Human exposure monitoring and evaluation in the Arctic: the importance of understanding exposures to the development of public health policy

Contamination of aquatic ecosystems by persistent organic pollutants (POPs) originating from landfills in Canada and the United States: A rapid scoping review

Persistent organic pollutants (POPs) are organic chemical substances that threaten human health and the planet's ecosystems due to their toxicity and their ability to remain intact for a long time, wide distribution throughout the environment, and accumulation and magnification in living organisms through the food chain. Discarded products from landfills and dumpsites are potential sources of POPs due to their persistence for several decades and constant release to surrounding environment. POPs in aquatic systems signal input predominantly from landfills, wastewater treatment plants, sewage, and urban runoff, suggesting a research gap to guide policies to address these unabated releases. This scoping review aims to rapidly identify the key concepts underpinning the containment, translation, and migration of POPs in Canadian and US landfill leachate. The review targeted multidisciplinary perspectives on the topic and spanned forensic biology, environmental sciences, chemistry, and geology. Contaminated municipal solid waste (MSW) landfill characteristics, as reported by government agencies in Canada and the US, were synthesized and harmonized to illustrate the geographical scope of MSW landfills releasing POPs into the surrounding environment. The knowledge and data gaps summarized in this study highlight the need to address the inadvertent release of POPs from Canadian and US landfills, particularly in consideration of dated and degrading landfill infrastructure, the proximity of marginalized people, and the implications of climate change on the countries' more vulnerable landscapes. This review is applicable to the development of future studies that aim to guide environmental protective policies.

Differential gene expression and developmental pathologies associated with persistent organic pollutants in sentinel fish in Troutman Lake, Sivuqaq, Alaska

Persistent organic pollutants (POPs) are lipophilic compounds that bioaccumulate in animals and biomagnify within food webs. Many POPs are endocrine disrupting compounds that impact vertebrate development. POPs accumulate in the Arctic via global distillation and thereby impact high trophic level vertebrates as well as people who live a subsistence lifestyle. The Arctic also contains thousands of point sources of pollution, such as formerly used defense (FUD) sites. Sivuqaq (St. Lawrence Island), Alaska was used by the U.S. military during the Cold War and FUD sites on the island remain point sources of POP contamination. We examined the effects of POP exposure on ninespine stickleback (Pungitius pungitius) collected from Troutman Lake in the village of Gambell as a model for human exposure and disease. During the Cold War, Troutman Lake was used as a dump site by the U.S. military. We found that PCB concentrations in stickleback exceeded the U.S. Environmental Protection Agency's guideline for unlimited consumption despite these fish being low trophic level organisms. We examined effects at three levels of biological organization: gene expression, endocrinology, and histomorphology. We found that ninespine stickleback from Troutman Lake exhibited suppressed gonadal development compared to threespine stickleback (Gasterosteus aculeatus) studied elsewhere. Troutman Lake stickleback also displayed two distinct hepatic phenotypes, one with lipid accumulation and one with glycogen-type vacuolation. We compared the transcriptomic profiles of these liver phenotypes using RNA sequencing and found significant upregulation of genes involved in ribosomal and metabolic pathways in the lipid accumulation group. Additionally, stickleback displaying liver lipid accumulation had significantly fewer thyroid follicles than the vacuolated phenotype. Our study and previous work highlight health concerns for people and wildlife due to pollution hotspots in the Arctic, and the need for health-protective remediation.

Physical exercise and persistent organic pollutants

Exposure to the legacy and emerging persistent organic pollutants (POPs) incessantly has become an important threat to individual health, which is closely related to neurodevelopment, endocrine and cardiovascular homeostasis. Exercise, on the other hand, has been consistently shown to improve physical fitness. Whereas associations between traditional air pollutants, exercise and lung function have been thoroughly reviewed, reviews on associations between persistent organic pollutants and exercise are scarce. Hence, a literature review focused on exercise, exposure to POPs, and health risk assessment was performed for studies published from 2004 to 2022. The purpose of this review is to provide an overview of exposure pathways and levels of POPs during exercise, as well as the impact of exercise on health concerns attributable to the redistribution, metabolism, and excretion of POPs in vivo. Therein lies a broader array of exercise benefits, including insulin sensitizing, mitochondrial DNA repair, lipid metabolism and intestinal microecological balance. Physical exercise is conducive to reduce POPs body burden and resistant to health hazards of POPs generally. Besides, individual lipid metabolism condition is a critical factor in evaluating potential link in exercise, POPs and health effects.

