ATSDR PFAS Activities and Research: Building on Lessons of the Past to Advance the Future

A small child with a pink shirt drinking water out of a glass.

“We have just scratched the surface of understanding where PFAS exposure is occurring. Our job is to identify where exposures to hazardous substances are occurring and to make recommendations to stop them. This work is 100% the bread and butter of ATSDR’s mission.”

— Rachel Rogers, PhD, MA, senior health scientist, NCEH/ATSDR

Over many years, ATSDR has and continues to advance the knowledge base concerning per- and polyfluoroalkyl substances (PFAS). ATSDR has been a leader in assessing community concerns about PFAS exposure and possible health effects through its Multi-site Study, PFAS exposure assessments, and a newly published research agenda framework to guide PFAS research priorities for the Agency.

Per- and polyfluoroalkyl substances (PFAS) are a group of thousands of manufactured chemicals that have been used in industry and consumer products worldwide since the 1940s. Some food packaging materials, water- and stain-repellent fabrics and carpets, firefighting foam, and cosmetics may still contain PFAS. PFAS are a public health concern because they can stay in people’s bodies for a long time and have been linked to harmful health effects in humans.

CDC and ATSDR are longtime leaders in understanding PFAS exposure. Beginning in 1999, CDC’s National Health and Nutrition Examination Survey (NHANES) was the first to document widespread exposure to PFAS in the United States in more than 98% of serum samples collected from people. By 2007, NHANES was expanded to include 11 additional PFAS. In 2009, ATSDR released its first draft Toxicological Profile for Perfluoroalkyls; the final PFAS toxicological profile was released in 2021 and is being further updated in 2022. In 2017, ATSDR added more PFAS to ATSDR’s Substance Priority list.

In 2019, ATSDR began exposure assessments in communities believed to be affected by PFAS drinking water contamination. It launched the Pease Health Study and Multi-site Study to assess and identify possible health effects from PFAS exposure. At that time, CDC’s National Center for Environmental Health (NCEH) and ATSDR also brought together a multi-disciplinary group of PFAS experts to identify priority PFAS research areas. They also worked on developing a comprehensive research agenda covering the broad range of PFAS-related research activities conducted or supported internally and by other federal agencies. The group explored scientific advances and knowledge gaps that, if addressed, could inform public health actions and the federal response to PFAS contamination. It also identified 30 compelling questions to serve as the foundation for a multi-faceted strategy for advancing the scientific knowledge about PFAS and its public health effects.

In March 2021, NCEH and ATSDR published “Advancing PFAS research: an overview of ATSDR and NCEH activities and recommendations” in the peer-reviewed Journal of Exposure Science and Environmental Epidemiology. NCEH and ATSDR Senior Health Scientist Rachel Rogers, PhD, MA; ATSDR Associate Director Christopher Reh, PhD; and NCEH and ATSDR Director Patrick Breysse, PhD, CIH, wrote the article that described more than 2 years of work on a public health framework for PFAS research activities. The framework assesses future research priorities based on five scientific domains: 1) toxicology, 2) exposure, 3) human health, 4) public health action, and 5) cross-cutting priorities. NCEH and ATSDR will continue building on these PFAS research priorities and identifying opportunities for interagency collaboration.

Pease Health Study: Water Consumption, Working Together, and Wellness
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In 2021, ATSDR completed participant enrollment and blood and urine sample collection for the Pease Health Study. This study evaluates the public health effects of people drinking PFAS contaminated water at the Pease International Tradeport and its supply wells in the Portsmouth, New Hampshire, area. Located on the site of the former Pease U.S. Air Force Base, the Tradeport’s soil and groundwater were contaminated with PFAS ⎯ particularly perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) ⎯ from the use of aqueous film-forming foam during firefighter trainings and to extinguish flammable liquid fires when the site was a military base. This contamination migrated to the three supply wells that serve the Tradeport’s main water distribution system. ATSDR hopes to finish analysis and present its findings and recommendations to the affected New Hampshire community in late 2022.

The Pease Study is the pilot and first site of the national Multi-site Study, which looks at human health effects of PFAS exposure from drinking contaminated water at sites in eight U.S. states. The Pease study encountered unique challenges because of the COVID-19 pandemic. During the pandemic, participant recruitment was paused for 7 months because of the difficulty in locating and reaching eligible participants. ATSDR has been able to incorporate lessons learned from this study, however, to enhance procedures and methods at other Multi-site Study sites.

ATSDR Releases First PFAS Exposure Assessment Report
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In 2019, CDC and ATSDR started PFAS exposure assessments in communities near current or former military bases known to have had PFAS in their drinking water. Persons who participated in the exposure assessments provided blood and urine samples to CDC and ATSDR for analysis.

One of these exposure assessment sites is in the city of Westfield, in Hampden County, Massachusetts, where the Barnes Air National Guard Base is located. Possibly as early as the 1970s, the base used aqueous film-forming foam containing PFAS for its firefighter training. Over time, PFAS from the foam entered the ground, moved into the groundwater to offsite locations, and affected nearby municipal wells, contaminating the water with PFAS.

Thanks to the participation of City of Westfield residents and CDC and ATSDR’s work, residents in this area now have a better understanding of PFAS exposure levels in their community. ATSDR released its Westfield PFAS exposure assessment report in November 2021, and held a virtual community meeting with residents to review the report’s findings and answer questions on December 2021.

The exposure assessment showed the following results:

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Higher blood levels of certain PFAS in the Westfield community, possibly associated with past drinking water contamination, when compared with PFAS levels in a nationally representative sample.

Glass of ice water on a white counter.

All Westfield tap water samples collected during the exposure assessment in 2019 met the Environmental Protection Agency’s (EPA) 2016 lifetime health advisory and Massachusetts Department of Environmental Protection’s public health guidelines for PFAS in drinking water.

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Patterns and levels of dust contamination measured in participating exposure assessment households are comparable to those reported in selected U.S. studies.

The results of the Westfield exposure assessment will help participants and their neighbors better understand their PFAS exposure and what they can do to protect themselves from exposures.