Final Study Enrollment

The table below shows the distribution by race/ethnicity and sex of the 1340 PA PFAS Health Study participants with a study questionnaire and blood sample. Most participants (94%) were non-Hispanic Whites with smaller but equal representation by members of other race/ethnic groups. It is also noteworthy that 58% of the participants were female.

Total Number of Health Study Participants by Race/Ethnicity and Sex

Race

Female

Male

Total

White Not Hispanic

728

530

1258 (93.9%)

White Hispanic

8

7

15 (1.1%)

Asian

7

6

13 (1.0%)

Black or African American

11

3

14 (1.0%)

American Indian/Native Hawaiian/More than One Race

14

5

19 (1.4%)

Unknown/Not Reported

11

10

21 (1.6%)

Total

779 (58.1%)

561 (41.9%)

1340

Initial Summary PFAS Results

 

The table below shows the community averages for PFOA, PFOS, PFHxS, and PFNA for the 1253 adults and 89 children with PFAS results who participated in the PA PFAS MSS Health Study. Note* table includes 2 adults who are missing questionnaire data. You can see the comparison of your community’s values with the national averages (shown in the National Health National Health and Nutrition Examination Survey (NHANES)).

 

  • The 50th percentile is the result which 50% of results are below and 50% are above.
  • The 95th percentile is the result which 95% of results are below and 5% of results are above.

 

At this time, there are no specific levels of PFAS that can be used to predict or diagnose disease. The comparison with the NHANES 50th and 95th percentile provides a way to compare PFAS blood levels for people participating in the PA PFAS MSS Health Study with people living in the U.S.

These results show that levels of PFOA, PFOS, and PFHxS, in adult Health Study participants exceed what would be expected in about 95 percent of the U.S. adult population.

PA PFAS Levels for Adults and Children Compared to the National Health and Nutrition Examination Survey (NHANES) in ng/mL

Age Group

PFAS

N

PA

50th
Percentile

NHANES

50th
Percentile1,2

PA

95th
Percentile

NHANES

95th
Percentile1,2

 

 

Adult

PFOA

1253

2.27

1.47

6.57

3.87

PFOS

1253

5.90

4.70

24.10

15.1

PFHxS

1253

4.30

1.20

25.60

3.80

PFNA

1253

0.50

0.40

1.40

1.40

 

 

 

 

 

 

 

 

 

Child 12-17

PFOA

48

1.27

1.17

3.37

2.34

PFOS

48

2.09

2.60

7.00

7.30

PFHxS

48

1.70

0.80

6.60

3.40

PFNA

48

0.20

0.40

0.90

1.20

 

 

 

 

 

 

 

 

 

Child 4-11

PFOA

41

1.67

1.94

3.27

3.84

PFOS

41

2.30

2.65

8.40

8.41

PFHxS

41

1.80

0.85

4.90

4.14

PFNA

41

0.30

0.75

1.30

3.19

1 CDC. 2021. 2017-2018 NHANES 50th to 95th percentiles among children 12-19 years old and adults 20+ years old from the Fourth National Report on Human Exposure to Environmental Chemicals, Updated Tables, March 2021.

2CDC. 2018. 2013-2014 NHANES 50th to 95th percentiles among children 6-11 old from the Fourth National Report on Human Exposure to Environmental Chemicals, Updated Tables, March 2018.

 

 

The table below presents clinical guidance by the National Academies of Sciences, Engineering, and Medicine (NASEM) for follow-up with patients after PFAS testing by exposure level. We also provide the number and percent of the adult and child participants in the PA PFAS MSS Health Study with PFAS results who fall into each NASEM exposure category. Note* table includes 2 adults who are missing questionnaire data.

Clinical guidance for follow-up with patients after PFAS testing1

Total PFAS Level and Clinical Follow-up Recommendation

PA Adults (N=1253)

PA Children (N=89)

>20 (ng/mL) PFAS*

High Exposure

High Exposure

Encourage PFAS exposure reduction if a source of exposure is identified, especially for pregnant persons.

In addition to the usual standard of care, clinicians should:

  • Prioritize screening for dyslipidemia with a lipid panel (for patients over age 2) following guidelines for high-risk children and adults
  • At all well visits:
    • Conduct thyroid function testing (for patients over age 18) with serum thyroid stimulating hormone (TSH)
    • Assess for signs and symptoms of kidney cancer (for patients over age 45), including with urinalysis
    • For patients over age 15, assess for signs and symptoms of testicular cancer and ulcerative colitis

 

 

 

 

 

N=379 (30.2%)

 

 

 

 

 

N=4 (4.5%)

2-<20 (ng/mL) PFAS

Moderate Exposure

Moderate Exposure

Encourage PFAS exposure reduction if a source has been identified, especially for pregnant persons.