A State-of-the-Art Review of Indigenous Peoples and Environmental Pollution

Indigenous peoples (IPs) worldwide are confronted by the increasing threat of pollution. Based on a comprehensive review of the literature (n = 686 studies), we present the current state of knowledge on: 1) the exposure and vulnerability of IPs to pollution; 2) the environmental, health, and cultural impacts of pollution upon IPs; and 3) IPs' contributions to prevent, control, limit, and abate pollution from local to global scales. Indigenous peoples experience large burdens of environmental pollution linked to the expansion of commodity frontiers and industrial development, including agricultural, mining, and extractive industries, as well as urban growth, waste dumping, and infrastructure and energy development. Nevertheless, IPs are contributing to limit pollution in different ways, including through environmental monitoring and global policy advocacy, as well as through local resistance toward polluting activities. This work adds to growing evidence of the breadth and depth of environmental injustices faced by IPs worldwide, and we conclude by highlighting the need to increase IPs' engagement in environmental decision-making regarding pollution control. Integr Environ Assess Manag 2020;16:324-341. © 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Screening-level microbial risk assessment of acute gastrointestinal illness attributable to wastewater treatment systems in Nunavut, Canada

Most arctic communities use primary wastewater treatment systems that are capable of only low levels of pathogen removal. Effluent potentially containing fecally derived microorganisms is released into wetlands and marine waters that may simultaneously serve as recreation or food harvesting locations for local populations. The purpose of this study is to provide the first estimates of acute gastrointestinal illness (AGI) attributable to wastewater treatment systems in Arctic Canada. A screening-level, point estimate quantitative microbial risk assessment model was developed to evaluate worst-case scenarios across an array of exposure pathways in five case study locations. A high annual AGI incidence rate of 5.0 cases per person is estimated in Pangnirtung, where a mechanical treatment plant discharges directly to marine waters, with all cases occurring during low tide conditions. The probability of AGI per person per single exposure during this period ranges between 1.0 × 10^-1 (shore recreation) and 6.0 × 10^-1 (shellfish consumption). A moderate incidence rate of 1.2 episodes of AGI per person is estimated in Naujaat, where a treatment system consisting of a pond and tundra wetland is used, with the majority of cases occurring during spring. The pathway with the highest individual probability of AGI per single exposure event is wetland travel at 6.0 × 10^-1. All other risk probabilities per single exposure are <1.0 × 10^-1. The AGI incidence rates estimated for the other three case study locations are <0.1. These findings suggest that wastewater treatment sites may be contributing to elevated rates of AGI in some arctic Canadian communities. Absolute risk values, however, should be weighed with caution based on the exploratory nature of this study design. These results can be used to inform future risk assessment and epidemiological research as well as support public health and sanitation decisions in the region.

Wastewater treatment and public health in Nunavut: a microbial risk assessment framework for the Canadian Arctic

Wastewater management in Canadian Arctic communities is influenced by several geographical factors including climate, remoteness, population size, and local food-harvesting practices. Most communities use trucked collection services and basic treatment systems, which are capable of only low-level pathogen removal. These systems are typically reliant solely on natural environmental processes for treatment and make use of existing lagoons, wetlands, and bays. They are operated in a manner such that partially treated wastewater still containing potentially hazardous microorganisms is released into the terrestrial and aquatic environment at random times. Northern communities rely heavily on their local surroundings as a source of food, drinking water, and recreation, thus creating the possibility of human exposure to wastewater effluent. Human exposure to microbial hazards present in municipal wastewater can lead to acute gastrointestinal illness or more severe disease. Although estimating the actual disease burdens associated with wastewater exposures in Arctic communities is challenging, waterborne- and sanitation-related illness is believed to be comparatively higher than in other parts of Canada. This review offers a conceptual framework and evaluation of current knowledge to enable the first microbial risk assessment of exposure scenarios associated with food-harvesting and recreational activities in Arctic communities, where simplified wastewater systems are being operated.

