Per- and polyfluoroalkyl substances (PFAS) are a class of chemicals used in many consumer products and industrial processes since the 1950s. Because there isn’t federal regulation of their use or disposal, PFAS are commonly released into the environment. When PFAS are released, people can be exposed to them through air, dust, food, and water, so PFAS exposure is common in the United States. Biomonitoring studies have found that certain species of PFAS are present in the blood of almost all US residents.

Many species of PFAS are known to have adverse health effects on humans including increased cholesterol levels, changes in liver enzymes, decreased vaccine response in children, increased risk of high blood pressure in pregnant women, and decreased birth weight. Epidemiologic studies also show a link between exposure to certain species of PFAS and increased rates of kidney, prostate, and testicular cancer.

While there many ways to be exposed to PFAS, one of the most common is through contaminated drinking water. It is estimated that 200 million people in the US receive PFAS-contaminated drinking water. In 2018 New Jersey became the first state to adopt enforceable standards for PFAS in drinking water. It established maximum contaminant levels (MCLs) – which are the highest amount of a contaminant allowed in drinking water – for three of the most common species of PFAS: perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA). In April 2024, the US Environmental Protection Agency (EPA) announced the first federal drinking water standards for six PFAS including PFOS, PFOA, and PFNA.

In establishing MCLs for PFAS, New Jersey mandated statewide testing of all Community Water Systems (CWSs, the government-regulated water utilities) in the state. These CWSs tested by New Jersey serve 77% of the statewide population. A recent study used 2019-2021 CWS testing data along with Census data to evaluate if there are demographic differences in PFAS contamination of New Jersey residents’ drinking water. The study calculated quarterly averages for 491 CWs over this time period. It found that PFAS were detected above New Jersey’s MCL in 14% of CWSs, which serve 23% of the population. 

The study also mapped demographic information from census block groups – which are portions of census tracts and generally contain 600-3,000 people – onto the boundaries of each CWS. This created a map where the demographic makeup and quarterly average PFAS concentrations for each CWS were known. 27% of the non-Hispanic white population were served by CWSs with PFAS above New Jersey’s MCL. In contrast, 52% of the Asian population, 38% of the Hispanic population, and 34% of the Black population were served by CWSs with PFAS above New Jersey’s MCL.

These results demonstrate that not only is PFAS contamination prevalent in drinking water in New Jersey, but that there are racial disparities in PFAS contamination by CWS service area. Compared to white populations, Hispanic, Asian, and Black populations are more likely to receive drinking water that has PFAS contamination above the state’s safe threshold. These racial disparities in drinking water quality mirror racial disparities in the US more generally. Historical and ongoing housing discrimination leads to communities of color being excluded from living in certain areas. Throughout the country, pollution-emitting facilities are disproportionately located in nonwhite neighborhoods, driving health and environmental problems that disproportionately affect people of color. Industrial and military facilities that use PFAS and are located in nonwhite neighborhoods may contaminate the water supplying nearby CWSs, which could explain the racial disparities in drinking water discovered in this study.

It is important to note that EPA’s new MCLs for PFAS species are below New Jersey’s MCLs. Complying with these federal standards could reduce racial disparities in PFAS water contamination in New Jersey, but only with robust federal enforcement. People in New Jersey and across the US – especially people of color who have been disproportionately harmed – need enforceable standards and effective enforcement of those standards in order to be safe from PFAS in their drinking water.

Communities exposed to toxic chemicals from industrial pollution struggle to get answers about whether the pollution has caused the health problems in their community. Groups organize to pressure the government to stop the pollution and to clean up the contamination. But these agencies have few answers and often little is done. Frequently states ask the Agency for Toxic Substances and Disease Registry (ATSDR) to investigate the health problems reported in a community. Initially, ATSDR is welcomed because people think that someone is finally going to provide some answers about the health problems in the community.

The Agency for Toxic Substances and Disease Registry (ATSDR) was created in 1980 to address health problems at Superfund sites. Their mission is to protect communities from harmful health effects related to exposure to both natural and man-made hazardous substances. ATSDR is the right agency to evaluate health complaints in a community and they have been doing so for more than 30 years. And for most of this time, the agency has repeatedly failed to answer the questions people raise about whether there’s a link between health problems and the pollution in the community. CHEJ has written much about ATSDR over the years¹.

Last month an investigative report by the news service Reuters took an extensive look at ATSDR’s work. The report, “How a US health agency became a shield for polluters,” analyzed 428 reports issued by the agency from 2012 to 2023. Those reports contained 1,582 conclusions about potential harms at contaminated sites. Reuters found that in 68% of its findings, the ATSDR declared communities safe from hazards or did not make any determination at all. That record of finding little harm “strains credulity,” said one former EPA official quoted in the report.

Other key findings included:

• The agency’s frequent declarations of no harm often are rooted in faulty research. At least 38% of the time, agency reports show, its researchers relied on old or flawed data.
• At least 20 times from 1996 to 2017 the agency declared that a potential hazard posed no health risk – only to be refuted later by other government agencies or the ATSDR itself. The errors impact communities in Alabama, California, Missouri, New York and North Carolina.
• Despite decades of criticism, the agency continues to publish research that relies upon practices its own review board called “virtually useless.”
• The agency’s common practice of publishing inconclusive reports feeds a long-standing corporate strategy of using scientific uncertainty to deflect regulation and liability for polluted sites.

How is it possible that ATSDR has operated like this for so long? Some answers come from a symposium hosted by ATSDR in 2012 on the Future of Science at ATSDR²:

“In conducting its core work of assessing health risks at contaminated sites, ATSDR has faced a large workload with limited authority and resources to collect needed data. Moreover, concerned communities have voiced legitimate public health questions that ATSDR could not answer fully with existing scientific tools and knowledge.