Within the usual standard of care clinicians should:

  • Prioritize screening for dyslipidemia with a lipid panel (once between 9 and 11 years of age, and once every 4 to 6 years over age 20)
  • Screen for hypertension disorders of pregnancy at all prenatal visits
  • Screen for breast cancer based on clinical practice guidelines based on age and other risk factors

 

 

 

 

N=863 (68.9%)

 

 

 

 

N=84 (94.4%)

<2 (ng/ML) PFAS*

Low Exposure

Low Exposure

Provide usual standard of care

N=11 (0.9%)

N=1 (1.1%)

* Simple additive sum of PFOA and PFOS (linear and branched isomers), PFHxS, PFNA, PFDA, PFUnDA, and MeFOSSA in serum or plasma

1Adapted from:  National Academies of Sciences, Engineering, and Medicine. 2022. Guidance on PFAS Exposure, Testing, and Clinical Follow-Up. Washington, DC: The National Academies Press. https://doi.org/10.17226/26156.

 

 

.

Information about Study Process

 

Are you eligible?

We are currently recruiting adults (ages 18+) and children (ages 5-17) who lived in the following Bucks and Montgomery townships between 2005 and 2017: Horsham, Ivyland, Warminster, Warrington, Abington, Hatboro, Northampton, Upper Dublin, Upper Moreland, Upper Southampton, or Warwick. Children whose mothers lived in these areas between 2005 and 2017, prior to their child's birth, may also be eligible to participate.

 

PA PFAS Multi-site Study Process

 

How many can participate?

We plan to enroll 1,000 adults ages 18 and older and 300 children ages 5 to 17 (with parent or guardian permission).

 

What's involved?

Study participants will be asked to:

 

  • Provide a blood sample, urine sample, and body measurements during a scheduled visit to our study office.
  • Complete a questionnaire, which can be administered by phone or during the office visit.
  • Complete a neurobehavioral assessment, which includes a series of learning and memory games (children and adolescents).

 

Adult participants will receive $50 in gift cards and children will receive $75 in gift cards for completing all parts of the study. Participants will also receive a personalized report with their blood test results.

 

Our study team follows strict COVID-19 precautions. Everyone entering the office will be required to wear a mask and be screened for COVID-19 symptoms. All our staff are fully vaccinated.


Hero

Frequently Asked Questions

RTI International, the Pennsylvania Department of Health (PA DOH), Temple University, and Brown University received federal funding to study PFAS and possible health effects from drinking PFAS-contaminated water in Pennsylvania.

The goal of the PA PFAS Multi-site Health Study is to learn more about the relationship between PFAS exposure and health outcomes among differing populations exposed to PFAS-contaminated drinking water. It will also compare different levels of PFAS exposure from different sites and health outcomes.

PFAS are human-made chemicals used since the 1950s in a variety of products, including some cosmetics; water, grease, and oil-resistant products; and some firefighting foams.

There is much to learn, but some studies show high levels of certain PFAS may lead to the following:

  • Increased cholesterol levels
  • Changes in liver enzymes
  • Decreased vaccine response in children
  • Increased risk of high blood pressure or preeclampsia in pregnant women
  • Small decreases in infant birth weights
  • Increased risk of kidney or testicular cancer

Adults who are age 18 and older and children ages 5 through 17 (with parent or guardian permission) who resided in households exposed to PFAS-contaminated drinking water, either via the public water system or private wells, may be eligible. Children exposed in utero or during breastfeeding may also be eligible.

Residents who were potentially exposed to PFAS on their job (e.g., ever worked as a firefighter or used firefighting foam and/or ever worked at facilities using PFAS chemicals) are not eligible to participate.

Residents who only had exposure to PFAS-contaminated drinking water before 2005 are not eligible to participate. Someone would be ineligible to participant in the study if they did not have relatively recent exposure to PFAS-contaminated drinking water. This requirement is to ensure that PFAS levels remain high enough to be measured in the blood.

There are no costs for the tests. Adults can receive up to $50 in gift cards for completing the entire study, and children can receive up to $75 in gift cards for completing the entire study.

The enrollment goal is 1,000 adults and 300 children. Recruitment will target groups of participants from these townships: Abington, Hatboro, Horsham, Ivyland, Northampton, Upper Dublin, Upper Moreland, Upper Southampton, Warminster, Warrington, and Warwick and participants who took part in the 2018-2019 Pennsylvania PFAS biomonitoring project. More information about the biomonitoring project can be found under Other Studies.