Health Consequences of Environmental Exposures in Early Life: Coping with a Changing World in the Post-MDG Era

Despite overall progress toward achieving the Millennium Development Goals, large health discrepancies persist between developed and developing countries. The world is rapidly changing and the influences of societal change and climate change will disproportionately affect the world's most vulnerable populations, thus exacerbating current inequities. Current development strategies do not adequately address these disproportionate impacts of environmental exposures. The aim of this study was to propose a new framework to address the health consequences of environmental exposures beyond 2015. This framework is transdisciplinary and precautionary. It is based on identifying social and economic determinants of health, strengthening primary health systems, and improving the health of vulnerable populations. It incorporates deliberate plans for assessment and control of avoidable environmental exposures. It sets specific, measurable targets for health and environmental improvement.

Exposure of Arctic populations to methylmercury from consumption of marine food: an updated risk-benefit assessment

Recent and powerful epidemiological studies have been used as a basis for revising international and domestic guidelines for human exposure to mercury. Long-range transport of mercury into the Arctic makes some Arctic peoples consuming traditional marine foods, especially newborns, children and pregnant women, very vulnerable to harmful exposures. The WHO, the USEPA and Health Canada have all recently revised their mercury intake guidelines as a result of neurological effects reported in children exposed in utero and adults. Guidance values are equivalent to 0.23 microg/kg-bw/d, 0.1 microg/kg-bw/d and 0.2 microg/kg-bw/d respectively. Differences between the numbers represent slight differences in the uncertainty factors applied, rather than in toxicological interpretation. More recent findings suggest that mercury may also be a factor in ischemic heart disease, which could lower guidance values in the future. Considering the benefits of marine fatty acids (n-3 fatty acids) and guidance that populations consume 300-400g fish/week, consumers face a reality that most open ocean and relatively 'unpolluted' fish species contain levels of mercury that would lead to exposures at current guidance levels. Clearly, there is no more room for further mercury pollution and there is an urgent need for international action to reduce mercury emissions. Concomitantly, while there may be a need for public health authorities to provide consumption advisories to some highly exposed populations, such as in the Arctic, there remains a need to better understand the interactions and benefits associated with marine foods that may reduce health risks associated with low-level mercury exposure.

The Pivotal Role of the Social Sciences in Environmental Health Sciences Research

Environmental health sciences research seeks to elucidate environmental factors that put human health at risk. A primary aim is to develop strategies to prevent or reduce exposures and disease occurrence. Given this primary focus on prevention, environmental health sciences research focuses on the populations most at risk such as communities of color and/or low socioeconomic status. The National Institute of Environmental Health Sciences research programs incorporate the principles of Community-Based Participatory Research to study health disparities. These programs promote community engagement, culturally appropriate communications with a variety of stakeholders, and consideration of the social determinants of health that interact with environmental factors to increase risk. Multidisciplinary research teams that include social and behavioral scientists are essential to conduct this type of research. This article outlines the history of social and behavioral research funding at National Institute of Environmental Health Sciences and offers examples of National Institute of Environmental Health Sciences-funded projects that exemplify the value of social science to the environmental health sciences.

