Jillian P. Fry

Periodic prompts and reminders in health promotion and health behavior interventions: systematic review.

Background Health behavior interventions using periodic prompts have utilized technology, such as the Internet, that allows messages to be sent to participants in cost-effective ways. To our knowledge, no comprehensive evidence review has been performed specifically to evaluate the effectiveness of communicating regular messages and to examine how characteristics of the prompts change the effectiveness of programs aimed at reminding people to adopt healthy behaviors, maintain those they already practice, and cease unhealthy behaviors. Objective A systematic literature review was performed to investigate the effectiveness of limited contact interventions targeting weight loss, physical activity, and/or diet that provided periodic prompts regarding behavior change for health promotion. The review sought to identify specific characteristics of these interventions that may be associated with superior results. Methods Electronic literature searches were performed between February and April, 2008. Articles were included if periodic prompts were used as an intervention or a component of an intervention, a behavioral or biological outcome measure was used, and an ongoing health promotion behavior was targeted. A rating system was applied to each study to provide a quantitative representation of the quality of the evidence provided by each article. Results There were 19 articles with a combined sample size of 15,655 that met the inclusion criteria, and 11 studies reported positive findings regarding the utility of periodic prompts. Several articles showed enhanced effectiveness when prompts were frequent and personal contact with a counselor was included. Long-term behavior change and health improvements were not examined by this review because of a lack of long-term follow-up in the literature. Conclusions In light of promising results of most studies, additional research on limited contact interventions targeting health behaviors including weight loss, physical activity, and/or diet is merited that utilizes rigorous methods including control groups; follow-up data collection; and testing of prompt frequencies, specific intervention components, or prompt characteristics. Future research would be especially valuable if it improves understanding of the most effective types of periodic prompts for fostering long-term behavior change in order to maximize use of this tool in limited contact health promotion programs. Specifically, various types of communication technology should be used and evaluated to expand and refine their use.

An International Survey of Aquaponics Practitioners

Aquaponics, a combination of fish farming and soilless plant farming, is growing in popularity and gaining attention as an important and potentially more sustainable method of food production. The aim of this study was to document and analyze the production methods, experiences, motivations, and demographics of aquaponics practitioners in the United States (US) and internationally. The survey was distributed online using a chain sampling method that relied on referrals from initial respondents, with 809 respondents meeting the inclusion criteria. The majority of respondents were from the US (80%), male (78%), and had at least a high school degree (91%). The mean age of respondents was 47±13 years old. Most respondents (52%) had three years or less of aquaponics experience. Respondents typically raised tilapia or ornamental fish and a variety of leafy green vegetables, herbs, and fruiting crops. Respondents were most often motivated to become involved in aquaponics to grow their own food, for environmental sustainability reasons, and for personal health reasons. Many respondents employed more than one method to raise crops, and used alternative or environmentally sustainable sources of energy, water, and fish feed. In general, our findings suggest that aquaponics is a dynamic and rapidly growing field with participants who are actively experimenting with and adopting new technologies. Additional research and outreach is needed to evaluate and communicate best practices within the field. This survey is the first large-scale effort to track aquaponics in the US and provides information that can better inform policy, research, and education efforts regarding aquaponics as it matures and possibly evolves into a mainstream form of agriculture.

Environmental health impacts of feeding crops to farmed fish.

Half of the seafood consumed globally now comes from aquaculture, or farmed seafood. Aquaculture therefore plays an increasingly important role in the global food system, the environment, and human health. Traditionally, aquaculture feed has contained high levels of wild fish, which is unsustainable for ocean ecosystems as demand grows. The aquaculture industry is shifting to crop-based feed ingredients, such as soy, to replace wild fish as a feed source and allow for continued industry growth. This shift fundamentally links seafood production to terrestrial agriculture, and multidisciplinary research is needed to understand the ecological and environmental health implications. We provide basic estimates of the agricultural resource use associated with producing the top five crops used in commercial aquaculture feed. Aquacultures environmental footprint may now include nutrient and pesticide runoff from industrial crop production, and depending on where and how feed crops are produced, could be indirectly linked to associated negative health outcomes. We summarize key environmental health research on health effects associated with exposure to air, water, and soil contaminated by industrial crop production. Our review also finds that changes in the nutritional content of farmed seafood products due to altered feed composition could impact human nutrition. Based on our literature reviews and estimates of resource use, we present a conceptual framework describing the potential links between increasing use of crop-based ingredients in aquaculture and human health. Additional data and geographic sourcing information for crop-based ingredients are needed to fully assess the environmental health implications of this trend. This is especially critical in the context of a food system that is using both aquatic and terrestrial resources at unsustainable rates.

