Mercury use and exposure among Santeria practitioners: religious versus folk practice in Northern New Jersey, USA.

OBJECTIVE: To understand and characterize exposure to and use of elemental mercury among practitioners of Afro-Cuban religions in Hudson County, New Jersey, USA.
DESIGN: Participant observation and open-ended interviews with 22 religious supply store employees and practitioners of Santeria, Espiritismo or Palo Mayombe probed respondents' knowledge and use of mercury, as well as their beliefs about its benefits and risks. Including a cultural and religious insider as part of the research team was crucial in working with this relatively closed community.
RESULTS: Seventeen of the 21 practitioners reported using mercury or mercury compounds in various forms of practice and in services that they provide to clients. The contained nature of these uses suggests that accidental spills, as opposed to the practices themselves, emerge as the greatest exposure concern for this population. Mercury was never recommended to clients for individual use. This restriction appears to be rooted in the way the religion is practiced and in the way santeros receive compensation, not in a perception of mercury as hazardous. Most practitioners were aware that mercury can be hazardous, but were not familiar with the most significant exposure pathway, inhalation of mercury vapor. A climate of fear surrounds the use of mercury in this community, so that health concerns pale in comparison to fear of reprisal from authorities. Among those who sell or formerly sold mercury, several shared the erroneous belief that it was illegal to sell mercury in New Jersey.
CONCLUSION: Despite widespread reported use, there were no reports of practices believed to result in the highest exposures. To reduce exposure in the community, interventions presenting general information on mercury hazards and instructions for cleaning up spills are recommended. To address insider-outsider dynamics and the climate of fear, educational materials should be accessible to the community and avoid any mention of religious practice.