Determination of selected chemical parameters in surface water samples collected from the Revelva catchment (Hornsund fjord, Svalbard)

ABSTRACT

Surface water samples (river and lake) were collected from the Revelva catchment every summer from 2010 to 2013. This study concerns importance of the use of some analytical techniques for pollutants and parameters determination in Arctic environmental samples based on the example of total organic carbon, phenols, and formaldehyde determination and measurement of pH and electrical conductivity parameters. Significant average concentration levels of formaldehyde were observed in 2012 and reached 0.26 mg/dm3. Furthermore, the highest determined levels of total organic carbon and electrical conductivity were observed in samples collected in summer 2013. The average value of total organic carbon in that year was 9.54 mg/dm3, and electrical conductivity increased to 63.0 µS/cm. The results of surface water samples analyses show an increasing trend in pollutants concentration levels over the years what may suggest that each year the emission of contaminants from lower latitudes is bigger and, consequently, more of them are deposited in the Arctic.

GRAPHICAL ABSTRACT

Water systems, sanitation, and public health risks in remote communities: Inuit resident perspectives from the Canadian Arctic

Safe drinking water and wastewater sanitation are universally recognized as critical components of public health. It is well documented that a lack of access to these basic services results in millions of preventable deaths each year among vulnerable populations. Water and wastewater technologies and management practices are frequently tailored to local environmental conditions. Also important, but often overlooked in water management planning, are the social, cultural and economic contexts in which services are provided. The purpose of this qualitative case study was to identify and understand residents' perceptions of the functionality of current water and wastewater sanitation systems in one vulnerable context, that of a remote Arctic Aboriginal community (Coral Harbour, Nunavut), and to identify potential future water related health risks. Semi-structured interviews were conducted with 28 Inuit residents and 9 key informants in 2011 and 2012. Findings indicate that the population's rapid transition from a semi-nomadic hunting and gathering lifestyle to permanent settlements with municipally provided utilities is influencing present-day water usage patterns, public health perceptions, and the level of priority decision-makers place on water and wastewater management issues. Simultaneously environmental, social and cultural conditions conducive to increased human exposure to waterborne health risks were also found to exist and may be increasing in the settlements. While water and wastewater system design decisions are often based on best practices proven suitable in similar environmental conditions, this study reinforces the argument for inclusion of social, cultural, and economic variables in such decisions, particularly in remote and economically challenged contexts in Canada or elsewhere around the world. The results also indicate that the addition of qualitative data about water and wastewater systems users' behaviours to technical knowledge of systems and operations can enhance the understanding of human-water interactions and be valuable in risk assessments and intervention development.

Persistent Organochlorine Pesticide Exposure Related to a Formerly Used Defense Site on St. Lawrence Island, Alaska: Data from Sentinel Fish and Human Sera

St. Lawrence Island, Alaska, is the largest island in the Bering Sea, located 60 km from Siberia. The island is home to approximately 1600 St. Lawrence Island Yupik residents who live a subsistence way of life. Two formerly used defense sites (FUDS) exist on the island, one of which, Northeast Cape, has been the subject of a $123 million cleanup effort. Environmental monitoring demonstrates localized soil and watershed contamination with polychlorinated biphenyls (PCB), organochlorine (OC) pesticides, mercury, and arsenic. This study examined whether the Northeast Cape FUDS is a source of exposure to OC pesticides. In total, 71 serum samples were collected during site remediation from volunteers who represented three geographic regions of the island. In addition, ninespine stickleback (Pungitius pungitius) and Alaska blackfish (Dallia pectoralis) were collected from Northeast Cape after remediation to assess continuing presence of OC pesticides. Chlordane compounds, DDT compounds, mirex, and hexachlorobenzene (HCB) were the most prevalent and present at the highest concentrations in both fish tissues and human serum samples. After controlling for age and gender, activities near the Northeast Cape FUDS were associated with an increase in serum HCB as compared to residents of the farthest village from the site. Positive but nonsignificant relationships for sum-chlordane and sum-DDT were also found. Organochlorine concentrations in fish samples did not show clear geographic trends, but appear elevated compared to other sites in Alaska. Taken together, data suggest that contamination of the local environment at the Northeast Cape FUDS may increase exposure to select persistent OC pesticides.

