may have misrepresented the study's mission and goals.
The Asian Pacific American Dietary Habit Study is a community owned study. Currently, there is
no existing study of this nature: this is the first. The Asian Pacific American community has been
a strong stakeholder and voice in the planning, development, and design phases of the study. We
wish to continue this approach. By assisting us in the study, you will be a strong voice for the
your community in providing positive change in the government regulations as well as developing
culturally appropriate educational curriculum.
Since our last discussion, we have gained tremendous cooperation from the religious
organizations within your community. Roughly 30 Asian Pacific American organizations have
either shared their membership directory with us or distributed letters on our behalf using the
directory. We are approaching your organization again to reconsider sharing your directory or
distributing the letters among your members. We do not want your community to be
underrepresented so we urge you to participate and be included in the study.
We are willing to make visitations and/or attend board meetings to discuss how we may be able to
work together.
Regardless of your decline, we plan to share the data results with you for the benefit of your
family, children, and community's health.
We would truly appreciate it if your organization would reconsider your decision.
Sincerely,
Connie Nakano Ruth Sechena, MPH, MD
Study Coordinator Director, Environmental Risk Information Service
Refugee Federation Service Center University of Washington
103
-------
GARY LOCKE ^^S^ APPENDIX F
Governor ^^"""'^
STATE OF WASHINGTON
OFFICE OF THE GOVERNOR —
P.O. Sox 40002 • Olympia, Washington 98504-0002 • (360) 753-6780 • TTY/TDD (360) 753-6466
June 13,1997
Dear Asian Pacific Americans of King County,
I am writing to encourage your participation in the Asian Pacific American Dietary Study, a
study being conducted by the University of Washington and the Refugee Federation Service
Center, and funded by the U.S. Environment Protection Agency.
Health guidelines in this country are based on dietary studies. Most of the dietary studies,
however, are based on the general population and may not reflect certain regional and cultural
factors. This study will provide scientific documentation through person-to-person interviews of
the eating preferences of 10 Asian and Pacific American ethnic groups (Cambodian, Chinese,
Filipino, Hmong, Japanese, Korean, Lao, Mien, Samoan, Vietnamese) in King County.
The information gathered in this study will help individuals in these ethnic groups better evaluate
their health risks. It will also be used to develop culturally appropriate educational materials
regarding dietary practices, and to establish a model for future studies throughout the United
States.
Your participation in this study will help assure that you, your family and your community are
properly represented in this pioneer study.
Sincerely,
GaryZ-ocke
Governor
104
-------
Refugee Federation Service Center
7101 Martin Luther King Jr. Way 5., Seattle, WA 98118 / 206-725-9181 Fax 206-725-9175
1215 S. Central Ave.. Suite 210. Kent. WA 98032 / 206-852-5150 Fax 206-852-1136
1002516th Ave. SW. Seattle, WA 98146 / 206-762-4894 Fax 206-762-4034—
APPENDIX F
Agreement of Consent
We, the Refugee Federation Service Center, affirm that we will use the agency's
mailing and roster lists solely for the research purposes of the Asian Pacific American
Dietary Habit Study. These purposes include identifying and selecting individuals to
invite to participate in this voluntary study. We will protect the names and addresses
on the lists from unauthorized usage. We will destroy the lists after the study is
conducted.
Connie Nakano, Study Coordinator Simon Truong, Social Service Director
Date Date
105
-------
Appendix G
106
-------
APPENDIX G
UNIVERSITY OF WASHINGTON
We need your help! The University of Washington is studying the Asian Pacific American Dietary
Habit Study. You have been chosen to take part in the study. 200 Asian Pacific American
community members will be interviewed to obtain valuable information about what you eat.
Please sign up for an interview by calling one of the following interviewers (see below) any time
of the day or night. Interviews will be held at your most convenient time and location.
• Cambodian @
• Chinese (3).
Hmong ' @
Filipino @
Korean @
Japanese @
Lao @
Mien @
Samoan @
Vietnamese (cb.
Your answers and identity will be kept confidential. In addition, you will receive $25 after the
questionnaire is completed. An interviewer will be contacting you within 5-7 days to confirm
your participation in the study.
Your answers are extremely important to your family's health arid your community! Your help is
greatly appreciated.
Sincerely,
Connie Nakano Ruth Sechena
Study Coordinator Director, Environmental Risk Information Service
Refugee Federation Service Center University of Washington
107
-------
JAPANESE
= ^ - r -f - 'c 13 '" T 2 5 K
* A £
O 7 r - -L^ I? A O ± , is is L T 7 $ ^ .
Ji , c V *-7.?j - t % 7- - 7' T- I* tt '^ T 7
^T^rBST-t. « S ± » ^ « « ^ II X *i
-------
HMONG
APPENDIX G
Pub ib zejlsoom numb zog Iliiab ua lau $25 los yam yooj yini.
i'suas yog iminb Itb ran tliinb xn rov qnb xwb! Lossis intiiih ib (him
itawv uas mu|aj koj njie, clmw nyob lo nrng. Nqi xa twb them uantej
a win, koin yoojyim rnti koj.
Zliaw Nyob
Nroog, Xeev, Zip code
Xoviooj
llaiv Necg
I Inub nyoog
'Hiov khij voojvoog: Txivncej Pojiiiam
SAMOAN
PESCMSCMNI i ou TAGATA ma M/\U/\ oi ma le FILEMU se
Na ona faalumu lava ma toe mcli vave mail Po'o le faapipi'i iai ma lot.
pepa faailoga i lau galuega. Ua mae'a ona lotogi atu le toe meli mat.
Svinfn
Tualusi
Nuu, Selctc. Numcra Ogamui_
Nuinci a Tclclbni
Tnnc
Fa fine
MIEN
VIETNAMESE
TICNGX uicih nyei l.AANC7^ 7AANCC micnh
canx IIUNC-IIKC niETV S25.00 nyanuli
Fluh zlnngx nilngli, aTnt zorqv mclli nycllmUiirss curd nactv
jlcnv lluzjulx Jaux itnnani; iiztion oc!
Julx llcnx ihiux nqaan gtiycl (s1:iiiip)J:i:i-T.liili nsirlv zl:iii|>x nilileiie
bxin incih mini..
Name ___ ______________
Address ____ _ ____________
Cily, Slum. 'li\> Code _________________ ; ___
I'houc No. _____________
I Iai fingx mienh
llnynngh Jcv Tovfcifingjienw Nnin Nyion/
G-ivip t\d Cong Doncj b<
XJm «(!en veto nMng clii \\et
keih tbeo tl«nb tliiep cito
Ten:
c\\jdc \vc\ \\\\* \c\o
» c/di \\-c\ loi!
cnn \rc\ bM'u phi
w cli:
Tlicwh Plio, tlen bone;, aip cot(&:
So *(ien
•
Dcin toe
TMOI'
XJin vonci tron:
XIni
-------
LAO
zmu u.3i
ii'xiTiivpJ it. U rj. Inn;: 1(4J. n^ufpo. tmi, OIUMU
.'-ioVuiUiu* & tiv>iktiniv.:i»o»>i)-j
.«• % ..... ....
ti;vi let cmi D*J f>ai'ujuuuivij«i>.i.
v. iu
CHINESE
APPENDIX G
KHMER
\iuihmi
tmn:
.»
mra aim a
ut
n*
It
u\nfiHfiOiJTfifoifiOiJfii5fhiiinaj m-^ wtyiuf
«« • i.«* t i»
KOREAN
~) o|
A
-------
Appendix H
in
-------
APPENDIX H
WE NEED YOUR HELP!
PARTICIPATE IN A University of Washington
DIETARY HABIT STUDY!
Each chosen volunteer will be paid for a full interview with a
$25 check or a grocery gift certificate.
VOLUNTEERS MUST BE:
• Korean, Chinese, Japanese, Filipino, Samoan,
Vietnamese, Lao (Mien and Hmong), or Cambodian
ethnicity
• 1st generation* Asian Pacific American or
• 2nd generation** Asian Pacific American
• 18 years or older
• Living in King County
To participate, please call one of the bilingual interviewers:
Cambodian
Chinese
Filipino
Japanese
Korean
Lao
Hmong
Mien
Samoan
Vietnamese
The information you provide is extremely important to your
community!
Volunteer for an interview now! Bilingual services are available!
•I" generation: those who were born abroad and immigrated to US from their country
"2nd generation: children of 1" generation immigrants and born in US
112
-------
i/
j/'^t"
APPENDIX H
If" fU™r™^*~
0-
/ ' >-
0 "
;
\
'
v/v'6/
^ ^> (/ £ — 9 /
\>
«v \
p T"A f il ^»« ^-». 1 •>.
-------
APPENDIX H
ffo!
$25.00 m
c^ eulecfy 6ld& :
A _ K
•
aD cn^S, ^u, S^u, SSOu, sojeu, OJODOD, 390(2031), £5), ccas
2CDD
: ibucieoc#D Sucec^
0 8%en6f>
d King County
.725-9181
114
-------
UA MATOU MANAOMIA LAU FESOASOANI! APPENDIX H
0 SE SU'ESU'EGA TAU MEA TAUMAFA MASANI!
Oseolea filifilia ina ia tuufesiliina ole a ia maua se siaki e
$25.00 lona aofa'ipo'o se faatauga mea taumafa foi.
