{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T11:34:51Z","timestamp":1793014491013,"version":"4.5.0"},"reference-count":42,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Mercury exposure is a preventable public health concern that arises from multiple environmental, dietary, and occupational exposure pathways and poses disproportionate risks to the fetus during pregnancy. However, routine identification in clinical care is limited. This study aimed to generate practice-informed evidence from primary care clinicians serving populations at risk of mercury exposure to inform the development and implementation of evidence-based guidance on mercury exposure screening in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In April 2025, we conducted a qualitative study using semistructured interviews online or by telephone with 12 primary care clinicians practicing in outpatient and hospital-affiliated settings in New York City. Interviewers examined clinicians\u2019 knowledge of mercury exposure, current screening practices, perceived barriers, and recommendations for practical supports. Informed by the Knowledge-to-Action framework, we analyzed data using reflexive thematic analysis and reported in accordance with consolidated criteria for reporting qualitative research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Clinicians described mercury exposure as a recognized but low-priority issue in routine primary care. Screening was rare and largely reactive rather than preventive. Clinicians identified health care system\u2013level barriers, including lack of training, lack of screening guidance, limited access to testing, health insurance restrictions, time constraints, and the absence of decision support for electronic health records. Despite these barriers, clinicians supported standardized, practical screening guidance, often referencing lead exposure screening as a useful model. They emphasized the need for simple risk-based tools, workflow integration, health care provider training, and policy support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Aligning public health evidence with clinical systems through evidence-based screening guidance, workflow integration, and supportive policy is essential to advance equitable mercury exposure identification and prevention in primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549261457425","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T15:52:23Z","timestamp":1782229943000},"page":"836-843","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["An Urgent Need for Evidence-Based Guidance on Mercury Exposure Screening to Inform Public Health Policy, Practice, and Prevention"],"prefix":"10.1177","volume":"141","author":[{"given":"Nevila","family":"Bardhi","sequence":"first","affiliation":[{"name":"Department of Population Health and Leadership, University of New Haven, West Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9464-7299","authenticated-orcid":false,"given":"Pavani","family":"Rangachari","sequence":"additional","affiliation":[{"name":"Department of Population Health and Leadership, University of New Haven, West Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra D\u2019Amato","family":"Palumbo","sequence":"additional","affiliation":[{"name":"Department of Allied Health, University of New Haven, West Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth R.","family":"Spaeth","sequence":"additional","affiliation":[{"name":"Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"World Health Organization. Mercury. October 24 2024. Accessed May 10 2026. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/mercury-and-health"},{"key":"e_1_3_3_3_2","unstructured":"US Environmental Protection Agency. How people are exposed to mercury. Updated February 20 2026. Accessed May 10 2026. https:\/\/www.epa.gov\/mercury\/how-people-are-exposed-mercury"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2018.10.408"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/10408440600845619"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.0901757"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2016.06.042"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.7743"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1104494"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxics6030045"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.02110721"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2022.306906"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10900-012-9646-9"},{"key":"e_1_3_3_14_2","unstructured":"US Environmental Protection Agency. America\u2019s Children and the Environment (ACE): biomonitoring\u2014mercury. 2022. Accessed April 30 2024. https:\/\/www.epa.gov\/americaschildrenenvironment\/biomonitoring-mercury"},{"key":"e_1_3_3_15_2","unstructured":"US Environmental Protection Agency. Trends in blood mercury concentrations and fish consumption in women of childbearing age in the United States using NHANES data (1999-2010). 2013. Accessed April 30 2024. https:\/\/www.epa.gov\/sites\/default\/files\/2018-11\/documents\/trends-blood-mercury-concentrations-report.pdf"},{"key":"e_1_3_3_16_2","unstructured":"New York State Department of Health. New York State Heavy Metals Registry: 2016 through 2020. 2022. Accessed April 30 2024. https:\/\/www.health.ny.gov\/environmental\/workplace\/heavy_metals_registry\/docs\/report_2020.pdf"},{"key":"e_1_3_3_17_2","unstructured":"US Food and Drug Administration. Mercury in food. Updated March 5 2024. Accessed April 30 2024. https:\/\/www.fda.gov\/food\/environmental-contaminants-food\/mercury-food"},{"key":"e_1_3_3_18_2","unstructured":"US Food and Drug Administration. Skin products containing mercury and\/or hydroquinone. April 2 2026. Accessed May 10 2026. https:\/\/www.fda.gov\/consumers\/health-fraud-scams\/skin-products-containing-mercury-andor-hydroquinone"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.113.077081"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.6587"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2014.07.019"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6850a4"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.13.1667"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-018-0269-z"},{"key":"e_1_3_3_25_2","unstructured":"National Institute for Occupational Safety and Health. Evalu-ating Mercury Exposure: Information for Healthcare Providers. Centers for Disease Control and Prevention; 2018. Accessed April 30 2024. https:\/\/stacks.cdc.gov\/view\/cdc\/157806"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/CEH.0000000000000399"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.1219"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/msj.20158"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2007.02.005"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1373490"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.17226\/13381"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/chp.47"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1021\/acs.est.8b02286"},{"key":"e_1_3_3_34_2","unstructured":"World Health Organization. Guidance for identifying populations at risk from mercury exposure. August 15 2008. Accessed April 30 2024. https:\/\/www.who.int\/publications\/m\/item\/guidance-for-identifying-populations-at-risk-from-mercury-exposure"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2020.08.005"},{"key":"e_1_3_3_36_2","unstructured":"New York City Department of Health and Mental Hygiene. Guidelines for health care providers: lead exposure in adults. 2024. Accessed May 10 2026. https:\/\/www.nyc.gov\/assets\/doh\/downloads\/pdf\/lead\/adult-lead-information.pdf"},{"key":"e_1_3_3_37_2","unstructured":"Advisory Committee on Childhood Lead Poisoning Prevention. Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention. Centers for Disease Control and Prevention; 2012. Accessed April 30 2024. https:\/\/www.cdc.gov\/lead-prevention\/media\/pdfs\/2025\/03\/cdc_11859_DS1-2.pdf"},{"key":"e_1_3_3_38_2","unstructured":"National Center for Environmental Health. Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women. Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention; 2010. Accessed April 30 2024. https:\/\/www.cdc.gov\/lead-prevention\/media\/pdfs\/2025\/03\/cdc_147837_DS1.pdf"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.08.016"},{"issue":"1","key":"e_1_3_3_40_2","first-page":"46","article-title":"Getting evidence into policy and practice: perspective of a health research funder","volume":"18","author":"Graham ID","year":"2009","unstructured":"Graham ID, Tetroe JM. Getting evidence into policy and practice: perspective of a health research funder. J Can Acad Child Adolesc Psychiatry. 2009;18(1):46-50.","journal-title":"J Can Acad Child Adolesc Psychiatry"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_3_3_43_2","unstructured":"New York City Department of Health and Mental Hygiene. Information for health care providers: mercury exposure and poisoning. Accessed May 10 2026. https:\/\/www.nyc.gov\/assets\/doh\/downloads\/pdf\/lead\/mercury-hcp-factsht.pdf"}],"container-title":["Public Health Reports\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549261457425","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00333549261457425","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549261457425","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T11:02:41Z","timestamp":1793012561000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00333549261457425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":42,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/00333549261457425"],"URL":"https:\/\/doi.org\/10.1177\/00333549261457425","relation":{},"ISSN":["0033-3549","1468-2877"],"issn-type":[{"value":"0033-3549","type":"print"},{"value":"1468-2877","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]}}}