Poly- and Per-fluoroalkyl Substances (PFAS)

Per- and Polyfluoroalkyl Substances (PFAS) are a group of synthetic chemicals that have been used for decades to manufacture household and commercial products that resist heat, oil, stains, grease, and water. PFAS have been used in many consumer products, including non-stick cookware, stain-resistant furniture and carpets, waterproof clothing, microwave popcorn bags, fast food wrappers, pizza boxes, shampoo and dental floss. They have also been used in certain firefighting foams and various industrial processes. PFAS, including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), can move through soil, get into groundwater, and be carried through air. Many PFAS are found in our environment and do not break down easily.

People are most likely exposed to PFAS by drinking or eating something that contains PFAS, such as:

• Drinking water contaminated with PFAS;
• Eating food that may contain high levels of PFAS (e.g., fish and shellfish);
• Eating food contaminated by packaging materials containing PFAS (e.g., popcorn bags, fast food containers, pizza boxes); and
• Hand-to-mouth transfer from surfaces treated with PFAS-containing stain protectants, such as carpets, which is thought to be most significant for infants and toddlers.

PFAS are stable chemicals and move easily in the environment, PFAS have been found far away from where they were made or used. The Centers for Disease Control and Prevention (CDC) National Health and Nutrition Examination Survey (NHANES) has tested and found that most people living in the United States have PFAS in their bodies, indicating widespread exposure to these chemicals. The Environmental Protection Agency (EPA) has classified PFAS as contaminants of emerging concern because of their widespread use and potential to affect human health.

Research shows widespread exposure to PFAS in the U.S. population because of their use in everyday products. PFAS do not break down easily in the environment and some PFAS can remain in the body for extended periods of time. While studies in humans do not consistently or conclusively show that PFAS cause any specific health effects, they suggest that PFAS may affect a variety of possible health endpoints, including but not limited to:

• Changes in liver enzymes
• Increases in cholesterol levels
• Lower immune function (lower antibody response to immunization)
• Increases in risk of high blood pressure or pre-eclampsia in pregnant women
• Small decreases in infant birth weights
• Increases in risk certain types of cancers, in particular prostate, kidney, and testicular cancer

Studies do not clearly show whether PFAS cause cancer in people. People exposed to high levels of PFAS may have increased risk of certain types of cancer. However, further research is necessary as these studies are not consistent and may not have considered other risk factors for cancer such as tobacco use, alcohol use, and diet. Additional research may change our understanding of the relationship between exposure to PFAS and human health effects.

You can take simple steps to reduce your exposure to PFAS:

• Test your well or check your community water source by asking for the consumer confidence report or water quality report
• Check for fish advisories indicating a PFAS risk for locally caught fish (PFOS, in particular)
• Avoid eating food that was packaged in material that contains PFAS like grease-resistant paper, fast food containers, microwave popcorn bags, pizza boxes, and candy wrappers.
• Avoid using personal care products, cosmetics, and other consumer products that contain PFAS including stain resistant carpeting and water repellant clothing.

Research has suggested that exposure to PFOA and PFOS from today’s consumer products is usually low, especially when compared to exposures to contaminated drinking water. To help reduce exposure to PFAS through consumer products, avoid those that may contain PFAS such as:

• Some grease-resistant paper, fast food containers/wrappers, microwave popcorn bags, pizza boxes, and candy wrappers
• Nonstick cookware
• Stain resistant coatings used on carpets, upholstery, and other fabrics
• Water resistant clothing
• Cleaning products
• Personal care products (shampoo, dental floss) and cosmetics (nail polish, eye makeup)
• Paints, varnishes, and sealants

Talk to your healthcare provider

If you were exposed to PFAS or you are concerned about your health, talk to your doctor. Anyone that has health concerns related to PFAS exposure should discuss these concerns with their healthcare provider, who can follow their health over time through regular check-ups. Additionally, there are important steps we should all take to protect our health and prevent disease. Tobacco use, alcohol, obesity and being overweight are all risk factors for chronic diseases, including many types of cancer. Having a healthy diet, exercising, reducing alcohol consumption, and avoiding tobacco use can help prevent illness.

It is possible to test for PFAS in human serum, but there are limitations. The PFAS blood test is not a medical test that will help determine the cause of a health problem or provide information on treatment. The blood test will tell you how much of each PFAS is in your blood at the time of the test. Blood testing provides individuals with information about their individual levels of PFAS exposure, and some have expressed interest in knowing their blood levels because it may provide information in the future as research continues and more science emerges. 