0 e manaomia ona tuuofo mai:
• Kolea, Saina, Sapani, Filipino,. Samoa, Vietinamu, Lao (Mien ma
Hmong), ma Kemupotia.
• Auga tupulaga muamua (1)* Amerika Asia Pasefika po'o
• Auga tupulaga lona lua (2)** Amerika Asia Pasefika
• 18 tausaga po'o le matua atu
• 0 lo'o alaala nei i King County
Faamolemole faafeso'ota'i . po'o
0 faamatalaga o le a e aumaia e matua taua tele mo
le faapotopotoga!
Ofo mai loa ina ia tuufesiligia oe! E maua fesoasoani i lau lava
gagana!
•Auga tupulaga muamua (1): O e sa fananau i fafo atu o Amerika a ua malaga mai ma nonofo i Amerika
-Auga tupulaga lona iua (2): O fanau a le auga tupulaga muamua (1) ua fananau i Amerika
115
-------
UNIVERSITY OF WASHINGTON APPENDIX H
• -f
116
-------
APPENDIX H
CHUNG TOI CAN QUI BA N GIUP D6
THAM GIA VAO CUQC PHONG VAN NGHIEN CUfU
TA P TUC AN UONG.
Moi ban $\16c chpn tham gia cuoc phong van, sau khi hoan tat ban se Ajc
tra thu \ao $25 ^ong bln^ chi phi£u hole phieu thi/c phlm.
Nhilng n^Lfoi ti/ nguyen tham gia phai la :
• Ngifcfi £)ai Han. Trung Hoa, Nhlt, Phi Lu|t TBn, Samoan. Viet Nam, Lao
(Mien & Hmong). hoac Cam D5t.
• The"'he thiJ nhlt: 0) ngi/dl My g6fc A Ghlu (ngJicfl A Ch^u sinh <5" cac niT^c
ngoai dSn sdhg cf My)
• The^he thtJ hai: @ NgiJcfi A Chiu sinh 3e <3 MY ( con chau cua nhLfng ngi/ol
the'he thiJ nhlt sinh ^e £ My)
• £)u 13 tu3i ho|c hcfn
• Hien cif tru trong quan King
• Xin vui long gpi cho JEFF DANG tai $6 hoac
314-3556 or 277-2599
• Tin trfc ban cung cl'p cho chung toi vo cung c^uan trpng dof vot Cong £>ong
ban.
M6l BAN THAM GIA CUQC PHONG VAN NAY!
CHUNG TOI SE CO NG J6l THONG D|CH CHO
QUYVI.
117
-------
APPENDIX H
YIE MBUO QIEMX ZUQC OIX LONGC MEIH TENGX!
BIEQC DAAIH CAUX JIENV NAAIV NORM KAUV ZAAH NYANC HOST
NYEI JAUV OC!
Halx dauh zuqc ginv daaih zoux sievjev nyeimienh naalv se duqv $25.00 nyaanh
check Fai duqv maaiz lai nyei zing-nyeic nyaanh.
Bieqc daaih zoux siev jev nyei mienh. se oix zuqc zeiz:
. Jan-Korea. Jan-Kaev, Jan-l Benv, Jan-fllipin, Jan-Samoan, Jan-Jau-Zei, Jan-La-zaa
(Mien caux Baeqc-Miuh) caux Jan-K'Menx.
. Da'yietv seix* mbuo Asia caux Jan-Pacific America a'fai
, Da'nyeic seix** mbuo Asia caux Jan-Pacific America
18 hnyangx gu'guaaic mdengx nyei mienh
Yiem naaiv King County deic nyei mienh
Tov meih heuc daaih lorz : Dienx waac hoc a'fai
Meih gorngv daaih nyei waac naaiv se gengh jienv haic nyei bun meih nyei laagz
zaangc mienh camv!
Tov meih sie jev bieqc daaih bun yie mbuo zaah naaic meih oc! Yie mbuo yaac
aengx maaih mienh tengx faan waac nyei!
seix: Cuotv seix yiem meih nyei deic bung, iiuz biaaux daaih yiem naaiv
Meiv Guoqv nyei mienh.
"Da'nyeic seix: Da'yietv seix biaaux daaih yiem naaiv Meiv Guoqv aengx caux cuotv
seix yiem naaiv Meiv Guoqv nyei fu'jueiv.
118
-------
UNIVERSITY OF WASHINGTON APPENDIX H
PEB XAV TAU KOJ KEY PAB! __
KOOMTES RAU KEY KAWM TXOG TEJ KHOOM UAS IB TXWM NOJ!
Txhua tus uas raug xaiv thiab txaus siab los teb tej lus nug kom tiav yuav tau txais ib daim tshev
$25 lossis ib daim tshev muas noj $25.
Cov txaus siab yuavtsum yog neeg:
• Kauslim, Suav, Yijpooj, Fislispisnaus, Xaismoos, Nyablaj, Nplog (Co thiab Hmoob),
lossis Khasnpausdias
• Txheej 1 * Neeg Tawvdaj nyob tebchaws Asmesliskas tuaj Esxias tuaj lossis
• Txheej 2** Neeg Tawvdaj nyob tebchaws Asmesliskas
• Dhau 18 xyoo rov saud
• Nyob koom tib lub nroog (King County)
Thov tivtoj rau • lossis
Tej uas koj qhia txog mas tseem ceeb kawg nkaus li rau ib zejtsoom nruab zog!
Tus uas txaus siab, cia li tso npe rau ib qho maimnav! Neeg txhais koj yam lus, peb muaj!
Txheej 1: Cov uas yug nyob yus tebchaws thiab tau tsiv teb tsaws chaw tuaj rau US (tebchaws Amesliskas)
Txheej 2: Cov menyuam ntawm txheej 1 uas tau yug nyob rau US (tebchaws Amesliskas)
119
-------
Appendix H
UNIVERSITY OF WASHINGTON
o] 7114,
o]uf
120
-------
APPENDIX H
KAILANGAN NAMIN ANG INYONGTULONG
SUMALI SA University of Washington DIETARY
HABIT STUDY!
Ang mapiling boluntaryo ay mabayaran ng
dalawamput limang dolyar tseke o grocery gift
certificate.
Mga boluntaryo ay:
• Korean, Intsik, Hapon, Filipino, Samoan, Vietnamese,
Lao (Mien and Hmong), o Cambodian ;
• Unang generasyon* Asian Pacific American o;
• Ikalawang generrasyon** Asian Pacific American;
• Labing walong taon o ma$ matanda;
• Nakatira sa King County.
Tawagan long ninyo ang numerong ito:
Filipino..! , o;
Ang mga impormasyon na ibigay ninyo ay malaking
bagay para sa inyong komunidad!
Magboluntaryo na kayo para sa pagtatanong! May tutulong
sa inyo sa pagsasagot.
•1" generation: those who were born abroad and immigrated to US from their country
"2nd generation: children of I" generation immigrants and born in US
121
-------
APPENDIX H
f a-
% 25
o 7
o 7
"J JJ > 2 it "g & -5 C. «»: .
at «t
^ a--r^ -Ci
« i it
122
-------
Appendix I
123
-------
UNIVERSITY OF WASHINGTON
APPENDIX I
CONSENT FOR FUTURE CONTACT
Resooncfent Code:
I agree to be recontacted so that I can consider whether or not to
participate in a future study.
Signature Date
Please list below two contacts (relatfves^or friends) who will be able to
help us find you if you move. We will only contact them in the event that
we are unable to reach you after several attempts.
1. Name of friend/relative: _ .
Address:
Telephone:.
2. Name of friend/relative:
Address:
Telephone:.
124
-------
Appendix J
125
-------
Appendix J
Questionnaire Number II II
ASIAN PACIFIC AMERICAN SEAFOOD CONSUMPTION STUDY
Re-inlerview data
DATE CALLED
1) 1 1 1 1
mo day yr
RE-INTERVIEW TIME
1) : D tarn CD 2 pm
RESULT CODES
1| completed interview d
2) 1 1 1 1
mo day yr
2) : D iam D 2pm
2) other Qz
3) 1 1 1 1
mo day yr
3) : DiamQjpm
INTERVIEWER'S CODE I
-------
Appendix/
A1. How often do you eal the following...
K>
NUMBER OF PORTIONS EATEN PER
NUMBER OF...PER YEAR
A2. For the following categories, please tell me approximately what percentage of the fish you get from: READ ALL
CATEGORIES---Answers must totall 00%.
1) Grocery stores/street vendors %
2) Fish caught from Puget Sound by yourself, family members or friends %
3) Fish caught from outside of Puget Sound by yourself, family members
or friends %
4) Restaurants %
A3. For the following categories, please tell me approximately what percentage of the shell fish you gel from: READ ALL
CATEGORIES - - -Answers must total 100%.
