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Seafood Choices: Balancing Benefits and Risks C Tables and Scenarios BOX C-1 A Case Scenario—The Pregnant Womana Pregnant women are advised of the potential advantage to their fetuses of EPA/DHA and other nutrients that seafood contains, as well as the potential consequences of exposure to toxicants (both microbiological and environmental). How do pregnant women balance these issues? A woman establishes her food choices early in life and continues this pattern as she matures (trajectory). Pregnancy is a major transition in a woman’s life. If this is her first pregnancy, the woman may rely on her family, her partner, medical professionals, and other authorities to provide information upon which to base her food choices (reflecting cultural influences and linked lives). If she has been pregnant before, she can base her decisions on her previous experience. If new information has been released since her last pregnancy (e.g., a seafood advisory), she may be unaware of the emerging issues (contextual influences and timing in lives) or she could consider them irrelevant to her own situation. Prior to making her food choices, she may make conscious decisions regarding which foods to eat or to avoid (adaptive strategies). For example, a woman who has eaten shrimp as her primary seafood choice throughout her life might consider choosing salmon during her pregnancy. If she was raised on local fish in Wyoming but moved to Michigan at the start of her pregnancy, she might cease to eat any fish (local or otherwise) in response to fish advisories. aItalicized words reflect key concepts of the Life Course Perspective (Wethington, 2005; Devine, 2005).
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Seafood Choices: Balancing Benefits and Risks TABLE C-1 Selected Theoretical Models Describing Health Behavior, Food Choice, and Behavior Change Theory Brief Description Health Belief Model (Rosenstock, 1974) Assumes individuals will protect their health if they think they are susceptible to the threat, believe that if they change behaviors they can reduce the threat (with benefits outweighing barriers), and that they are able to make the change. Life Course Perspective (Wethington, 2005) Key concepts: trajectories (stable patterns of behavior over time); transitions (changes in social responsibilies and roles); turning points (major life events); cultural and contextual influences (environmental events that shape and constrain change and adaptation); timing in lives (interaction between the timing of the event and the age/stage of the life course); linked lives (dependence of one person on another); and adaptive strategies (conscious decisions) Optimistic Bias (Shepard, 1999) (Weinstein, 1987) Underestimation of the risk to oneself relative to others. PEN-3 (Airhihenbuwa, 1995) Consists of three interrelated and interdependent dimensions of health: health education diagnosis (identification of the target audience); education diagnosis of health behavior (exploration of target audience’s supporting factors and beliefs); and cultural appropriateness of the health behavior (both positive and negative). Transtheoretical Model (Stages of Change) (Prochaska, 1995) (Prochaska and Vellicer, 1997) (Weinstein et al., 1998) Integrates a variety of theories (transtheoretical) to both describe progression of changes and to explain associated behaviors necessary to achieve change. Stages include: Precontemplation (time when an individual is not considering or not aware that change is needed); Contemplation (time when an individual is aware of a problem and is considering action to resolve it); Preparation (time when an individual commits to taking action); Action (time when effort is noted); Maintenance (time when a person tries to stabilize the change); Termination (time when no temptation to revert back to old behavior).
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Seafood Choices: Balancing Benefits and Risks TABLE C-2 Processes of Change Processes Description Thinking and Feeling Processes Occurring in Precontemplation, Contemplation, Preparation, and Maintenance Consciousness raising Increases information, feedback and understanding about self and problem Dramatic relief Expresses and experiences feelings about one’s problems and solutions Self-reevaluation Assesses one’s feelings about oneself with respect to problem Self-liberation Consciously chooses and commits to act; believes in ability to change Social liberation Increases available alternatives for non-problem societal behaviors Environmental reevaluation Assesses how one’s problems affect physical condition and social environment Doing and Reinforcing Processes Occurring in Preparation, Action, and Maintenance Helping relationships Is open and trusting about one’s problems with someone who cares Reinforcement management Rewards self for making changes Interpersonal systems control Counter-conditioning Substitutes alternatives for problem behavior Stimulus control Avoids stimuli that produce problem behavior SOURCE: Adapted from the Journal of the American Dietetic Association, 102(Supplement 3), Sigman-Grant, Strategies for counseling adolescents, S32–S39, Copyright (2002), with permission from the American Dietetic Association.
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Seafood Choices: Balancing Benefits and Risks BOX C-2 A Family Seafood Selection Scenario Description of Family Members Tom: father; 57 years old; his father died of a heart attack at 56 years old Nan: mother; 55 years old; no family history of cardiovascular disease Dave: son; 32 years old; healthy, but his BMI is 28 Sharon: daughter; 25 years old; married to Jim and is 2 months pregnant with her first child Cindy: cousin; 28 years old; lives in Alaska and is visiting Sharon Context of their lives Tom, Nan, Dave, Sharon, and Jim live near a lake in the Midwest. They are recreational fishers but tend to catch and release. They usually purchase seafood from the local supermarket. The family is very health-conscious, and every member goes for yearly check-ups. During Tom’s last visit to his cardiologist, the nurse gave him a pamphlet that encouraged him to eat two servings per week of fish high in omega-3 fatty acids. Nan’s gynecologist confirmed that she is in menopause, encouraged her to continue her healthy lifestyle, and suggested she might want to go to the MyPyramid.gov website to get a personalized diet plan using the new Food Guidance System. Since Tom’s father died from a heart attack at a young age, Nan has tried to choose lean meat for dinner, including a weekly serving of lean seafood (primarily shrimp). She chooses shrimp because of local advisories warning against eating fatty fish, due to their DLC content. When she goes to her market, she is unable to tell where the fish came from, so she figured shrimp would be the safest. Dave relies on fast foods. His primary seafood selection, which is a fried fish sandwich, is eaten at least three times a week. Dave was told by his general practitioner to lose weight and he suggested eating lean poultry, meat, and fish. Sharon and Jim became more thoughtful about their eating patterns when Sharon’s pregnancy was confirmed. Before this time, they rarely ate seafood except for canned white tuna which they used occasionally for luncheon sandwiches. On Sharon’s first visit to her obstetrician, she told Sharon to increase her intake of DHA and EPA but then Sharon was given a pamphlet that warned her against eating certain fish because they contain methylmercury. Sharon left the office very confused. Cindy lives in Alaska with her husband’s family, who are Inuit. Cindy has acclimated to her new lifestyle with her husband and family. She now eats their traditional diet, including marine seafood. She is planning to get pregnant and is excited to learn what to expect from Sharon.