What do people need to know about endocrine disrupting chemicals and health? A mental models approach using focus groups of community-engaged research teams and a national survey.
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BACKGROUND: Endocrine disrupting chemicals (EDCs), which interfere with the body's natural hormones, are ubiquitous in everyday environments and consumer products. Nearly everyone is routinely exposed, and growing evidence links them to adverse health outcomes including cancers, impaired fertility, metabolic disorders, and neurodevelopmental effects. Major medical and scientific groups recommend exposure reduction. To make informed decisions about individual- and societal-level exposures to EDCs, people need relevant knowledge. Knowledge is one component of environmental health literacy, a multidimensional concept supporting readiness to protect health from environmental risks. This study sought to develop expert consensus about communications targets for EDCs and to learn how public knowledge matches these targets. METHODS: We convened focus groups with community-engaged research teams (n = 38) to define targets for public understanding. We coded transcripts, mapped causal pathways influencing EDC exposures and health outcomes using a mental models approach, and identified communication priorities. We then fielded a quantitative online survey among adults living in the U.S. (n = 504) to compare their knowledge with the mental model. We computed response frequencies and used multiple regression to evaluate associations between a knowledge index and participant characteristics. RESULTS: Focus group participants highlighted that people need to know that EDCs affect nearly all systems in the human body and that scientific evidence supports limiting exposure. They emphasized that policy controls can be more effective than personal action at reducing exposure, and that current U.S. chemicals regulations are not protective. Survey respondents were generally aware that EDCs can affect fertility, cancer, and child brain development (84-90%, n = 426-452), and they had some understanding of exposure pathways (58-86%, n = 295-435). However, most participants had large knowledge gaps about U.S. chemicals regulation and wrongly believed that chemicals must be safety-tested before being used in products (82%, n = 414), that product ingredients must be disclosed (73%, n = 368), and that restricted chemicals cannot be replaced by similar substitutes (63%, n = 317). CONCLUSIONS: U.S. adults typically understood that EDCs affect health. However, incomplete information about how people get exposed to EDCs and misconceptions about U.S. chemicals regulations limit appropriate actions. These knowledge gaps are targets for future communications about EDCs and harmful chemicals more broadly.