1) Grocery stores/street vendors %
2) Fish caught from Puget Sound by yourself, family members or friends %
3) Fish caught from outside of Puget Sound by yourself, family members
or friends _, %
4) Restaurants %
-------
APpendixJ
A4.1'n) going to ask you about whal parts of the fish you eat. Please tell me what percentage of Ihe time you eat the following
categories when you eat fish.
—READ ALL CATEGORIES FIRST—Please answer 0-100%. Answers 1 & 2 must total 100%.
1) Fillet with skin: %
2) Fillet without skin: % 11 & 2 total 100%)
3) Head, bones, eggs, organs: % (0-100%)
AS. The following questions will ask about your eating patterns at social events. In the last 12 months, how often did you attend
special celebrations (holiday celebrations, Chinese New Year, cultural or community events, weddings, etc.):
times
A6. Please indicate your age . If you choose not to. please select your age category.
18-29DI 30-54 D2 55+D3
NJ
00
-------
Appendix K
129
-------
Appendix K
1
Types of Seafood Consumed/Respondents Who Consume (%)
Anadromous Fish (%)
salmon
trout
smelt
salmon eggs
Pelaeic Fish
tuna
cod
mackeral
snapper
rockfish
herring
dogfish
snowfish
93
61
45
27
(%)
86
66
62
50
34
21
7
6
Freshwater Fish
catfish
tilapia
perch
bass
carp
crappie
Bottom Fish
halibut
sole/flounder
sturgeon
suckers
(%)
58
45
39
28
22
17
(%}
65
42
13
4
Shellfish
shrimp
crab
squid
oysters
manila/little-
neck clams
lobster
mussel
scallops
butter clams
geoduck
cockles
abalone
(%)
98
96
82
71
72
65
62
57
39
34
21
15
razor clams
sea cucumber
sea urchin
horse clams
macoma clams
moonsnail
Seaweed/Kelp
seaweed
kelp
16
15
14
13
9
4
(%}
57
29
-------
Appendix L
131
-------
Table. Outliers and Substitution
APPENDIX L
QX*
aim*
BR: -
FRI5-
JRI •
JVOI-
;v43*
Pelasic
BRIS"
FR13-
JRII'
JV02'
JV43"
CV05~
FR15*
JRIf
IR2&+
JR42+
JV02'
JV43"
BRIS"
CV05+
CV25-"
JV02B
JRIf
JV43"
Shellfish
BRAS"
ER04*
JRII-
JV02*
JV43"
BRIS*
OR22+
DVQ8+
EVQ5+
EV06f
JV02-
BRIS'
DR22+
OVQ8*
ERI3-
JRlf
JV02*
JV4J-
8RI3'
JRII'
JVOI1
JV43-
Lao
Uo
Vietnamese
Lao
Jaoanese
Vietnamese
F
F
M
M
F
M
F
M
M
F
M
F
M
M
M
M
F
M
F
F
M
F
M
M
F
M
M
F
M
F
F
F
F
F
F
F
F
F
F
M
M
F
M
F
,\t
F
M
5 Us
59 lea
Tilcz
66
Ij
49
57 ka
79 ka
66
45
49 kz
54 kz
75 ka
66
65 k*
54 U
45
49
57 lea
54 kz
63k?
45
66
49
57 ta
73kg
66
45
49 ka
57 Ice
54kg
41ki
59kg
50kg
45
_
57 kz
49 leg
54 ka
43 kz
61 kz
66
45
49
57ksi
00
45
44
< (Ok
25-35 k
< 10 k
<10te
< 10 k
< !0k
1 5-10 k
< 10k
< 10 k
< 10k
< 10k
25-35 k
< 10k
< 10k
< lOlc
45k
-------
Appendix M
133
-------
Appendix M-l-a
Participation rates by participant category
Participant Attempted Unable to Reached Disqualified Refused Participated
Category Contacts Contact
Volunteer
Roster
150
365
24 (16)
198(54)
126(84)
167 (46)
16(13)
24(14)
4(4)
47 (33)
106 (96)
96(67)
134
-------
Appendix M-l-b
Miscellaneous seafood consumers
Species # of Consumers % of all respondents 1
Octopus
Eel (freshwater/saltwater)
Fish egg (all kind)
Yellow fish
Bonito Flakes
Milk fish
Jelly fish
Beltfish
Fly fish
Sardine
Galung Gong
Monk fish
Dried small fish
Shad
Shark
Barracuda
Sword fish
23
21
21
19
12
9
8
6
6
4
2
1
1
1
1
1
1
11%
10%
10%
9%
6%
4%
4%
3%
3%
2%
1%
0%
0%
0%
0%
0%
0%
135
-------
Appendix M-2-b
Demographic and seafood preparation characteristics of "higher" and "lower" seafood consumers.
I^^^^^^^^^^^^^H All Finfish Shellfish
n
7emale
Male
18-29
30-54
55+
Cambodian
Chinese
7ilipino
apanese
torean
.aotian
Mien
imong
Satnoan
Vietnamese
3FPL
IS or Less
Above HS
^on-fishermen
107
95
78
85
39
20
30
30
29
22
20
10
5
10
26
71
39
38
39
69
98
136
'ishermen 66
(Higher Consi
1.144
Lower
Consumers
76%
^ 81%
• 85%
79% ;
• 64%
f ,- 90%
1:83% K
V7f 80%'-
- :48%
' 91% X
i 75% ;
* X90%; '^
^noo%- •
" '100%
69%
79%
92%
76%
74%
74%
81%
82%
71%
imer: > 75%tile =
g/day/kg)
Higher
Consumers
24%
19%
15%
21%
36%
10%
17%
20%
52%
9%
25%
10%
0%
0%
31%
21%
8%
24%
26%
26%
19%
. 18%
29%
(Higher Consumer: > 75%tile =
1.072 g/day/kg)
Lower
Consumers
71%
79%
73%
; 78%
72%
' 70% !
'•'.•:•'• 70%' ;
87% "* •'.,
79% ; ,
68%
75%
90%
:-' 100% "
100%
50%
68%
77%
82%
80%
70%
76%
76%
73%
Higher
Consumers
29%
21%
27%
22%
28%
30%
30%
13%
21%
32%
25%
10%
0%
0%
50%
32%
23%
18%
20%
30%
24%
24%
27%
136
-------
Appendix M-2-b
Demographic and seafood preparation characteristics of "higher" and "lower" seafood consumers.
^H^B^^H^^^^^^I AH Finfish Shellfish ^^H
Read in Books
Listen to someone
See Video
Learn on Computer
Tape Recording
See Slide Show
Read Comic book
Fillet with Skin
Fillet w/o Skin
Head/Bone/Organ
Bake, Boil, etc.
Canned, Fried, etc.
Purchased
Caught
(Higher Consu
1.144
Lower
Consumers
(n=158)
65%
54%
39%
d5%
8%
3% :
.5% ;
52% (3%)
41% (3%)
20% (3%)
58% (2%) i
36% (2%)
75%
25%
mer: > 75%tile =
?/day/kg)
Higher
Consumers
(n=44)
84%
59%
23%
18%
7%
7%
2%
51% (6%)
44% (7%)
19% (4%)
72% (4%)
24% (3%)
82%
18%
(Higher Consumer: > 75%tile =
1.072g/day/kg)
Lower
Consumers
(n=151)
72%
55%
36%
15%
7%
3%
3%
76% (2%)
,22% (2%)
86%
14%
Higher
Consumers
(n=51)
61%
55%
33%
18%
10%
8%
10%
79% (3%)
21% (3%)
93%
7%
137
-------
Seafood consumption rates by ethnicity*
Appendix M-3
1 Category
Anadromous
Fish
(p
-------
Appendix M-3
Seafood consumption rates by ethnicity (continued)
Category Ktlmkity Sample Mean S.K. 10% tile Median 1st 3rd Motile <7< with Consum- 95<7< <>5<7<-UCl|
sue Quartilc Quartile non-/cro crs(%) LCI 1
(n) loiisuinp- 1
lion 1
Seaweed/Kelp
(p
-------
Seafood consumption rates by ethnicity and gender*
Appendix M-4
IFi male
Category
Anadromous
Fish
Pelagic Fish
Freshwater
fish
Bottom Fish
Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese '
All Ethnicity
n
II
15
15
1?
12
10
5
".3'';.
5 .
14
107
11
|5
15
17
12
10
•5;
3
5
14
107
11
15
15
17
12
10
5
3
5
14
107
n
15
15
17
12
10
5
3
5
14
107
Mean
0.040
0.292
0.173
0.362
0.079
0.122
0.011
o;o78
6.066
0.091.
0.165
0.118
0.421
0.428
0.515
0.265
0.311
O.J59
; 0.083
0.545
0.325
0.349
0.125
0.068
0.157
0.026
0.012
0.344
0.145
0.169
0.026
0.276
0.13!