The effects of Young Adults Eating and Active for Health (YEAH): a theory-based Web-delivered intervention

OBJECTIVE

To assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process.

DESIGN

A 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail.

SETTING

Thirteen college campuses.

PARTICIPANTS

A total of 1,639 college students.

INTERVENTION

Twenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content.

MAIN OUTCOME MEASURE

All participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline.

ANALYSIS

Chi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes.

RESULTS

There were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control.

CONCLUSIONS AND IMPLICATIONS

Young Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.

Community-based participatory research projects and policy engagement to protect environmental health on St Lawrence Island, Alaska

Objectives

This article synthesizes discussion of collaborative research results, interventions and policy engagement for St Lawrence Island (SLI), Alaska, during the years 2000–2012.

Methods

As part of on-going community-based participatory research (CBPR) studies on SLI, 5 discrete exposure-assessment projects were conducted: (a) a biomonitoring study of human blood serum; (b–d) 3 investigations of levels of contaminants in environmental media at an abandoned military site at Northeast Cape – using sediment cores and plants, semi-permeable membrane devices and blackfish, respectively; and (e) a study of traditional foods.

Results

Blood serum in residents of SLI showed elevated levels of polychlorinated biphenyls (PCBs) with higher levels among those exposed to the military site at Northeast Cape, an important traditional subsistence-use area. Environmental studies at the military site demonstrated that the site is a continuing source of PCBs to a major watershed, and that clean-up operations at the military site generated PCB-contaminated dust on plants in the region. Important traditional foods eaten by the people of SLI showed elevated concentrations of PCBs, which are primarily derived from the long-range transport of persistent pollutants that are transported by atmospheric and marine currents from more southerly latitudes to the north.

Interventions

An important task for all CBPR projects is to conduct intervention strategies as needed in response to research results. Because of the findings of the CBPR projects on SLI, the CBPR team and the people of the Island are actively engaging in interventions to ensure cleanup of the formerly used military sites; reform chemicals policy on a national level; and eliminate persistent pollutants internationally. The goal is to make the Island and other northern/Arctic communities safe for themselves and future generations.

Conclusions

As part of the CBPR projects conducted from 2000 to 2012, a series of exposure assessments demonstrate that the leaders of SLI have reason to be concerned about the health of people due to the presence of carcinogenic chemicals as measured in biomonitoring and environmental samples and important traditional foods.

State calculations of cultural survival in environmental risk assessment: consequences for Alaska Natives

In 2007, the Alaska Division of Public Health issued their first-ever fish consumption advisory to reduce exposure to methylmercury. Interestingly, they utilized a toxicity level in their calculations of risk that is four times higher than the U.S. Environmental Protection Agency's (EPA) level, arguing that the EPA's calculation is "inappropriately restrictive" for Alaskans. This article explores the institutional reasoning and scientific calculations behind the state's fish consumption advice, with special attention paid to the consequences for Alaska Natives. I argue that a discourse of "Alaskan exceptionalism" is utilized by the health department to justify their assessment of risk. Although this exceptionalist discourse is intended to accommodate the unique lifestyles of Alaskan citizens, it may actually serve to undermine the very lifeways and traditions that it presumes to preserve. This article contributes insights into the ways that states can influence the social and material reproduction of communities through the deployment of "cultural difference" during the risk-assessment process.

Organochlorine and metal contaminants in traditional foods from St. Lawrence Island, Alaska

