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The report of Geraghty et al.1 on a survey of breastfeeding mothers shows the importance of developing and testing methods for reporting biomonitoring results to study participants. They found that 68% of breastfeeding women said they wanted to know about levels of environmental chemicals in their milk, but more than three-fourths speculated that they would discontinue breastfeeding or pump and discard their milk if they learned their milk contained phthalates. Such a decline in breastfeeding as a result of routine breastmilk biomonitoring would be alarming; however, this study does not provide information about how women would respond in a study that used informative and supportive practices for communicating with research participants. Geraghty et al.1 asked women three multiple choice survey questions following a two-sentence statement that told them breastfeeding is recommended by the American Academy of Pediatrics even though breastmilk may contain contaminants and that doctors do not know the potential effects of the contaminants in breastmilk. The researchers apparently did not frame the hypothetical survey questions by providing information about phthalates, the expectation that nearly every mother in the United States carries measurable levels in her body, the opportunities to reduce phthalate exposures, or the environmental contaminants or nutritional deficiencies in infant formula. They apparently provided no opportunity for participants to interact with researchers to gain further information and did not directly state their recommendation for breastfeeding.
In our own experience, women who were informed of environmental contaminants in their urine, house dust, and indoor air were able to assimilate this information without undue alarm in a community-based participatory research study in which results were reported along with contextualizing information and opportunities to interact with the researchers.2 The National Academy of Sciences Human Biomonitoring report provides helpful guidance on the issues to be considered in reporting individual results, while calling for additional empirical investigation.3 While Geraghty et al.1 highlight the potential harm from poor reporting methods in breastmilk monitoring, it should not be inferred that similar results would occur in a biomonitoring program with a well-developed communications protocol.