Epidemiology: Occupational and Environmental


For information about the July 2023 Cape Fear River Fish Consumption Advisory, please see the NCDHHS press release. Additional information about this specific advisory and planned community meetings related to the advisory can be found on our Fish Consumption Advisory webpage.

On March 14, 2023, the Environmental Protection Agency (EPA) released new drinking water regulations for 6 PFAS chemicals. We are in the process of updating materials to reflect this change, but interim information is available in this factsheet along with information about water testing and filtration options .

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

Per- and Polyfluoroalkyl Substances

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Per- and polyfluoroalkyl substances (PFAS) are a large group of man-made chemicals that have been used in industry and consumer products worldwide since the 1950s. These chemicals are used to make products to resist stains, grease, and water. The most studied PFAS are perfluorooctanic acid (PFOA or C8) and perfluorooctane sulfonic acid (PFOS).

Common Uses of PFAS

  • Stain resistant carpet and clothing
  • Non-stick cookware
  • Firefighting foam

PFAS do not occur naturally but are widespread in the environment. PFAS can be found in the environment near areas where they are manufactured or where products containing PFAS are often used. PFAS are found in people, wildlife, and fish all over the world. Most PFAS do not break down easily in the environment. Some PFAS can stay in people's bodies a long time.

Photo of Non-stick cookware Photo of firefighting foam

PFAS contamination may be in drinking water, food, indoor dust, some consumer products, and workplaces. Most exposures occur through drinking contaminated water or eating food that contains PFAS . If you are concerned about PFAS in your drinking water, granulated activated carbon (GAC) filters or reverse osmosis water treatment systems can be effective at removing PFAS from your water. Any water treatment system will require maintenance to make sure it keeps working over time. Consult with a professional about which option is best for your household.

Although some types of PFAS are no longer being manufactured, many products such as food packaging materials, stain and water resistant fabric treatments, and firefighting foam still contain PFAS.

Photo of a glass of drinking water

Studies of communities and individuals exposed to PFAS have shown that certain PFAS may:

  • negatively affect growth, learning, and behavior of infants and older children;
  • lower a woman's chance of getting pregnant;
  • impair thyroid function;
  • increase cholesterol levels;
  • decrease immune system function; and,
  • increased risk of certain types of cancer, including testicular and kidney cancer.

Animal toxicity studies are also a helpful starting point for understanding potential health Laboratory studies in animals showed:

  • increased pancreatic cancer
  • birth defects, delayed development, and newborn deaths in lab animals
  • delayed mammary gland development
  • effects on brain development

Humans and animals react differently to PFAS and not all effects observed in animals may occur in humans.

Whether or not you develop health problems after being exposed to PFAS depends on how much, how often, and for how long you are exposed, as well as which PFAS you are exposed to. Personal factors including age, lifestyle, and overall health can impact your body's ability to respond to chemical exposures.

Researchers are working to better understand how exposure to PFAS might affect people's health -- especially how exposure to PFAS in water and food may be harmful. 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 , the PFAS UNITEDD study , and North Carolina State University's GenX Exposure Study .

NCDHHS is aware of several communities in NC where high levels of PFAS are a known or suspected issue.

Cape Fear River Basin

PFAS contamination in the Cape Fear River Basin first came to attention with publication in 2016 of a study by researchers at North Carolina State University. Since 2017, NCDHHS has been working with the NC Department of Environmental Quality (NCDEQ), local health departments, academic researchers, community partners, and others to respond to community concerns in these areas. Affected communities identified by this study in the Cape Fear River Basin include:

  • Lower Cape Fear River: An emerging PFAS, called GenX, was found in the drinking water downstream of the Chemours Fayetteville Works facility. Further investigation by NCDEQ has found GenX and other PFAS in private drinking water wells near the Chemours facility. The NCDHHS response in this region has included setting a provisional drinking water health for GenX (now replaced by the EPA drinking water health advisory for GenX), leading targeted biomonitoring, and conducting a community survey of residents living near the Chemours facility. More information about GenX and the NCDHHS response in this region can be found here.
  • Upper Cape Fear River Basin (Pittsboro): Elevated legacy PFAS have been measured in the Pittsboro drinking water source and finished drinking water. NCDHHS has obtained these data from the researchers leading this study, as well as additional data collected by the drinking water utility.

Greensboro, NC

NCDHHS has assisted the local health departments and other government agencies with health education and outreach concerning PFAS in drinking water in Greensboro, NC. More information about the City of Greensboro’s activities and response to PFAS in drinking water can be found here.


The Department of Navy is investigating potential PFAS contamination on or near several bases in the North Carolina. NCDHHS assists the Department of Navy and other government agencies with health education and outreach for sites in North Carolina. More information about the Department of Navy’s investigation into possible PFAS groundwater contamination is available here.

NCDHHS is working to address PFAS issues throughout the state. Our work includes:
  • 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).
  • Reviewing new data: We regularly review new environmental data about PFAS exposures to better understand potential public health implications and recommend actions to reduce exposure and protect public health.
  • Engaging with researchers: We continue to engage with researchers at the forefront of PFAS research to evaluate and integrate new health and toxicity information as it becomes available.
    • Coordinate with PFAS Testing Network researchers to better understand the extent of exposure from drinking water across our state and to reach out to local health departments to interpret water testing results.
    • Serve on advisory boards for ongoing research projects: the GenX Exposure Study at North Carolina State University and the PFAS UNITEDD multi-university project headed by the Colorado School of Mines.
    • Communicate with researchers and subject matter experts from federal agencies such as the US Environmental Protection Agency, National Institute of Environmental Health Sciences, and the ATSDR.
    • Attend local and national seminars, symposiums, and conferences with a focus on PFAS.
  • Health education: We provide affected communities with health information through factsheets and assist other agencies with health education and outreach. We participate in public meetings, field phone calls from concerned residents, and act as a resource for local health departments.
  • 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 .
  • Public Health Assessments and Health Consultations: The Health Assessment, Consultation & Education (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. 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.

Last Modified: 11-30-23