0.056
0.132
0.243
0.161
0.077
0.086
0.004
0.045
0.030
0.089
0.115
SE
0.023
0,094
0.047
0.060
0.024
0.060
0.005
0.006
0.016
.0.035
0.022
0.033
0.117
0.151
0.070
0.072
,0.120
0.154
0.049
0.021
0.096
O.OJ7
0.056
0.024
0.065
0.007
0.007
0.117
0.075
0.084
0.010
0.081
0.021
0.044
0.047
0.080
0.040
0.024
0.061
0.003
0.034
0.008
0.057
0.019
Median
0.015
0.086
0.103
0.250
0.054
0.042
0.009
0.074
0.066
0.051
0.076
0.074
0.214
.0.247.
: 0.398
0.178
0.111
0.005
0.043
0.559
0.188
0.215
0.048
0.033
0.091
0.012
0.000
0,168
0,072
0.091
0.033
0.128
0.054
0.000
0.054
0.119
0.099
0.048
. 0.003
0.000
0.024
0.025
0.014 .
0.040
n
9
15
15
12
10
10
5
2
5
12
95
9
15
15
12
10
10
5
2
5
12
95
9
15
15
12
10
10
5
2
5
12
95
9,
15
15
12
10
10
5
2
5
12
95
Malt
Mean
0.214
0.093
0,132
0.392
0.107
0.253
0.025
0.029
0.068
0.162
0.169
0.051
0.229
0.206
0.663
0,371
0.513
0.055
0.107
0.453
0.439
0.334
0.156
0.101
0.107
0.014
0.057
0.221
0.050
0.078
0.026
0.417
0.137
0.032
0.031
0.087
0.191
0,169
0,046
0.008
0.021
0028
0,118
0087
SE
0.102
0.035
0.026
0.107
0.052
0.113
0.016
0.002
0.032
0.036
0.024
0.016
0.063
0.053
0.164
0.089
0.253
0.033
0.017
0.122
0.151
0.043
0.077
0.040
0.025
0.009
0.030
0.102
0.014
0.003
0.010
0.101
0.023
0.016
0.014
0.015
0.093
0.047
0.018
0.006
0.021
0.007
0.069
0.017
Median
0.088
0.031
0.097
0.309
0.043
0.108
0.014
0.029
0.050
0.141
0,080
0.045
0.122
0.117
0,566
0,391
0.115
0.023
0.107
0.518
0.222
0.148
0,042
0,008
0.070
0.000
0.015
0.077
0.050
0,078
0,025
0.324
0,054
0.006
0.014
0.091
0.051
0.156
0.010
0.000
0.021
0.026
0.033
0.034
140
-------
Seafood consumption rates by ethnicity and gender (continued)
Appendix M-4
IFiraak
Category
Shellfish Fish
Seaweed/Kelp
Miscellaneous
Fish
AIIFinfish
Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian .^
Mien '[',
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
n
'I
15
15
17
12
10
• 5 '',-•
.,3 ;'; '--.'-'•
5 •• ' '.•''•'
'.- 14 "--' - i':-\
;u>7 ••'
.-",.•-// .V
' I5 "•-.••
,15 .- . -.,.'.. :
17 ; .-;
12
•'°\rS
iiSV^V'
3:^v.!;'; •
' 5 • •':-.•:;.
14
107
11
15
15
17
12
10
5
3
5
14
107
11
15
15
17
12
10
5
3
5
14
107
Mean
0.715 .
1.115
0.689
0.524 .
0.858
1.088
0.311
0.266
0.191
..1725 v
0.864
0.002
0.076
0.005
0.241 '."-
0.242
0.006.:
o!ooo /:
0.003
0.000
0.010
0.079
0.108
0.080
0.094
0.253
0.062
0.084
0.002
0.003
0.069
0.084
0.105
0.338
0.912
1.001
1.063
0.432
0.862
0.318
0.375
0.666
0.781
0.759
SE
0.184
0.259
0.118
0.101
0.216
0.326 •;
0.129
0.007
.1. .0.043
OJ65
. 0.086
.-,.-• .Q.ooi ..
0.014
0.003
0.068
0.083 ..!
v : 0-005
..':.';• 0.000
" 0.001
0.000
0.007
0.018
0.034
0.029
0.040
0.046
0.015
0.027
0.001
0.002
0.025
0.014
0.013
0.129
0.225
0.275
0.126
0.104
0.228
0.236
0.116
0.025
0.227
0.071
Median
0.404
0.768
0.789
0.372
0.430
0.692
0.214 .
0.271 ;
0.168
1.772 " '
0.432 '"•;..-
0.000
0.018
0.000
0.101
.'- 0.087;;
".-' o.oop ;.:':,
0.000 .
0.004
0.000
0.000
0.005
0.071
0.029
0.037
0.258
0.047
0.054
0.001
0.001
0.050
0.087
0.061
0.188
0.371
0.462
1.070
0.339
0.722
0.092
0.288
0.692
0.384
0.512
n
9
15
15
12
10
10
5
2
5
12
95
9
15
15
12
10
10
5
2
5
12
95
9
15
15
12
10
10
5
2
5
12
95
9
15
15
12
10
10
5
2
5
12
95
Male |
Mean
1.168
0.855
0.538
0.712
1.270
0.709
0.365
0.221
0.116
1.405
0.836
0.002
0.047
0.013
0.118
0.149
0.002
0.000
0.001
0.000
0.026
0.044
0.119
0.082
0.072
0.237 .
0.128
0.064
0.028
0.042
0.082
0.094
0.104
0.453
0.454
0.531
1.259
0.703
1.032
0.137
0.235
0.575
1.135
0.726
SE
0.426
0.216
0.060
0.162
0.496
0.412
0.201
0.024
0.010
0.379
0.104
0.002
0.030
0.007
0.036
0.048
0.001
0.000
0.001
0.000
0.026
0.010
0.044
0.030
0.030
0.058
0.065
0.035
0.014
0.033
0.054
0.023
0.015
0.156
0.121
0.083
0.245
0.108
0.349
0.041
0.033
0.117
0.258
0.072
Median 1
0.843
0.497
0.498
0.468
0.555
0.373
0.127
0.221
0.113
0.946
0.490
0.000
0.017
0.004
0.066
0.114
0.000
0.000
0.001
0.000
0.000
0.002
0.088
0.036
0.046
0.177
0.041
0.021
0.016
0.042
0.023
0.076
0.055
0.321
0.241
0.437
1.217
0.618
0.740
0.099
0.235
0.620
0.721
0.458
141
-------
Seafood consumption rates by ethnicity and gender (continued)
Appendix M-4
1 Category Ethnicity
All Fish Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
All Seafood Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
n
II
15
15
17
12
10
5
3
5
14
I
107
11
|5
15
17
12
10
•5.
3
5
14
107
Mean
1.161
2.108
1.784
1.840
1.351
2.034
0.631
0.644
0.927
2.589
,, .. ,f
1.728
1.163
2.184
1.789
2.081
1.593
X * ' •- '
2.040
0.631
0.647
0.927
2.599
1.807
-i male
SE
0.318
0.458
0.386
0.214
0.283
0.472
.0.360
0.108
0.039
0.485
0.135
0.318
0.479
0.386
0349
0.330
0.470
0.360
0.106
0.039
0.488
0.139
Male
Median
0.799
1.542
1.370
1.723
0.819
1.675
0.296
0.560
0.896
2.494
1.328
0.799,
1.663
1.417
. -.- . i.
1.830
0.893
1 • v
1.675
0396
0.564
0.896
2.494
.1.417
n
9
15
15
12
10
10
5
2
5
12
95
9
15
15
12
10
10
5
2
5
12
95
Mean
1.739
1.390
1.140
2.208
2.101
1.805
0.530
0.497
0.774
2.634
1.666
1.742
1.437
1.153
2.325
2.251
1.807
0.530
0.498
0.774
2.660
1.710
SE
0.468
0.320
0.109
0.424
0.486
0.557
0.195
0.024
0.152
0.613
0.149
0.468
0.329
0.113
0.437
0.509
0.557
0.195
0.024
0.152
0.611
0.152
^^^^B
1.353
0.753
0.994
1.794
1.670
1.205
0.272
0.497
0.732
1.911
1.202
1.353
0.757
0.994
1.860
1.686
1.205
0.272
0.498
0.732
2.065
1.257
No weight applied.
*AII consumption rates in g/kg bodyweighl/d.