This meeting documented many scientific limitations and challenges facing the agency. ATSDR’s Board of Scientific Counselors hired a consultant who reviewed the agency’s scientific work and came to these conclusions and observations:

• An alarming gap persists between public expectations and the limited tools available to scientists to assess the public health effects of hazardous waste sites and uncontrolled releases. This gap is due, in part, to the inherently complex and uncertain relationship between diseases and chemicals emanating from hazardous waste sites and uncontrolled releases. Many substances commonly found at hazardous waste sites and in uncontrolled releases may also emanate from other sources and are routinely detected at low levels in air, water, food, consumer products, or other media. No field-based methods are readily available for measuring the portion of a particular ambient exposure or internal dose that is attributable to a specific hazardous waste site or uncontrolled release.
• In the absence of scientific methods for assessing the unique contribution of releases from hazardous waste sites and uncontrolled exposures to disease, ATSDR scientists rely upon surrogate methods and designs (e.g., comparing exposures to disease rates in communities with a hazardous waste site with “background” levels). Such approaches, although squarely within the mainstream of environmental science, typically are not robust enough to detect adverse health effects caused by site-specific exposures to toxic chemicals.
• EPA and ATSDR scientists calculate theoretical risk estimates based on a host of assumptions about contaminant concentrations, exposure duration, characteristics of the exposed population, acute and long-term health risks and other factors.
• ATSDR relies predominately on environmental data collected by other agencies (primarily EPA and state agencies) for its health assessments. Such data often are not adequate or appropriate for addressing specific questions about current exposures and pathways.

Without good tools to evaluate the impact of chemical exposures on people, ATSDR, EPA and other government agencies will continue to struggle to address pollution and contamination in communities. It’s time to recognize and to acknowledge that scientists know very little about how exposures to toxic chemicals, especially to low level mixtures, lead to adverse health outcomes.

Instead of trying to link cause and effect (the agencies default approach), which is virtually impossible to achieve because of the inherently complex and uncertain relationship between disease and chemical exposure and the limited tools to evaluate health effects, isn’t it time to consider whether there’s enough information and evidence about exposure and adverse health problems in a community to take action to protect people exposed to toxic chemicals?

Until there is a change in how government approaches health problems in a community, you can expect ATSDR to continue to investigate health problems in communities using the same approach that’s reflected in the Reuters article.

Acrylamide is a clear, odorless chemical. It has many industrial uses, including treating waste water
discharge from water treatment plants. It is also used in the production of industrial products like dyes,
paper pulp, grout, plastics, and construction materials. Many consumer products are also produced
using acrylamide, such as contact lenses, cosmetics, fabrics, textiles, and sugar. When acrylamide enters
the environment, people are most likely to be exposed to it by drinking contaminated water. Acrylamide
can enter drinking water through the water treatment process or through improper disposal from
industrial facilities that use it to manufacture products.

Exposure to acrylamide can have serious effects on the brain, causing numbness in the hands and feet,
disorientation, loss of balance, and muscle weakness. Skin contact with acrylamide can cause irritation,
dermatitis, and nerve damage. Studies in laboratory animals have found that acrylamide exposure can
also cause defects in the male reproductive system, but it is unknown if it has the same effects in
humans. Based on studies in laboratory animals, the US Environmental Protection Agency classifies
acrylamide as probably causing cancer in humans. The International Agency for Research on Cancer
classifies it as likely causing cancer in humans.

In 2002, acrylamide was discovered to form when foods rich in starch are grilled, baked, or fried above
250°F. This includes foods like potato chips, French fries, and breakfast cereals. The resulting acrylamide
can be found in the dark brown or burnt areas of these foods. Since this discovery, many regulatory and
public health agencies across the world have called for more research into whether this dietary
exposure to acrylamide increases the risk for cancer. The American Cancer Society says that based on
existing studies in humans, dietary acrylamide exposure is unlikely to be linked to increased cancer risk.
However, the ACS says that more research on this topic is needed to fully know if dietary acrylamide
poses a cancer risk. This research will be crucial in understanding how widespread cancerous acrylamide
exposure may be.

Styrene is a chemical compound that can be linked together with itself or other compounds to create strong, flexible polymers that make up plastics, rubbers, and resins. Many products such as foodware containers, printer toner, shoes, plastic pipes, carpeting, fiberglass insulation, and automobile parts contain styrene.

Styrene can enter the air, water, and soil through manufacturing and disposal of styrene-containing products. Styrene is a colorless liquid but it readily evaporates, so a large portion of styrene that enters water or soil ends up in the air. While manufacturing and disposal can cause exposure, most people are exposed to styrene through their use of styrene-containing products.  For example, people inhale it indoors because styrene-containing building materials and printers release styrene vapors. In addition, the styrene in foodware containers can migrate into the food they hold, causing people to ingest styrene.

Once inhaled or ingested, styrene can have many adverse effects on the body. Many of these effects are in the brain, such as impaired vision, impaired hearing, loss of coordination, slowed reaction time, fatigue, and difficulty concentrating. Studies in laboratory animals have found that styrene exposure can also cause damage to the liver, though it is unknown if it has this effect in humans. The US Department of Health and Human Services classifies styrene as being reasonably anticipated to cause cancer. The International Agency for Research on Cancer classifies styrene as probably causing cancer. The pervasiveness of styrene-containing plastics in consumer and industrial products makes these adverse health effects particularly concerning. Decreasing the reliance on plastics – through government regulation, scientific innovation, and consumer education – would help protect people from styrene exposure and its associated health effects.