Marine mammals (bowhead whale, walrus, and various seals) constitute the major component of the diet of the Yupik people of St. Lawrence Island, Alaska. St. Lawrence Island residents have higher serum concentrations of polychlorinated biphenyls (PCB) than in the general U.S. population. In order to determine potential sources, traditional food samples were collected from 2004 to 2009 and analyzed for PCBs, three chlorinated pesticides, and seven heavy metals (mercury, copper, zinc, arsenic, selenium, cadmium, and lead). Concentrations of PCB in rendered oils (193-421 ppb) and blubber (73-317 ppb) from all marine mammal samples were at levels that trigger advisories for severely restricted consumption, using U.S. Environmental Protection Agency (EPA) fish consumption advisories. Concentrations of pesticides were lower, but were still elevated. The highest PCB concentrations were found in polar bear (445 ppb) and the lowest in reindeer adipose tissue (2 ppb). Marine mammal and polar bear meat in general have PCB concentrations that were 1-5% of those in rendered oils or adipose tissue. PCB concentrations in organs were higher than meat. Concentrations of metals in oils and meats from all species were relatively low, but increased levels of mercury, cadmium, copper, and zinc were present in some liver and kidney samples. Mercury and arsenic were found in lipid-rich samples, indicating organometals. These results show that the source of the elevated concentrations of these contaminants in the Yupik population is primarily from consumption of marine mammal blubber and rendered oils.

Levels of polychlorinated biphenyls (PCBs) and three organochlorine pesticides in fish from the Aleutian Islands of Alaska

BACKGROUND

Persistent organic pollutants (POPs), including polychlorinated biphenyls (PCBs) and chlorinated pesticides, have been shown to have many adverse human health effects. These contaminants therefore may pose a risk to Alaska Natives that follow a traditional diet high in marine mammals and fish, in which POPs bioaccumulate.

METHODS AND FINDINGS

This study examined the levels of PCBs and three pesticides [p, p'-DDE, mirex, and hexachlorobenzene (HCB)] in muscle tissue from nine fish species from several locations around the Aleutian Islands of Alaska. The highest median PCB level was found in rock sole (Lepidopsetta bilineata, 285 ppb, wet weight), while the lowest level was found in rock greenling (Hexagrammos lagocephalus, 104 ppb, wet weight). Lipid adjusted PCB values were also calculated and significant interspecies differences were found. Again, rock sole had the highest level (68,536 ppb, lipid weight). Concerning the PCB congener patterns, the more highly chlorinated congeners were most common as would be expected due to their greater persistence. Among the pesticides, p, p'-DDE generally dominated, and the highest level was found in sockeye salmon (Oncorhynchus nerka, 6.9 ppb, wet weight). The methodology developed by U.S. Environmental Protection Agency (USEPA) was used to calculate risk-based consumption limits for the analyzed fish species. For cancer health endpoints for PCBs, all species would trigger strict advisories of between two and six meals per year, depending upon species. For noncancer effects by PCBs, advisories of between seven and twenty-two meals per year were triggered. None of the pesticides triggered consumption limits.

CONCLUSION

The fish analyzed, mainly from Adak, contain significant concentrations of POPs, in particular PCBs, which raises the question whether these fish are safe to eat, particularly for sensitive populations. However when assessing any risk of the traditional diet, one must also consider the many health and cultural benefits from eating fish.

Methylmercury risk and awareness among American Indian women of childbearing age living on an inland northwest reservation

American Indian women and children may be the most overrepresented among the list of disparate populations exposed to methylmercury. American Indian people fish on home reservations where a state or tribal fishing license (a source of advisory messaging) is not required. The purpose of this study was to examine fish consumption, advisory awareness, and risk communication preferences among American Indian women of childbearing age living on an inland Northwest reservation. For this cross-sectional descriptive study, participants (N=65) attending a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic were surveyed between March and June 2006. An electronic questionnaire adapted from Anderson et al. (2004) was evaluated for cultural acceptability and appropriateness by tribal consultants. Regarding fish consumption, approximately half of the women surveyed (49%) indicated eating locally caught fish with the majority signifying they consumed medium- and large-size fish (75%) that could result in exposure to methylmercury. In addition, a serendipitous discovery indicated that an unanticipated route of exposure may be fish provided from a local food bank resulting from sportsman's donations. The majority of women (80%) were unaware of tribal or state fish advisory messages; the most favorable risk communication preference was information coming from doctors or healthcare providers (78%). Since the population consumes fish and has access to locally caught potentially contaminated fish, a biomonitoring study to determine actual exposure is warranted.