142
-------
Seafood consumption rates by age*
Appendix M-5
Category
Anadromous Fish
(p=0.001)
Pelagic Fish (p=0.3)
Freshwater Fish
(P=0.3)
Bottom Fish (p=0.9)
Shellfish Fish
(P=0.6)
Seaweed/Kelp
(p=0.9)
Miscellaneous seafood
(P=0.4)
All Finfish (p=0.4)
All Fish (p=0.6)
All Seafood (p=0.6)
Age Group
18-29
30-54
55+
18-29
30-54
55+
18-29
30-54
55+
18-29
30-54
55+
18-29
30-54
55+
18-29
30-54
55+
18-29
30-54
55+
18-29
30-54
55+
18-29
30-54
55+
18-29
30-54
55+
n
78
85
39
78
85
39
78
85
39
78
85
39
78
85
39
78
85
39
78
85
39
78
85
39
78
85
39
78
85
39
Mean
0.134
0.164
0.237
0.387
0.287
0.372
0.098
0.134
0.206
0.102
0.099
0.105
0.862
0.795
0.950
0.050
0.056
0.102
0.119
0.096
0.094
0.721
0.684
0.919
1.702
1.575
1.964
1.752
1.631
2.065
SE
0.024
0.027
0.037
0.053
0.035
0.071
0.016
0.023
0.053
0.022
0.016
0.034
0.105
0.088
0.198
0.014
0.014
0.035
0.018
0.013
0.021
0.075
0.072
0.145
0.152
0.138
0.293
0.155
0.144
0.296
Median
0.065
0.073
0.151
0.265
0.140
0.172
0.045
0.056
0.072
0.036
0.031
0.043
0.505
0.490
0.367
0.002
0.004
0.001
0.061
0.055
0.037
0.577
0.443
0.476
1.319
1.206
1.352
1.370
1.217
1.427
75%tile
0.130
0.201
0.305
0.504
0.443
0.689
0.111
0.117
0.156
0.123
0.124
0.103
1.087
1.058
1.482
0.037
0.028
0.073
0.146
0.124
0.117
0.966
0.966
1.434
2.055
2.223
2.993
2.147
2.299
3.217
90%tile 1
0.399
0.428
0.537
0.814
0.742
1.063
0.277
0.368
1.032
0.191
0.261
0.202
1.645
1.996
3.247
0.205
0.219
0.387
0.340
0.277
0.278
1.312
1.424
2.456
3.914
3.162
5.241
3.916
3.841
5.241
*A11 consumption rates in
Note: P-value is based on
g/kg bodyweight/d.
Kruskal Wallis Test. No weight applied
143
-------
Seafood consumption rates by income*
Appendix M-6
Category
Anadromous Fish
(p=.036)
Pelagic Fish (p=0.5)
Freshwater Fish
(p=0,6)
Bottom Fish (p=0.007)
Shellfish Fish (p^O.7)
Seaweed/Kelp
(p=0.001)
Miscellaneous seafood
(p=0.062)
All Finfish (p=0.3)
All Fish (p=0.6)
All Seafood (p=0.6)
Income Group
Under FPL**
1.0 -2.0 FPL
2.0 -3.0 FPL
>3.0FPL
Under FPL
1.0 -2.0 FPL
2.0 -3.0 FPL
>3.0 FPL
;Under FPL
fh()-:2.bFPL
f2.0-/3.6FPL
I>3#FPL"
Under FPL
1.0 -2.0 FPL
2.0 - 3.0 FPL
>3.0 FPL
£UnderFPL
[iJipfrFPL
<2j6>3lb FPL
>3X)FPL
Under FPL
1.0 -2.0 FPL
2.0 -3.0 FPL
>3.0 FPL
Under FPL
1.0 -2.0 FPL
2.0 - 3.0 FPL
>3.0 FPL
Under FPL
1.0 -2.0 FPL
2.0 -3.0 FPL
>3.0 FPL
Under FPL
1.0 -2.0 FPL
2.0 - 3.0 FPL
>3.0 FPL
Under FPL
1.0 -2.0 FPL
2.0 - 3.0 FPL
>3.0 FPL
n
71
39
38
39
71
39
38
39
71
39
38
39
71
39
38
39
71
39
38
39
71
39
38
39
71
39
38
39
71
39
38
39
71
39
38
39
71
39
38
39
Mean
0.121
0.094
0.196
0.211
0.352
0.265
0.381
0.310
0.196
0.090
0.128
0.105
0.094
0.086
0.070
0.141
0.984
:0.832
0.750
:6.766
0.031
0:049
0.081
0.053
0.072
0.087
0.125
O.Q88
0.763
0.535
0.774
0.768
1.819
1.453
1.649
1.622
1.850
1.502
1.731
1.674
SE
0.021
0.013
0.043
0.044
0.048
0.063
0.087
0.049
0.035
0.018
0.029
0.030
0.025
0.022
0.019
0.033
0.140
0^154
0.095
0.133
0.013
0.016
0.030
0.017
0.012
0.020
0.023
0.017
0.097
0.086
0.118
0.108
0.208
0.202
0.178
0.193
0.209
0.208
0.189
0.196
Median
0.049
0.074
0.086
0.119
0.182
0.104
0.172
0.194
0.069
0.056
0.066
0.052
0.017
0.037
0.030
0.095
0.386
0.424
0.535
0.516
0.000
0.008
0.005
0.005
0.032
0.060
0.068
0.044
0.441
0.364
0.489
0.458
1.029
0.894
.364
.328
.029
0.906
.427
.425
75%tile
0.107
0.108
0.251
0.264
0.553
0.340
0.441
0.513
0.259
0.093
0.154
0.097
0.071
0.111
0.088
0.154
1.455
0.973
0.987
1.056
0.005
0.030
0.036
0.034
0.091
0.112
0.171
0.126
0.925
0.805
1.126
1.210
2.529
1.838
2.450
2.003
2.565
1.859
2.450
2.055
90%tile
0.468
0.249
0.618
0.551
0.865
0.676
0.825
0.775
0.749
0.336
0.449
0.334
0.180
0.222
0.191
0.324
3.187
2.029
1.441
1.482
0.048
0.219
0.261
0.207
0.178
0.202
0.295
0.206
2.072
1.099
1.798
1.467
4.494
3.162
3.159
3.909
4.496
3.162
3.522
3.909
*A11 consumption rates in g/kg bodyweight/d.
* * FPL—Federal Poverty Level
Note: 15 respondents with unknown income are excluded in this table. P-value is based
on Kruskal Wallis Test. No weight applied.
144
-------
Seafood consumption rates by education*
Appendix M-7
Category
i • -=™^DSE^"™=^=^=*3SS=^=X^=^=^^^
Anadromous Fish
(P=0.7)
Pelagic Fish
(P=0.3)
Freshwater Fish
(p=0.000)
Bottom Fish
(P=0.1)
Shellfish Fish
(p=0.6),
Seaweed/Kelp
(p=0.001)
Miscellaneous seafood
(p=0.045)
All Finfish
(p=0.068)
All Fish
(P=0.6)
All Seafood
(P=0.8)
Education
Level
HS
HS
HS
HS
HS
HS
HS
HS
HS
HS
mM
69
98
69
98
69
98
69
98
69
98
69
98
69
98
69
98
"69
98
69
98
Mean
•Hi
0.1657
0.1605
0.3913
0.3183
0.2072
0.1031
0.0892
0.1340
0.9039
0.8904
0.0409
0.0763
0.0881
0.1057
0.8535
0.7160
1.8455
1.7120
1.8864
1.7883
SE
0.027
0.023
0.051
0.040
0.031
0.021
0.019
0.022
0.114
0.101
0.017
0.016
0.016
0^013
0.087
0.075
'0.182
0.145
0.183
0.151
Median
^^^^H
0.0720
0.0797
0.2659
0.1567
0.0890
0.0332
0.0295
0.0603
0,4473
0.4983
0.0000
0.0053
0.0320
0.0644
0.6141
0.4213
1.4628
1.2535
1.4812
1.2676
75%tilc 90%tilc|
^^^^H
0.2261
0.1642
0.6306
0.4337
0.2700
0.0952
0.1173
0.1383
1.4988
1.0706
0.0082
0.0490
0.1070
0.1360
1.2440
0.9644
2.5540
2.2109
2.5960
2.4464
0.4978
0.4306
0.8652
0.8440
0.5898
0.2137
0.1911
0.3550
2.2534
2.5680
0.0988
0.3218
0.2346
0.2775
1.9357
1.5971
4.1507
3.9282
4.1507
4.0798
*A11 consumption rates in g/kg bodyweight/d.
**HS—High School
Note: P-value is based on
Mann-Whitney Test. No weight applied.
145
-------
Seafood consumption rates by roster and volunteer*
Appendix M-8
Category
Anadromous Fish (p=0.4)
IPelagic Fish (p=0.6)
(Freshwater Fish (p=0.6)
iBottom Fish (p=0.3)
Shellfish Fish (p=0.4)
Seaweed/Kelp (p=0.2)
Miscellaneous seafood
(p=0.07)
All Finfish (p=0.4)
All Fish (p=0.5)
All Seafood (p=0.5)
Resource
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
Roster
Volunteer
n
96
106
96
106
96
106
96
106
96
106
96
106
96
106
96
106
96
106
96
106
Mean
0.148
0.184
0.324
0.359
0.142
0.126
0.085
0.116
0.873
0.831
0.045
0.079
0.091
0.117
0.698
0.785
1.662
1.733
1.707
1.811
SE
0.022
0.024
0.041
0.041
0.025
0.020
0.016
0.019
0.109
0.081
0.012
0.017
0.013,
0.014
0.070
0.072
0.149
0.135
0.152
0.139
Median
0.074
0.082
0.175
0.205
0.057
0.049
0.029
0.043
0.422
0.494
0.002
0.005
0.034
0.068
0.452
0.494
1.129
1.409
1.206
1.477
75%tile
0.170
0.228
0.457
0.493
0.131
0.142
0.098
0.137
1.020
1.152
0.027
0.065
0.130
0.137
0.936
1.112
2.085
2.404
2.284
2.586
90%tile
0.337
0.503
0.829
0.826
0.430
0.366
0.195
0.289
2.289
1.811
0.134
0.312
0.260
,0.315
1.512
1.738
4.004
3.899
4.020
3.986
*A11 consumption rates in
Note: P-value is based on
g/kg bodyweight/d.