In the fall of 2021, eligible residents will be invited to schedule a clinical visit and complete tests for the study.

Trained professionals from the community will:

  • Collect your blood and urine samples (samples will NOT reveal drug/alcohol use)
  • Take your body and clinical measurements
  • Ask questions about your residential, drinking water usage, occupational, and medical histories
  • Study behaviors in child participants

With your consent, staff will also collect information from your medical records and your child's school records.

The study will examine associations between PFAS compounds and lipids, renal function and kidney disease, thyroid hormones and disease, liver function and disease, glycemic parameters and diabetes, and immune response and function in both children and adults. In addition, the study will investigate PFAS differences in sex hormones and sexual maturation, vaccine response, and neurobehavioral outcomes in children. In adults, additional outcomes of interest include cardiovascular disease, osteoarthritis and osteoporosis, endometriosis, and autoimmune disease.

Participants' results will be used to inform public health specialists on how PFAS impacts human health. In addition, each individual participant will receive their own testing results, enabling them to learn more about their own health.

Aqueous Film Forming Foams (AFFF). Large-scale drinking water contamination has occurred in many states among communities near military bases where PFAS were used in firefighting exercises. These bases were routinely performing firefighting trainings using PFAS-containing Aqueous Film-Forming Foams (AFFF) for several decades. The use of AFFF in training exercises led to direct emissions of PFAS into surface and ground waters. Montgomery and Bucks counties in Southwestern Pennsylvania were the locations of two such large military bases.

Bucks County. The former Naval Air Warfare Center (NAWC) in Warminster Township, Bucks County, Pennsylvania, was used to research, develop, and test naval aircraft systems, and was located near four of the 18 Warminster Municipal Authority (WMA) public water supply wells. PFAS compounds were detected in the WMA system in the summer of 2013. Further study was performed by the U.S. Environmental Protection Agency (EPA), and as of September 2015, PFAS were detected in 93 out of the 100 private wells within a 1- to 3-mile radius of the military site.

Montgomery County. The Horsham Air Guard Station (HAGS) in Horsham Township, Montgomery County, Pennsylvania, located a few miles away from NAWC is on a 1,200-acre site that was shared with the Naval Air Station Joint Reserve Base. Military operations began during the 1920s and the base is currently operated under the Pennsylvania Air National Guard. The AFFF used on the HAGS base resulted in PFAS-contamination of two nearby public water systems — the Horsham Water and Sewer Authority and the Warrington Township Water and Sewer Department.

Yes, PFAS drinking water contamination in the area impacted by the former and current Department of Defense bases has been addressed. Contaminated public water wells in the Horsham, Warrington, and Warminster public systems were taken out of service by July 2014, and bottled water and later public water hookups were provided to certain residents with contaminated private wells. A subset of additional private wells with lower levels of PFAS within 25 percent of the perfluorooctanesulfonic acid (PFOS) or perfluorooctanoic acid (PFOA) Preliminary Health Assessment Levels (PHALs) are being monitored through quarterly resampling.

Yes, the PA PFAS Multi-site Health Study will be asking questions about personal and family history of cancer.

The PA PFAS Multi-site Health Study is using the same questionnaire that is being used in the Pease, NH, study. The adult questionnaire includes sections on Residential History and Drinking Water Exposures, Occupational History, Medical History, Reproductive History (women only) including use of birth control pills, Family Medical History, and Social History including questions about smoking and alcohol use. The currently approved questionnaire does not include questions around diet or use of prescription, over-the-counter, or illicit drugs.

Based on current knowledge, ingestion is clearly the dominant concern. Inhalation of house dust represents an additional path of exposure, but there are uncertainties about its contribution to human exposure. Risks associated with dermal exposures, either through direct contact with PFAS-containing materials (e.g., carpets or bathing/swimming in waters contaminated with PFAS at typical levels) remain largely unknown. However, the information available suggests that environmental conditions for dermal exposure may not make this a major contributor to overall exposure.

Although most mixtures of pesticides, herbicides, and insecticides used at golf courses to maintain their turf do not consist of PFAS chemicals, there is evidence that some pesticide and herbicide formulations may contain some PFAS. Thus, application of large amounts of PFAS-containing lawn care chemicals could be another potential pathway for PFAS to contaminate groundwater.

