An Urgent Need for Evidence-Based Guidance on Mercury Exposure Screening to Inform Public Health Policy, Practice, and Prevention

OBJECTIVES: 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. METHODS: 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' 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. RESULTS: 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-level 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. CONCLUSIONS: 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.