Mann-Whitney Test. No weight applied.
146
-------
Seafood source by ethnicity
Appendix M-9
| Fish Source I
Groeery/V cndor (%)
Caught in King County
Caught outside King
Restaurants (•/•)
" ' ' (%) '; ' Coun1y(%)
CategoT
AnadromousFish
Pelagic Fish
Freshwater Fish
Bottom Fish
Shellfish Fish
Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
n
18
30
29
29
22
18
7
5
10
26
194
17
30
30
29
22
20
7
5
10
26
196
18
24
30
20
13
18
10
5
9
26
173
10
28
27
28
18
14
4
3
10
21
163
30
30
29
22
. 19
10
5
10
26
201
Mean
71%
"68%
77%
65%
170%
-63%
44%
65%
•43%
?84%
69%
83%
61%
78%
61%
95%
93%
,«%
85%
<55%
88%
. i77%
67%
73%
82%
40%
49%
66%
13%
70%
20%
79%
62%
73%
60%
64%
59%
97%
38%
0%
83%
18%
66%
61%
78%
50%
76%
54%
80%
76%
64%
89%
43%
72%
67%
SE
9%
5%
'5%
5%
9%
8V
15%
19%
9%
;5% .
2%
7%
6%
5%
•7%
J%
A%
18%
.10%
;7%
"4%'
2%*
8%
7%
6%
9%
14%
9%
10%
20%
8%
6%
3%
13%
8%
7%
7%
3%
13%
0%
17%
7%
10%
3%
6%
5%
5%
6%
6%
6%
14%
7%
4%
7%
2%
Mean
7%
3%
4%
6%
2%
13%
30%
35%
3%
3%
7%
7%
0%
1%
2%
2%
6%
28%
15%
2%
3%
4%
14%
0%
4%
11%
45%
18%
68%
30%
17%
3%
15%
13% .
4%
1%
6%
3%
10%
25%
17%
0%
23%
8%
. 9%
7%
7%
12%
16%
7%
29%
7%
2%
5%
9%
SE
4%
1%
1%
3%
1%
5%
14%
19%
3%
2%
1%
4%
0%
1%
1%
2%
4%
18%
10%
2%
1%
1%
7%
0%
2%
7%
13%
7%
13%
20%
12%
2%
2%
9%
2%
1%
3%
3%
7%
25%
17%
0%
9%
2%
5%
2%
3%
4%
6%
4%
12%
5%
2%
2%
1%
Mean
16%
4%
11%
6%
18%
12%
.24%
0%
8%
0%
9%
3%
1%
10%
0%
0%
6%
7%
0%
20%
1%
- '3%
10%
0%
5%
0%
4%
9%
18%
0%
40%
0%
6%
0%
5%
10%
9%
0%
33%
' 75%
0%
13%
0%
9%
0%
1%
3%
0%
2%
0%
5%
0%
29%
0%
2%
SE
8%
2%
4%
3%
8%
8%
14%
0%
5%
0%
2%
2%
0%
5%
0%
0%
0%
7%
0%
7%
1%
1%
6%
0%
4%
0%
4%
6%
11%
0%
12%
0%
2%
0%
4%
5%
5%
0%
12%
25%
0%
9%
0%
2%
0%
1%
3%
0%
1%
0%
5%
0%
6%
0%
1%
Mean
6%
25%
8%
24%
10%
12%
1%
0%
47%
13%
16%
8%
38%
11%
37%
2% '
2%
0%
0%
14%
9%
16%
9%
27%
9%
49%
2%
8%
1%
0%
23%
17%
17%
10%
31%
26%
27%
0%
20%
0%
0%
70%
10%
22%
12%
41 %
15%
34%
3%
17% .
3%
4%
27%
23%
21%
SC
4%
4%
2%
5%
5%
4%
1%
0%
9%
5%
2%
5%
6%
3%
7%
2%
1%
0%
0%
4%
4%
2%
5%
7%
4%
9%
2%
• 6%
1%
0%
11%
5%
2%
15%
8%
6%
6%
0%
9%
0%
0%
13%
7%
3%
'5%
5%
3%
5%
1%
5%
3%
4%
3%
6%
2%
147
-------
Seafood source by ethnicity (continued)
Appendix M-9
Fish Source
Grocery/Vendor (%)
Seaweed/Kelp Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Mien
Hmong
Samoan
Vietnamese
All Ethnicity
7
29
IS
29
21
7
0
3
0
5
116
64%
71%
86%
82%
90%
89%
0%
100%
0%
84%
81%
18%
7%
8%
4%
5%
11%
0%
0%
0%
10%
3%
Caught in King County
('/.)
0%
1%
12%
0%
7%
0%
0%
0%
0%
0%
3%
0%
1%
8%
0%
5%
0%
0%
0%
0%
0%
1%
Ought outside King
County (•/.)
0%
0%
1%
0%
0%
0%
0%
0%
,0%
0%
0%
0%
0%
1%
0%
0%
0%
0%
0%
0%
0%
0%
Restaurants (%)
36%
28%
2%
18%
2%
11%
0%
0%
0%
16%
16%
18%
7%
1%
4%
2%
11%
0%
0%
0%
10%
3%
148
-------
Appendix M-10
Comparison between original survey and re-interview responses on selected questions
! SaltJftn I Halibut 1 Shrimp I Finfish Parts Cor sum*] 1 Auadnmious Fish 1 Shellfish
#of
servings
/year
"i~~] if
0
9
21
6
8
6
8
6
6
48"
48
60
6
6
12
1 I
4 1
' 3
15
13
3
20
40
...._
14
T
18
12"
24
44
60
52
6
8
2
7
4
i
8
1
#of
servings
/year
"TTir
0
6
8
I
2
1
12
2
3
6
12
36
12
0
0
0
0
3
14
24
5
6
8
0
3
0
12
12
3
18
24
5
18
8
0
0
0
2
0
1
#of
servings
/year
I ^
315
12
8
15
8
56
15
104
12
6
12
60
18
48
12
2
10
5
30
76
II
24
24
22
8
52
52
24
52
12
18
48
60
12
17
10
2
24
2
4
8
Fillet
with
Skin
I
100
80
50
100
0
100
75
75
25
5
0
0
20
0
0
10
100
0
80
25
II
100
100
80
25
80
80
0
100
60
100
0
98
50
50
80
0
20
0
50
50
Fillet
without
Skin
I
0
20
50
0
100
0
25
25
75
95
100
100
80
0
100
90
0
100
20
75
II
0
0
20
75
20
20
100
0
40
0
100
2
50
50
20
100
80
100
50
50
Head,
bone,
egg.
organ
I
100
20
5
0
20
95
0
75
50
0
0
0
0
0
10
0
0
0
100
5
II
50
30
0
0
10
50
0
10
10
0
0
0
0
0
0
7
0
0
10
10
Purchase
from
Groceries
I
30
100
100
85
25
90
75
100
75
85
100
80
50
100
90
100
50
0
99
90
II
80
100
85
50
50
80
90
100
70
70
80
100
50
100
100
100
100
0
100
100
Caught
in
King
County
I
0
0
0
0
25
10
10
0
25
0
0
0
25
0
10
0
20
0
0
3
II
0
0
0
0
0
20
0
0
10
0
0
0
50
0
0
0
0
50
0
0
Caught
outside
King
County
I
70
0
0
0
25
0
0
0
0
5
0
0
0
0
0
0
30
50
0
2
II
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
0
0
Consumed
at
Restaurants
I
0
0
0
15
25
0
15
0
0
10
0
20
25
0
0
0
0
50
1
5
II
0
0
15
50
50
0
10
0
20
30
20
0
0
0
0
0
0
0
0
0
Purchased
from
Groceries
I
100
100
80
50
34
90
90
90
50
80
95
70
100
100
90
100
100
50
95
70
II
100
50
80
25
50
100
95
90
70
75
70
85
100
100
100
100
100
0
100
50
Caught
in
King
County
I
0
0
0
20
33
0
5
0
50
10
0
10
0
0
0
0
0
0
0
0
II
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Caught
outside
King County
I
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
25
0
0
II
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
0
0
Consumed at
Restaurants
I
0
0
20
30
33
10
5
10
0
10
5
20
0
0
10
0
0
25
5
30
II
0
50
20
75
50
0
5
10
30
.25
30
15
0
L °
0
0
0
50
0
50
vO
Note: I = survey response; II = re-interview response.
