Community Level Results: Spokane County, Washington

Selecting Airway Heights

When selecting EA sites, ATSDR considered:

• The extent of PFOA and PFOS contamination in drinking water supplies.
• The possible duration of the exposure.
• The number of potentially affected residents.

Airway Heights was identified as one of several U.S. sites with PFAS drinking water contamination from use of products like aqueous film forming foam (AFFF).

As early as the 1970s, the Fairchild Air Force Base used AFFF containing PFAS for firefighter training. Over time, these PFAS:

• Entered the ground.
• Moved into the groundwater to offsite locations.
• Affected nearby municipal wells.

PFAS were first detected in Airway Heights municipal wells in May 2017. Airway Heights authorities immediately removed the contaminated drinking water wells from service. Residents were provided with bottled water until drinking water was obtained from the uncontaminated City of Spokane water supply.

By June 2017, the city declared the water safe to drink. Since 2017, Airway Heights has reactivated some of its drinking water wells with treatment systems to remove PFAS.

ATSDR recommendations

At this time, ATSDR does not recommend that community members who get drinking water from the City of Airway Heights public water supply use alternative sources of water.

Based on the information reviewed by ATSDR, the City of Airway Heights public drinking water supply currently meets or is below the U.S. Environmental Protection Agency's (EPA) 2016 health advisory (HA) for PFAS in drinking water.

Sampling Area and Eligibility

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Timeline

How testing was conducted

ATSDR invited Airway Heights residents who met eligibility criteria to participate in the EA. Household members were eligible if they had:

• Received drinking water from the City of Airway Heights Water Department.
• Lived west of Hayford Road for at least one year before June 8, 2017.

These residents were most likely to have past exposures to PFAS through public drinking water.

Residents were also eligible if they had:

• Past exposures to PFAS through the public drinking water supplies.
• Been older than three years at the time of sample collection.
• Not been anemic or had a bleeding disorder preventing a blood sample.

Households with private wells were not eligible for participation.

Measuring PFAS in the blood of people from selected households allowed us to estimate exposure from consumption of public drinking water for the entire community in the affected area. This included even those who were not tested.

Results

Average blood levels

The average blood levels of five PFAS (PFHxS, PFOS, PFOA, PFNA, and PFDA) in Airway Heights EA participants were higher than national average levels.

In May 2022, CDC/ATSDR released a summary of the biological and environmental test results. The full report was released March 10, 2022.

In November 2019, ATSDR collected samples and other information from participants. Data was analyzed from:

• 333 people:
  • 286 adults.
  • 47 children.
• 168 households.
• Questionnaires completed by participants.
• Blood and urine samples provided by participants.
• Tap water and dust collected from some homes.

ATSDR sent each participant their individual results in May 2020 and published community summary results.

Key takeaways

• Levels of some PFAS in the blood of residents were up to 56 times higher than national levels.
• Elevated blood levels may be linked with past drinking water contamination.
• Some demographic and lifestyle characteristics were linked with higher PFAS blood levels.

It should be noted that all tap water samples collected during the EA in 2019 met or were below EPA's HA and Washington State public health guidelines for PFAS in drinking water.

What was learned about PFAS levels in blood

Average PFAS blood levels

What the results mean for Airway Heights

This PFAS EA provides evidence that past exposures to PFAS in drinking water have impacted the levels of PFAS in people's bodies. PFAS are eliminated from the body over a long period of time. This allowed ATSDR to measure PFAS even though exposures through drinking water were mitigated or lowered years ago.

Community members and city officials can take steps to further reduce exposure and protect public health.

Based on the recent PFAS drinking water test results from the Airway Heights municipal water system, ATSDR does not recommend an alternate source of drinking water at this time.

Information to protect our communities

Airway Heights PFAS blood levels

Long-time residents had higher PFHxS, PFOS, and PFOA blood levels. For every additional year an adult participant lived in Airway Heights, there was an increase in PFHxS (7.2%), PFOS (5.6%), and PFOA (3.9%) levels.

Three PFAS (PFHxS, PFOS, and PFOA) were detected in Airway Heights drinking water in 2017. No prior data is available. Therefore, it's unknown if contamination began earlier.

Airway Heights municipal drinking water met the EPA's HA for PFOA and PFOS in 2017. There were more than two years and five months between the reduction of exposure via contaminated drinking water and the collection of the EA blood samples.

Due to long half-lives of PFHxS, PFOS, and PFOA in the human body, past drinking water exposures may have contributed to participants' blood levels. Typically, participants who had elevated blood PFHxS levels also had elevated blood PFOS and blood PFOA levels.