ATSDR selected a cross-sectional study design for the PA PFAS Multi-site Health Study to be comparable with other studies and to establish a baseline for potential follow-up in longitudinal studies. The cross-sectional study design involves looking at data from a population at one specific point in time; therefore, this study will not compare any past evidence obtained over time. However, the results of this research will be available to the public under CDC’s Open Access plan. Thus, future researchers with access to the Department of Defense Serum Repository could build on the results of the PA PFAS Multi-site Health Study to conduct a longitudinal study using this resource.

Unfortunately, there is not a good layperson's guide to the health effect of PFAS. Below are links to some factsheets and reports that provide useful information.

Meet Our Investigators

 

RTI and PA DOH have assembled a collaborative group of experts who have led projects and tasks of similar size and complexity, with expertise in all substantive and technical requirements of the PA PFAS Multi-site Health Study. The study team will be led by Linda Morris Brown, MPH, DrPH (RTI), and Anil Nair, PhD, MPH (PA DOH). Drs. Brown and Nair will be supported by Co-Investigators from Temple University (Drs. Resa M. Jones and Robin Taylor Wilson) and Brown University (Dr. David Savitz).

Linda Morris Brown, MPH, DrPH

Linda Morris Brown, MPH, DrPH

RTI International
Anil Nair, PhD, MPH

Anil Nair, PhD, MPH

Pennsylvania Department of Health
Resa M. Jones, MPH, PhD

Resa M. Jones, MPH, PhD

Temple University
Robin Taylor Wilson, PhD

Robin Taylor Wilson, PhD

Temple University
David Savitz, PhD

David Savitz, PhD

Brown University

Community Engagement

 

 

Community Assistance Panel

Susan Wood
Susan Wood

Interested in learning more about the study and helping investigators with recruitment and communication?

Please contact Susan Wood at
PA DOH at c-swood@pa.gov.

 

 

Community Meetings

March 23, 2022 - Click here to access the recording.
Kick-off Meeting on November 16, 2021 - Click here to access the recording.
March 25, 2021 - Click here to access the recording.
January 26, 2021 - Click here to access the recording.
December 3, 2020 - Click here to access the recording.
July 9, 2020 - Click here to access the recording.

 

 

Community Videos

 

Community Voices - Renee Frugoli
Community Voices - Anne Blastic

 

Community Voices - The Bells
Community Voices - Mike Brooks

 

Community Voices - Kyle Bagenstose
Community Voices - The Bell Kids

 

Community Voices - Julie Cassidy
Community Voices - Tina O'Rourke

 

Community Voices - Rob Bilott
Community Voices - Brian Fitzpatrick

 

Community Voices - Todd Stephens
Community Voices - Bells Grandparents

 

Community Voices - Rob Bilott 2
Community Voices - Todd Stephens 2

 

Community Voices - Madeleine Dean

 

 

Community Groups

Stanton
Joanne Stanton
Grosse
Hope Grosse

Buxmont Coalition for Safer Water:
https://www.buxmontwater.org

Other Studies

PFAS Biomonitoring
The PA DOH in 2018 measured PFAS levels in a random sample of 235 residents in the Horsham, Warrington, and Warminster communities. This was a pilot study to determine whether this region has higher-than-average levels of PFAS compounds in residents’ blood. The community’s average PFAS levels were compared to the U.S. general population and were found overall to be above average. In 2019, PA DOH collected dust and tap water from a random sample of households, and urine samples were collected from the original biomonitoring participants. More information on the national EA work can be found in the next column.
PFAS Exposure Assessment

The CDC and ATSDR are assessing the PFAS exposure in communities near current or former military installations. The exposure assessment compares PFAS levels in blood and urine from the Horsham, Warminster, and Warrington community to levels in the general population or to those reported in other studies. The CDC and ATSDR will also identify and assess environmental factors that affect exposure, like household dust and drinking water.

PA Cancer Studies
PA DOH has performed cancer data reviews over the last 40 years, examining the rates of cancers in the Horsham, Warminster, and Warrington area.
Cancer data review
(1985-2013) - selected zip codes

Evaluated incidence rates of seven cancers (multiple myeloma, non-Hodgkin lymphoma, and cancers of the bladder, kidney, liver, prostate, and testis).

Cancer data review - Addendum 1
(1985-2013) - selected zip codes

Evaluated incidence rates of two additional cancers: pancreatic and pediatric cancers.

Cancer data review - Addendum 2
(1985-2013) - selected zip codes

Improved precision in cancer incidence rate analysis for the above nine cancers by geocoding cancer cases to confirm their geographic location and by using the water service areas as the study area.

Contact Us

Submit a message below to papfashealth@rti.org for general study information.