-------
Appendix N
150
-------
Appendix N-l
LIST OF FIFTEEN SEAFOOD RELATED HEALTH CONCERNS HELD BY ADVISORY AND TECHNICAL COMMITTEE
MEMBERS WHICH WERE LATER RANKED BY CSC MEMBER'S PERCEIVED IMPORTANCE OF THE ISSUE TO
THE APA COMMUNITY.
Seafood Health Concerns
Cited by Advisory' and
Technical Committee
• Members
Safe fishing practices
Risks from eating seafood
Ways to reduce health risk
associated with seafood
Seafood from foreign markets
Sensitive populations
Chemical contaminants
How to determine safe seafood
and fish
Safe seafood
j Preservation of fish and
seafood
Health effects of chemical
contaminants
Environmental quality
Fishing resources
Biological contaminants
Emphasize the health benefits
of eating seafood
Reduce fear in the community
of "uniformed" officials
Example
Percentage Percentage of
Safe fishing locations, do not fish near
sewers, posted warning signs
Red tide, PSP (Paralytic Shellfish
Poisoning)
Safe cooking preparations, removing
unsafe parts of fish (liver, guts,...)
What risks are there buying from markets?
Pregnant women, children
Mercury, pesticides, other poisons
Visible signs, odor of seafood
Which seafoods are safe to eat
Proper refrigeration, bacteria
contamination in raw seafood or water
How much fish can be eaten without
getting sick
How to improve healthy seafood growth
Limitations on how many fish or clams to
collect
E. Coli, bacteria
Seafood monitoring police or Fish and
Wildlife officials
of CSC
Members*
Technical and
Advisory
Committee
members
69*
63*
50*
50*
38*
38*
38*
31
25
25
19
19
19
19
63
50
75
13
25
38
25
50
25
38
13
13
50
13
13
*Top six health concerns cited by the CSC Committees.
4Each CSC member (n= 16) selected the five they felt to be most important for the APA from the list of 15
concerns listed by the Advisory and Technical committees
151
-------
Appendix N-2 shows the draft brochure which was evaluated using the Focus
Group Questionnaire (Appendix N-3).
152
-------
For More
Information
About Seafood:
Community
Contacts
•Refugee Federation Service Center
(RFSC).
Bilinsua! semces available.
206-725-91 SI
•Wilderness-Inner City Leadership
Development (WILD) Project at
International District Housing
Alliance (IDHA).
206-623-5132
•People for Puaet Sound
206-382-7007"
Public Health
Contacts
•County Health Departments
•KJng'County 206-296-47S4
•Snohomish County 425-S39-5250
Washington State Dept. of Health
Consumer Assistance Hotline
1-SS8-5S6-9427
Red Tide Information Line
1-800-562-5632
J.S. Environmental Protection
Ksency
1 -800-424-43 72
•Environmental Risk Information
Service. University of Washington
206-616-7557
A Friendly Health Message
About Eating Seafood
From the
-Puget Sound-
Is Good
far You!
But did you know that it
can also harm you?
Tv% an effort 10. understand ihe unique risks faced by ihe Asian Pacific American
JLll community, a study was conducted by the refugee Federation Service Center
and the University of Washington's Department of Environmental Health. For more
information about the study, contact the Refugee Federation Servicc_Center or the
University of Washington (see For More Information page).
Risks From
Eating Bad Seafood
Biological contaminants cause many
illnesses: hepatitis, diarrhea and PSP.
PSP (Paralytic Shellfish Poison) or "Red
Tide" is a poison. You may have
tingling or numbness on your lips.
tongue, neck, fingers or toes if you have
PSP poisoning. In worse cases, you may
have breathing problems and trouble
movina vour bodv.
Call to seek medical
attention immediately if
you experience these
problems. This problem
can be life threatening.
Eating too much seafood contaminated
with chemicals can lead to the build-up
of chemicals in your body. This may
increase your risk for:
•Cancer
• Kidney Damage
• Brain Damage, and the
•Ability to have healthy children.
Contaminants
There are 2 kinds of contaminants:
biological
and chemical
contaminants.
Biological contaminants are bacteria,
parasites, viruses, and fish poisons.
Fish poisons are caused by the food
the seafood eat.
Industries, farms, and sewers all
contribute to the pollution that affects
your seafood. Fish that live close to
these sources of pollution are often
the most affected.
Examples of chemical contaminants
include mercurvjead, and PCBs.
-------
Who is affected toy
eating contaminated
seafood i*
Everybody!!!!
But...
•Pregnant women and
their unbom children
• Children of any aee
• Elderly
•People
with
medical
problems,
especially liver
disease,
diabetes, and
problems with
the immune
system
arc more sensitive and should be
more careful about eating
contaminated s-eatood.
Here's How to Protect Yourself
1
Know what types of seafood
are more likely to cause
problems:
• Older and larger fish have more
chance to store up toxins than younger.
smaller fish
•Fish that live at the bottom of the
water and shellfish tend to have more
contaminants
• Some parts of the seafood may have
higher amounts of contaminants, for
instance, the "butter" of crabs is higher
in toxins than the meal
•Some species have special risks. For
example, poison from germs on
spoiling tuna may cause allergic
reactions.
2
Know where your seafood
came from.
•Use safe fishing practices.
Washington State will provide safety
information to vou.
• Pay attention to warning sisns at the
beaches and piers.
•Check with the Washington State
Department of Health for safe and
open fishing locations.
3
Use safe preparation practices
•Check to see if your fish is spoiling
before you eat it. A strong fishy smell,
softening of the meat, and hazy eyes
on fish can be signs of bad fish.
• Keep raw fish away from other foods
being prepared
•Proper refrigeration after catching, and
cooking all fish and shellfish before
eating can kill most of the germs that
can make you sick, but not all of them.
• Cooking does not get rid of "red tide"
or Paralytic Shellfish Poison (PSP).
You can not tell from the color of the
water or the seafood if it has PSP.
For an updated recorded message of
beaches closed due to PSP or "red tide,
call the PSP Hotline ai:
1-800-562-5632
For a list of beaches closed for health
reasons, call the King County Health
Dcpar'.menl ai:
106-296-4112.
•Remove the guts of the fish.
Chemicals build-up in them
• Remove the skin of the fish or
poke holes in the skin. This lets
the fai dram out and
reduces the chemicals
in the fish
•After cooking,
throw out the
remaining fat
and juice from
the fish (the fats
and juices may
have chemical
coniaminanonV
-------
Appendix N-C
Asian and Pacific Islander Seafood Consumption Study
Focus Group Testing
Evaluation Questionnaire
Date_
Name
Please circle your ethnicity
Cambodian Chinese Filipino Hmong Japanese Korean
Lao Mien Samoan Vietnamese
Please evaluate the following categories based on your judgement of the Asian and
Pacific Islander Consumption Study Questionnaire. Please take your time. If you have
any questions, please ask the E.P.A. Project Coordinator.
CONTENT
1. Do you feel the questions are intrusive or insensitive? YES NO
If yes, please state your reason(s) why and which questions seem intrusive or
insensitive.
Please rate the length of the questionnaire.
LONG AVERAGE SHORT
FORMAT
Do the questions flow logically and smoothly section to section?
ALWAYS SOMETIMES NEVER
a. If "SOMETIMES" or "NEVER," please state your reason(s) why and which
question(s) should be rearranged?
155
-------
WORDING/LANGUAGE/TRANSLATION
I. Is the use of language clear and concise? Do the questions read easily?
ALWAYS SOMETIMES NEVER
2. Is the translation thorough and accurate enough? YES NO
PRESENTATION AND USE OF THE VISUAL DISPLAYS
1. Are the usage of the visual displays (seafoods) effective and helpful in answering the
questions?
YES NO
a. If no, please state your reason(s) why. •
2. Are the visual displays of seafood easily identifiable?
YES NO
a. If no, please state your reason(s) why.__
3. Are the use of the maps effective?
YES NO
a. If no, please state your reason(s) why.
MISCELLANEOUS
I. Are there any other recommendations which should be made to improve the
questionnaire?
2. Overall, how would you rate the questionnaire?
EXCELLENT GOOD AVERAGE POOR
Thank you very much for your cooperation and participation in the
Asian and Pacific Islander Seafood Consumption Study.
156
-------
APPENDIX N4
TABLE R-15 DESCRIBES THE ANALYSIS COMPLETED BY THE EIGHT FOCUS CROUP MEMBERS VIA
QUESTIONNAIRE. THE QUESTION ABOUT FORMAT FLOW WAS MISUNDERSTOOD.
"Chinese
! Format
i Flow
Yes
Yes
S*g^5psP^F:^^s^?rl^mvii*^!^lSf^
^^wsl^gf^eG^aa^atiaa.'^^^^^^^^l
M*&'®fy$X$*8x^
%gmi^
! 1. Clear, concise
Yes
Yes
Yes
No
Yes
Yes* Yes
Yes
2. Translation
Exc.
2. Graphics
3. Effectiveness
Good
Exc.
Ave.
Good
Good
Exc.
Ave.
Ave.
Exc.
Exc.
Good
**
Good
Good
Good
Good
4. Decision-making Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
DNA=did not answer
"Very good, but I suggested minor changes. Pis. see enclosed.