The Centers for Disease Control and Prevention’s Agency for Toxic Substances Disease Registry (ATSDR) has recently published information for healthcare providers related to PFAS. These materials can be found through the links below.

• ATSDR Guidance on Talking to Your Doctor about Exposure to PFAS 
• ATSDR PFAS Information for Clinicians

Test your well water for PFAS

New Hampshire Department of Environmental Services (NHDES) recommends that anyone with a private well should periodically have their drinking water tested for a number of different contaminants that can affect water quality and health, including common contaminants like arsenic, lead and radon. Homes should also be tested for radon gas in air. If a private well owner decides to test for PFAS and finds levels above the drinking water standards/MCLs, they can consider installing a treatment system. 

For more information about water testing and treatment options and about reducing PFAS exposure through drinking water, review the recommendations found on the NHDES Well Water website and on the PFAS in New Hampshire Well Water factsheet. 

The NHDES NH PFAS Investigation website is used to update interested parties on NHDES’ current investigation on the presence of PFAS in New Hampshire.

See a summary of data from previous PFAS Investigations in New Hampshire, including the Pease PFAS Blood Testing Program, the Southern NH Blood Testing Program, and the Merrimack Village District (MVD) Community Exposure Assessment, on the DHHS Data Portal.

Pease Tradeport Investigation

In May 2014, a well on the Pease Tradeport reported levels of concern of PFOS and PFOA. Additional PFAS were also detected on the Pease Tradeport, including PFHxS. The City of Portsmouth immediately shut down the well once the exposure was discovered. DHHS worked in collaboration with the NHDES, the Air Force, the City of Portsmouth, the CDC, Portsmouth Hospital, and the Seacoast community on the response. In response to the Tradeport community’s concern about the exposure to PFAS in humans, DHHS conducted a two-phase blood testing program in 2015 for affected residents, which included almost 1,600 tests for PFAS. 

• Pease PFC Blood Testing Program Final Report (2016)
• Per- and polyfluoroalkyl substance (PFAS) exposure assessment in a community exposed to contaminated drinking water, New Hampshire, 2015

ATSDR completed a study of the human health effects of PFAS exposure through contaminated drinking water at Pease, the first in a multi-site study.

• Information on the Agency for Toxic Substances and Disease Registry (ATSDR) Pease Study

Southern New Hampshire Investigation

In March 2016, PFOA was discovered in private drinking water wells near the Saint-Gobain Performance Plastics facility in Merrimack, NH. DHHS is collaborating with NHDES on their response to drinking water contamination in the surrounding towns. For the latest information on the status of the ongoing response to the PFAS discovery in Southern New Hampshire, please visit the NH PFAS Investigation.

In March 2016, PFOA was discovered in several southern NH communities initially around the Saint-Gobain Performance Plastics facility in Merrimack, including in groundwater wells that feed into the MVD system. The MVD public water system serves residents of Merrimack and Bedford and is supplied by multiple individual wells that are combined prior to delivery of residential drinking water. Two MVD supply wells (wells 4 & 5) were taken offline in June 2016 when they tested above 70 nanograms per liter (ng/L), which is the Lifetime Health Advisory Level set by the U.S. Environmental Protection Agency. The New Hampshire Department of Health and Human Services (DHHS) launched the MVD Community Exposure Assessment in 2016 to evaluate exposure to PFAS among residents served by the MVD public water system. DHHS initiated the MVD Community Exposure Assessment in response to concerns by MVD customers and Merrimack and Bedford town officials. The Community Exposure Assessment tested the blood (serum) of 217 randomly selected MVD customers. Results from this assessment provide residents with information about levels of PFOA exposure in the community. 

• Merrimack Village District Community Exposure Assessment Summary Report (2017)

Other Investigations Across the State

NHDES continues their investigation of contaminated sites across the State, identifying possible exposures to PFAS. Visit the NH PFAS Investigation website to learn more. 

Anyone that has health concerns related to PFAS exposure should discuss these concerns with their healthcare provider, who can follow their health over time through regular check-ups. Talk to your healthcare provider to help address your medical concerns.

For more information on how to talk to your healthcare provider about PFAS and your medical concerns, review the ATSDR Guidance on Talking to Your Doctor about Exposure to PFAS. 

If you are a healthcare provider interested in learning more about PFAS, see Per- and Polyfluoroalkyl Substances (PFAS): Guidance for New Hampshire Clinicians and the ATSDR Guidance for Clinicians.

If you are a healthcare provider interested in learning more about PFAS, see Per- and Polyfluoroalkyl Substances (PFAS): Guidance for New Hampshire Clinicians and the ATSDR PFAS Information for Clinicians.