Epidemiology: Occupational and Environmental


NCDHHS has developed new guidance for clinicians working with patients exposed to PFAS chemicals in our NCDHHS PFAS Clinician Memo.

On June 15, 2022, The Environmental Protection Agency (EPA) released a national drinking water health advisory for GenX. More information about GenX is available on this factsheet along with information about water testing and filtration options.

GenX in the Cape Fear River Basin

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GenX is a member of a large group of man-made chemical compounds known as per- and polyfluoroalkyl substances (PFAS). PFAS are man-made chemicals that do not occur naturally in the environment. These chemicals have broad uses in commercial products such as food packaging, nonstick coatings, and firefighting foam.

GenX is a trade name for one unregulated PFAS used in manufacturing nonstick coatings and for other purposes. It is also produced as a byproduct of certain manufacturing processes.

In June 2017, the North Carolina Department of Health and Human Services (NCDHHS) was notified of a chemical, called GenX, found in drinking water sourced from the lower Cape Fear River. GenX and other emerging PFAS were found in the river and drinking water in a study led by researchers at North Carolina State University. The Chemours facility in Fayetteville was identified as the source of the GenX chemical. Further investigation by the NC Department of Environmental Quality (NCDEQ) found GenX in private drinking water wells near the Chemours facility.

GenX and other PFAS were measured in air emissions from the Chemours facility and have been found in rainwater and other bodies of water close to the facility. Under a consent order between NCDEQ, Chemours, and the Cape Fear River Watch, Chemours is responsible for characterizing GenX in the environment and reducing or eliminating their emissions through wastewater and air.

For more information about environmental monitoring for GenX and other PFAS, visit DEQ's GenX Investigation webpage.

GenX in the Cape Fear River Basin

There is limited information about the health effects of GenX. In October 2021, EPA released a human health toxicity assessment of GenX chemicals, which is a written summary of available information about the potential health effects associated with this chemical. Laboratory studies of animals show effects on the liver at GenX exposure levels lower than levels where other effects are seen, indicating that the liver may be sensitive to GenX. Other negative effects seen in animal studies at higher levels include effects on the kidney and immune system, and developmental effects as well as liver, pancreatic, and testicular cancer.

Animal toxicity studies are a helpful starting point for understanding potential health effects of GenX, but the relevance to human health cannot be fully understood without more human research studies. Limited information from a small exposure investigation (i.e. targeted biomonitoring) suggests that GenX may not stay in the body for a long period of time.

Scientists are actively studying the health effects of PFAS to learn more. NCDHHS continues to work with various federal and state partners to review all new health and toxicity information about these compounds and shares new information with communities, as it becomes available. This includes the ongoing Agency for Toxic Substances and Disease Registry (ATSDR) Exposure Assessments and Multi-Site Health Studies and North Carolina State University's GenX Exposure Study.

Photo of a glass of drinking water

In July 2017, DHHS set a provisional health goal of 140 nanograms per liter (ng/L) or parts per trillion (ppt) for GenX in drinking water. This is a level of GenX in drinking water below which no adverse health effects would be expected over a lifetime of consumption.

The provisional health goal was calculated to protect the most vulnerable populations (i.e., bottle-fed infants) using the available toxicity studies. This Questions and Answers document provides additional information on the calculation of the provisional drinking water health goal. The NC Secretaries' Science Advisory Board reviewed and approved the NCDHHS provisional drinking water health goal in a report released in October 2018.

The provisional drinking water health goal is not a regulatory level and is not a boundary line between a "safe" or "dangerous" level of GenX, but can be used to provide information to affected communities and residents about potential risks from exposure to GenX through drinking water.

The provisional drinking water health goal is for drinking water only and cannot be compared to GenX levels in other environmental media (e.g., rainwater or fish).

NCDHHS is currently reviewing EPA's human health toxicity assessment for GenX chemicals. The current provisional drinking water health goal will likely be replaced by EPA's national health advisory level for GenX in drinking water when that becomes available, which is expected in spring 2022.

NCDHHS is working to address PFAS issues throughout the state, including in the lower Cape Fear River Basin. These efforts are led by the Health Assessment, Consultation, and Education (HACE) program. The HACE program works with other state, local, and federal partners to evaluate public health impacts from exposure to toxic substances in the environment throughout North Carolina and provide recommendations to protect human health. HACE activities include:

  • Reviewing EPA's GenX final toxicity assessment to determine how this affects our current understanding of health effects from GenX
  • Conducting public health assessments for affected communities (see below).
  • Reviewing environmental data regarding exposure to PFAS.
  • Evaluating new health and toxicity information as it becomes available.
  • Providing outreach and health education to affected communities
  • Coordinating with federal partners at the Centers for Disease Control and Prevention (CDC), U.S. Environmental Protection Agency (EPA), and the National Institute of Environmental Health Sciences (NIEHS), as well as colleagues in other states.
  • Continuing to provide requested information to the Secretaries' Science Advisory Board for their review and recommendations.

Guidance for Physicians

NCDHHS has developed new guidance for clinicians working with patients exposed to PFAS chemicals in our NCDHHS PFAS Clinician Memo. This is based on recent recommendations from the National Academies of Science and Medicine Guidance on PFAS Testing and Health Outcomes.

Specific activities and reports associated with GenX response include the following:

Cancer and birth defects investigations

NCDHHS has completed investigations into the prevalence of certain types of cancer and birth defects in the Lower Cape Fear Region. Overall, most cancer and birth defects rates were similar to state rates. Only a comprehensive research study can provide information about whether a specific exposure might be associated with an elevated prevalence of a specific birth defect or type of cancer.


NCDHHS worked with the Cumberland and Bladen County Health Departments, the CDC, and the ATSDR to conduct biomonitoringby testing for GenX and other PFAS in blood and urine samples from approximately 30 residents living close to the Chemours facility. This summary report details the results of this investigation. The results were also documented in an article in the CDC's scientific series Morbidity and Mortality Weekly Report (MMWR).

PFAS Community Survey

In early 2019 NCDHHS conducted a survey of residents near the Chemours Plan to document concerns about GenX and other PFAS chemicals. These survey results will be used to tailor health education activities to better meet community needs. Results from that survey are summarized in this report (PDF) and appendix (PDF).

Assisting Researchers

NCDHHS staff are advising researchers performing ongoing studies. These include:

Public health assessments and health consultations gather information about hazardous substances at a site and evaluate whether exposure to those substances might cause harm to people. These public health assessments or health consultations are completed through a cooperative agreement with ATSDR and include the following regions:

  1. Lower Cape Fear (under development)
    The public health assessment for people on public water supplies that draw water from the Lower Cape Fear River is currently under development. We are in the process of reviewing the available environmental data.
  2. Around the Chemours Fayetteville Works Facility (ongoing)
    Environmental sampling in the communities around the Chemours Fayetteville Works Facility remains ongoing. We are reviewing data as we receive it from DEQ or other agencies and providing public health recommendations as necessary to protect people from potentially harmful exposures. Due to the ongoing investigation and sampling, the public health assessment is still under development.
  3. Camp Dixie (completed)
    DEQ sampled the lake at Camp Dixie for GenX and other PFAS in October 2017, since the lake is located close to the Chemours facility. The HACE program evaluated these sampling results and issued a letter to the director of the camp. HACE concluded that exposure to GenX at levels measured in October 2017 while recreating in the lake is not expected to harm people's health.

Last Modified: 09-19-2022