** Very good, again pis. see comments for minor changes.
Mdjl'ona' Comments by Focus Group Members
i 1. I didn't care for the images of the child on a bike and the elderly man. They seem disjointed with the
i pregnant figure. _ _^ _
I ' ~~~ - • -
I 2. It is very informative. _
LJ: __ UleJ[gnslation is easy and simple to read. The words are concise and meant directly to the content.
I 4. Please see attached. (Refers to editing on brochure.) _
j 5. (No comment) _
brochure in English and Tagalog. Thank you. _________
| 7. They are OK graphics and translation, except too many incorrect spellings.
.8- ____ People will [ read_& L_understand easier after corrected. _
157
-------
ua=in 'red tide' c: Porolylic Shellah
Poison (PSP).
tide.'
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tturts-«r^:ur»i King County
Health Deportment at.
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Developmenl |WiLD| Project at
inleioalional Distnsl Housing Aliance
IIDHAJ.
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reop/e forPugel So.;od 206-JS2-7007
iy :oi-296-4784
ounly -::5-839-5:30
hiiigion Sia.'e Depi. of Heaiili
Coiisumec AssislciKe Haline
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Reel fide iiVoimolioii Line
U.S. Enviroi-imenlol ProlecKon Agency
I-SS8-424-4372
pwionmental Risk Infoimolcn Sen/ice.
Uiiiversily Ol .
206-6 1 6-75 57
ttn!' miu 8tidiiJiJ8incihjoijrc
fiioariohu?
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TA *
ol EnwonmenlorHeall
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i«rwcfle7»in reufig. irofi K-UJ a-mSSn cihi '
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thftei
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ccaianu'i
ua'-w "red lido" or Paratylk: ShclllJ^l
Poison (PSP).
tide.'
1-800-542-5*32
resin
auns-vs^ajran King County
Health Deparlmeni ol:
206-296-4121 ,
fr«T tn-Rrfugn fidmnon StnictCmrr
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baengc.
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.
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• Mbuc mbiaua nyei juar, hoqc &ix fim fflbatc
maA »ou BJUULZ meh nyei.
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_• Mei obt irpiac oeyi zkngb hbc .
out zuqc dknr naogc g»u inei nyri tnbiaua
buy ayei £u. tyfbaaz birr naxic zucn njo, oer
jaac mau apfc nyd, cam mbiauz nyei oaxic-
anjjaac nwul^aouc nyei
• Mair duagx ckxh mbauh oyKfnz mrr £»tr
da'oycih uyungc bu doogfa nuv jienr orei
J*'<-»
• Mbiauz mix. ZOOJT ozuoox daxih hmagr^on
mqc rotqv dapr jienv (^£jafSqr. Mr •&*.*,
gocugv bai^ ajungc «Ar»rr £^ mbLra^r-dbajh
og nyinr na«jc oil rucjc aourzuoqc ozengc.
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2ouz bun meib burr tneogc wuor deiz juog cLfr • '
caov jiei, nrr baac mr haih «^«J» duqv nyuog^,—
• Oiz loogc soo-daan mange pax haix moa
koiv-hlcu guon mmgh «Moc BM^C !aA rram}i
benx t»cngc oyn jauv IKK, hmc loa
Couity Health Dcpirnncnt (King County
Hung-Jaa Zaah Dimv Baengc Nya Docngi)
(206) 2JW-4722
Loofc oaarr diuc ri tU nmr.
• Puk guoogc ga-dyuoz^ mteogi mbouz ayei
mngh jfi-aiiih acngc oya ga-naarr.
• Zoor nyei jiuv "^•'^ nrajr haih zcir» maiv
daic £u, cnxrr haih 2our diKjr cuocv oaafr
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nya hinf ii CDCKV
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i^eic 2i oa^r deix g»-'
naaih Wage ^»SP fin nd tide) nyei JUT not.
mbocqv naair noon doogh finx woe. 1-800-
562-5632 fan "••«g> ainlk mboa at*
-------
rr- / , . APPENDIX N5
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3.
Heuc Loa Domb Zuongx
Hungh Jaa nyei Zaah dimv
baengc zingh Dorngx
•Coucry Kealrb Dey
Soohomoh Couorr (425)839-5250
•Wutu^mo Sac Dept of HalA Conojjner
AuaaaxHodne 1-888- S856-94 27
•Red Tde lufoanaboa Line
•US EorironaimaJ IVnection Age
1-80O424-«372
•EovTOHrmnl Rck lajbereatxjn Service.
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206-616-7S57
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Appendix fs
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For More
Information
About Seafood:
Community
Contacts
•Refugee Federation Service Center
Bilingual services available.
206-725-9181
•Wilderness-Inner City Leadership
Development (WILD) Project at
International District Housing
Alliance (IDHA).
206-623-5132
• People for Puget Sound
206-382-7007
•Community Coalition for
Environmental Justice
206-720-0885
Public Health
Contacts
• County Health Departments
•Seattle/KJneCo. 206-296-4784
•SnohomislTCo. 425-839-5250
•Washington State Dept. of Health
Consumer Assistance Hotline
1-888-586-9427
•Red Tide Information Line
1-800-562-5632
•U.S. Environmental Protection
Agency
1-800-424-4372
•Environmental Risk Information
Service, University of Washington
206-616-7557
A Friendly Health Message
About Eating Seafood
From the
•Puget Sound-
Is Good
for You!
But did you know that it
can sometimes harm you7
TM an effort to understand the unique risks faced by the Asian Pacific American
JL11 community, a study was conducted by the Refugee Federation Service Center
and the University of Washington's Department of Environmental Health. For more
information about the study, contact the Refugee Federation Service Center or the
University of Washington (see For More Information).
Risks From
Eating Bad Seafood
Biological contaminants can cause many
illnesses: hepatitis, diarrhea and PSP.
PSP (Paralytic Shellfish Poison) or "Red
Tide" is a poison. You may have
tingling or numbness in your lips,
tongue, neck, fingers or toes if you have
PSP poisoning. In worse cases, you may
have breathing problems and trouble
moving your body.
Call for medical
attention immediately if
you experience these
problems.
This problem can be life threatening.
Eating too much seafood contaminated
with chemicals can lead to the build-up
of chemicals in your body. This may
increase your risk of:
•Cancer
• Kidney Damage
• Brain Damage, and the
•Ability to have healthy children.
Contaminants
Contaminants are things which can
get into food and make you sick
There are 2 kinds of contaminants:
biological
and chemical
contaminants.
Biological contaminants are bacteria,
parasites, viruses, and fish poisons.
Fish poisons are caused by the food
the seafood eat.
Industries, farms, and sewers all
contribute to the pollution that affects
your seafood. Seafood that live close
to these sources of pollution are often
the most affected.
Examples of chemical contaminants
include mercury, lead, and PCBs.
-
-
-------
Who is affected by
eating contaminated
seafood?
Everybody!!!!
But some people are
more sensitive and
should be more careful
about eating potentially
contaminated
seafood, such
•Pregnant women and
their unborn children
Here's How to Protect Yourself
Children of any age
•The elderly and
•People with medical problems,
especially liver disease, diabetes,
and problems with the immune
svstem
1
Know what types of seafood
are more likely to cause
problems:
•Older and larger fish have more
chance to store up toxins than younger,
smaller fish.
•Fish and shellfish that live at the
bottom of the water tend to have more
contaminants.
• Some parts of the seafood may have
higher amounts of contaminants, for
instance, the "butter" of crabs is higher
in toxins than the meat
•Some species have special risks. For
example, poison from germs on
spoiling tuna may cause allergic
reactions.
2
Know where your seafood
came from:
• Use safe fishing practices. Contact the
Washington State Department of
Health for safety information:
1-888-586-9427
•Pay attention to warning signs at the
beaches and piers.
• Check with the Washington State
Department of Health for safe and
open shellfish harvesting locations.
3
Use safe preparation practices:
•Check to see if your fish is spoiling
before you eat it. A strong fishy smell,
softening of the meat, and hazy eyes
on fish can be signs of bad fish.
•Keep raw fish away from other foods
being prepared.
•Proper refrigeration after catching, and
cooking all fish and shellfish before
eating will kill most of the germs that
can make you sick, but not all of them.
•Cooking does not get rid of "red tide"
[Paralytic Shellfish Poison (PSP)].
You cannot tell if the seafood has PSP
from the color of the water.
For an updated recorded message of
beaches closed due to PSP or "red tide,
call the PSP Hotline at:
1-800-562-5632
For a list of beaches closed for health
reasons, call the King County Health
Department at:
206-296-4722
Safe Cooking Ideas:
' Remove the guts of the fish.
Chemicals build-up in them.
• Remove the skin of the fish or
poke holes in the skin. This lets
the fat drain out and
reduces the chemicals
in the fish.
•After cooking,
throw out the
remaining fat
and juice from
the fish (the fats
and juices may
have chemical
contamination).
_
-
f untied tn L 'S Environmental Protection Agency Community I University Partnership Grant »EQ825003-01-0
tgenfiics and Environmental Health
------- |