Public Health Perspectives on Aquaculture

Nearly half of all seafood consumed globally comes from aquaculture, a method of food production that has expanded rapidly in recent years. Increasing seafood consumption has been proposed as part of a strategy to combat the current non-communicable disease (NCD) pandemic, but public health, environmental, social, and production challenges related to certain types of aquaculture production must be addressed. Resolving these complicated human health and ecologic trade-offs requires systems thinking and collaboration across many fields; the One Health concept is an integrative approach that brings veterinary and human health experts together to combat zoonotic disease. We propose applying and expanding the One Health approach to facilitate collaboration among stakeholders focused on increasing consumption of seafood and expanding aquaculture production, using methods that minimize risks to public health, animal health, and ecology. This expanded application of One Health may also have relevance to other complex systems with similar trade-offs.

Investigating the Role of State and Local Health Departments in Addressing Public Health Concerns Related to Industrial Food Animal Production Sites

Objectives Evidence of community health concerns stemming from industrial food animal production (IFAP) facilities continues to accumulate. This study examined the role of local and state health departments in responding to and preventing community-driven concerns associated with IFAP. Methods We conducted semi-structured qualitative interviews with state and county health department staff and community members in eight states with high densities or rapid growth of IFAP operations. We investigated the extent to which health concerns associated with IFAP sites are reported to health departments, the nature of health departments’ responses, and barriers to involvement. Results Health departments’ roles in these matters are limited by political barriers, lack of jurisdiction, and finite resources, expertise, and staff. Community members reported difficulties in engaging health departments on these issues. Conclusions Our investigation suggests that health departments frequently lack resources or jurisdiction to respond to health concerns related to IFAP sites, resulting in limited engagement. Since agencies with jurisdiction over IFAP frequently lack a health focus, increased health department engagement may better protect public health.

Offshore Finfish Aquaculture in the United States: An Examination of Federal Laws That Could be Used to Address Environmental and Occupational Public Health Risks

Half of the world’s edible seafood comes from aquaculture, and the United States (US) government is working to develop an offshore finfish aquaculture industry in federal waters. To date, US aquaculture has largely been regulated at the state level, and creating an offshore aquaculture industry will require the development of a new regulatory structure. Some aquaculture practices involve hazardous working conditions and the use of veterinary drugs, agrochemicals, and questionable farming methods, which could raise environmental and occupational public health concerns if these methods are employed in the offshore finfish industry in the US. This policy analysis aims to inform public health professionals and other stakeholders in the policy debate regarding how offshore finfish aquaculture should be regulated in the US to protect human health; previous policy analyses on this topic have focused on environmental impacts. We identified 20 federal laws related to offshore finfish aquaculture, including 11 that are relevant to preventing, controlling, or monitoring potential public health risks. Given the novelty of the industry in the US, myriad relevant laws, and jurisdictional issues in an offshore setting, federal agencies need to work collaboratively and transparently to ensure that a comprehensive and functional regulatory structure is established that addresses the potential public health risks associated with this type of food production.

Investigating the role of state permitting and agriculture agencies in addressing public health concerns related to industrial food animal production.

Objectives Industrial food animal production (IFAP) operations adversely impact environmental public health through air, water, and soil contamination. We sought to determine how state permitting and agriculture agencies respond to these public health concerns. Methods We conducted semi-structured qualitative interviews with staff at 12 state agencies in seven states, which were chosen based on high numbers or rapid increase of IFAP operations. The interviews served to gather information regarding agency involvement in regulating IFAP operations, the frequency and type of contacts received about public health concerns, how the agency responds to such contacts, and barriers to additional involvement. Results Permitting and agriculture agencies’ responses to health-based IFAP concerns are constrained by significant barriers including narrow regulations, a lack of public health expertise within the agencies, and limited resources. Conclusions State agencies with jurisdiction over IFAP operations are unable to adequately address relevant public health concerns due to multiple factors. Combining these results with previously published findings on barriers facing local and state health departments in the same states reveals significant gaps between these agencies regarding public health and IFAP. There is a clear need for regulations to protect public health and for public health professionals to provide complementary expertise to agencies responsible for regulating IFAP operations.