This suggests a common source of exposure, like the Airway Heights public water supply before June 8, 2017. Other sources of exposure were not measured but could have contributed to PFAS concentrations measured in blood of the EA participants.

Elevated blood levels of three PFAS in the Airway Heights EA participants may be linked with past contamination of the city's drinking water.

Relationships between various demographics and lifestyles

Blood levels of PFHxS, PFOS, and PFOA were higher in older participants (+1.1% to +1.8% per year/age).

Males had 77% higher PFNA blood levels than females.

Participants who ate fast food a few times per month had lower blood PFHxS, PFOS, PFOA, PFNA, and PFDA blood levels than those eating fast food a few times per year or less. Other studies differ; this may be due to differences in diet and lifestyle correlated with fast food consumption.

Adult participants identifying as non-White or Hispanic had higher PFNA (+37%) and PFDA (+33%) blood levels than White, non-Hispanic participants.

Female participants' PFAS blood levels decreased with increasing number of child births. For each child, PFAS levels were lower (PFHxS -11.7%, PFOS -9.3%, PFOA -13.7%, PFNA, 8.1% lower).

Participants who reported ever using stain-resistant products had 26% higher blood levels of PFDA than those who reported never using these products.

Adults who reported donating blood at least once a year had lower blood levels of PFHxS (67%), PFOA (60%), and PFNA (49%) than participants who never reported donating blood.

Though many exposure factors couldn't be evaluated due to the small number of participants, two associations were observed in children:

• Breastfed children had higher blood levels of PFNA. Current science shows the benefits of breastfeeding outweigh the risks of exposure to PFAS in breast milk.
• Children who drank formula prepared with tap water had higher PFHxS (+2.2%) and PFOS (+1.5%) blood levels than children who didn't. Increases for each on formula.

Results should be interpreted with caution due to sample size. Data will be gathered from children across all exposure assessment sites. A detailed analysis will follow.

What the results mean for Airway Heights community members

Not recommended: alternate source of drinking water

An alternate source of drinking water is not recommended by ATSDR at this time. This is based on the recent PFAS drinking water test results from the Airway Heights municipal water system.

This exposure assessment provides evidence that past exposures to PFAS in drinking water have impacted PFAS levels in people's bodies. PFAS are eliminated from the body over a long period of time. This allowed ATSDR to measure PFAS even though exposures through drinking water were mitigated, or lowered, years ago.

Although the exposure contribution from PFAS in drinking water in Airway Heights has been mitigated (reduced), there are actions community members and city officials can take to further reduce exposures to PFAS and protect public health.

What community members can do

Retesting

At this time, ATSDR does not have plans to conduct additional blood testing for PFAS. It also doesn't recommend PFAS EA participants get individually retested.

For the general population, blood tests for PFAS are most useful when they are part of a scientific investigation like the EA. It takes a long time for many of the PFAS measured in blood to decrease by 50%. PFHxS take the longest time, ranging in the decades. PFAS blood levels are not expected to change significantly in the near term, even if exposure stops. It's also unclear what an individual's PFAS test results mean in terms of possible health effects. To reduce future exposure:

• Know your water quality. Check Consumer Confidence Reports for the City of Airway Heights water quality.
• Private well owners living in the area affected by PFAS should consider having their wells tested if it's not been done before.

NSF International developed a test method to verify a water filter's ability to reduce PFOA and PFOA to below the HA levels set by the EPA. Select "reduction devices" at the bottom of the page for PFOA and PFOS.

When possible, eliminate or decrease potential exposure to PFAS in things like stain-resistant products and food packaging materials.

Discuss health concerns or symptoms with your health care provider. Share results of PFAS blood testing and make them aware of ATSDR resources for clinicians. Follow their advice for checkups, vaccinations, and health screening tests.

Protecting infants and children

Nursing mothers should continue breastfeeding. Based on current science, the benefits of breastfeeding outweigh the risks for infants exposed to PFAS in breast milk. For children's health and environmental exposures, contact the Pediatric Environmental Health Specialty Units. This nationwide network is an expert source for reproductive and children's environmental health.

Follow the advice of your child's health care provider and the recommendations for well child checkups, vaccinations, and health screening tests. Consult https://health.gov/myhealthfinder to help identify those vaccinations and tests.

Pay attention to advisories about food consumption, such as local fish advisories.

What the city of Airway Heights can do

Municipal water system operators should continue to monitor concentrations of PFAS in drinking water delivered to the Airway Heights community. This ensures that concentrations of PFAS remain below the EPA's HA for specific PFAS in drinking water.

Properly maintain treatment systems to remove PFAS from the public drinking water. This ensures that PFAS concentrations remain below the EPA's HA for PFAS in drinking water.

Continue to share results of PFAS drinking water monitoring with community members.