with the degree of evidence for that guidance, which is used to categorize a spectrum of recommendations. These tools are generally not set up to provide information to individuals, but rather to public health practitioners and individual care providers. Their recommendations are evidence-based but not easily translatable to the lay community. Although the Clinical Guide to Preventive Services is aimed toward practitioners, AHRQ has tried to make it understandable to the general public—e.g., if you are over 50, and have a risk factor, then get a mammogram.

A more coordinated approach is needed for developing and disseminating evidence-based recommendations to health care practioners that can then be provided to consumers. Such recommendations should be updated on a continuous, rotating basis, to allow for more rapid translation of science to practice. Where HRA tools are targeted for intermediaries who are experts in their own right, guidance or additional tools are necessary to help them translate and target information for consumers. The Clinical Guide to Preventive Services has a handbook that attempts to provide user-friendly tools to help providers translate and target information to consumers. If the goal is to guide consumption decisions that balance benefits and risks, there needs to be a similar translation mechanism because of the limited and continuously evolving knowledge base concerning seafood benefits and safety. Currently, consumers are receiving piecemeal information about methylmercury and persistent organic pollutants such as dioxins and polychlorinated biphenyls (PCBs); for the most part, that information is not pulled together sufficiently to facilitate consumers’ understanding it in context and thus being able to use it to inform their choices (see Table 6-2). (Also see Chapter 6 for discussion of the effectiveness of online nutrition information.)

A general framework for developing this kind of communication is a consumer checklist that engages the user in interactive identification of his or her benefit-risk factors, and uses that information to produce a tailored benefit-risk estimation and associated recommended actions. Determining how to communicate the resulting estimates and actions requires a series of judgements, including whether and how to represent this information as text, numbers, or graphics. Empirical testing of the effects of the final tool is essential, given the difficulties of predicting the effects of communications on individual consumers, or even specific target populations.

Decision Support for Consumers

The committee’s balancing of the benefits and risks of different patterns of seafood consumption for different target populations resulted in the analysis presented in Chapter 5. This type of expert identification of the characteristics that distinguish target populations who face substantially dif-



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