Fisheries, food, and health in the USA: the importance of aligning fisheries and health policies

Background Food availability, access, and utilization are the three pillars of food security and need to be aligned in order to support a healthy population. United States (US) fisheries policy plays an important role in seafood availability. US health policy impacts access and utilization of seafood in various ways; however, health policies are often disconnected from fisheries policy. Aligning fisheries and health policies is imperative to improve food security. We address two questions with our work: (1) how would US federal fisheries policy be different if our fisheries were managed with beneficial health outcomes for Americans as clear objectives; and (2) how would US health policy be different if one of its goals was to support sustainable domestic fisheries and aquaculture?ResultsWe report how fisheries policies and health policies are additive, synergistic, or antagonistic with regard to seafood, and provide illustrative examples of collaboration between health and fisheries communities at different levels of the food system (federal and state policies, corporate partnerships, and civil society). We also develop a list of topics for future research, and opportunities to align and integrate fisheries and health policies.ConclusionsManaging fisheries to promote optimal nutrition and efficient food production likely requires a different approach to fisheries management—new outcomes will need to be monitored, new approaches found, and fisheries, aquaculture, and health policies better integrated. Health policies rarely consider the source of fish, their connections with US fisheries systems, and global distribution of seafood. Change can begin where the most promising opportunities exist, such as institutional food procurement, Farm to School programs, social marketing campaigns, and private sector start-ups. Continued development in fisheries and health policies, however, will need to occur at multiple levels of federal policy, and across the different domains and dimensions of the food system (e.g., social, political, biophysical, economic).

Environmental Public Health And Recommendations For Fish Oil And Seafood Intake

We commend Greene et al. for discussing declining global fisheries in their analysis of current evidence regarding fish oil supplementation and treatment of coronary heart disease (CHD).1 As the authors stated, it is important to reassess dietary and supplement recommendations not only because of conflicting evidence and new treatments for CHD but also because current recommendations are at odds with the earth’s capacity to provide fish oil and seafood.1–3 Additionally, information on critical issues such as food safety and the public health effects of aquaculture should be included in cross-discipline assessments of seafood and health. Aquaculture, or farmed seafood, has expanded in recent decades to meet a growing demand and now accounts for one half of all seafood destined for human consumption.4 Importantly, aquaculture includes a vast array of production methods and species ranging from shellfish (which filter surrounding water and require no feed) to carnivorous finfish (which rely on formulated feed made with wild fish). As the authors briefly state, certain types of aquaculture are closely linked to wild fish supplies. In 2010, 16.6% of wild-caught fish (15 million metric tons) were processed into fishmeal and fish oil, and the majority of both products were used in aquaculture feed.5 The reliance of aquaculture on fish meal and fish oil as feed is problematic when wild fish stocks continue to decline.4 In addition to relying on wild fish as feed, some production methods have significant impacts on marine ecology and public health. Large-scale offshore finfish aquaculture uses open nets or pens and can result in pollution from concentrated waste, chemicals, metals, uneaten feed, and veterinary drugs including antibiotics.6 Use of certain chemicals impacts occupational health and food safety and may contaminate nearby fish populations in which commercial or recreational fishing may occur.7–10 This is a critical and timely public health issue in the United States because federal agencies are poised to permit large-scale offshore aquaculture in the Gulf of Mexico. Evidence from other countries demonstrates a need for strict environmental regulation and active monitoring,6,9,11 but it is unclear how these aquaculture sites will be regulated in the United States.12 Seafood is often overlooked within the sustainable and healthy food systems movement. The discussion by Greene et al. is a good start to rectifying this pervasive omission. The United States is investing significant funds into expanding domestic aquaculture, and health professionals’ engagement with these issues would complement the work of marine scientists to encourage responsible development. More evidence on the links between aquaculture and public health could direct public funds toward researching and evaluating aquaculture methods that limit the use of chemicals and that contain or recycle waste products. Some of these methods include recirculating aquaculture, aquaponics, biofloc shrimp production, and integrated multitrophic aquaculture.13 The scope of public health considerations regarding terrestrial food animals has expanded to include resource use, climate change, pollution, community health impacts, and overuse of antibiotics.14–17 Similarly, future recommendations regarding seafood and fish oil consumption should take into account declining fisheries and the myriad of externalities of certain types of aquaculture.