Epidemiology: Occupational and Environmental

In April 2024, the U.S. Environmental Protection Agency implemented new drinking water regulations known as maximum contaminant levels (MCLs) for six PFAS chemicals. The MCLs are part of the National Primary Drinking Water Regulations, which are legally enforceable primary standards and treatment techniques that apply to public water systems. The MCLs reflect levels that protect human health and that water systems can achieve using the best available treatment technologies.

Water from a Private Well

• If you live in the Fayetteville area or lower Cape Fear region, you may be eligible for free Visit the North Carolina Department of Environmental Quality (NCDEQ) website or contact the Chemours Fayetteville Works Plant to request well testing:
  • Bladen, Cumberland, Robeson, and Sampson counties: (910) 678-1101
  • New Hanover, Brunswick, Pender, or Columbus counties: (910) 678-1100
  • Those with GenX levels exceeding the EPA MCL or other PFAS contamination may be eligible for replacement drinking water supplies or filtration systems at no cost.
• Other private well owners should regularly test their wells for various contaminants that may be impacting their well water. Information on PFAS testing and filtration is available on the PFAS testing and filtration factsheet and routine well testing information can be found on this FAQ about testing.
• EPA provides training and technical assistance to private drinking water well owners. This includes test kits for emerging contaminants, including PFAS and assistance when test results indicate there is contamination.

Water from a Public Water Supply

• Reach out to your water utility provider with questions regarding concentrations of PFAS in your public water Based on the National Primary Drinking Water Regulations implemented in April 2024, water systems must take action to reduce the levels of these PFAS in drinking water if the levels exceed MCLs. Public water systems have 5 years to meet this new requirement.
• Several utilities in the lower Cape Fear region are already implementing treatment systems to limit levels of GenX and other PFAS in municipal drinking water supplies.

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,
• increase risk of certain types of cancer, including testicular and kidney cancer.

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

• increased pancreatic cancer
• birth defects, delayed development, and newborn deaths in lab animals
• delayed mammary gland development; and,
• 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 advisory 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.

Statewide

The Department of Navy is investigating potential PFAS contamination on or near several bases in 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.

• 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 have been 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.

FAQs and Fact Sheets

• Per- and Polyfluoroalkyl Substances (PFAS) English, Spanish
• Fish Consumption Advisories
• PFAS Clinician Memo English, Spanish (PDF)
• PFAS Water Testing and Filtration Resources  (PDF)
• PFAS and Gardening Factsheet (PDF)

• NCDEQ: GenX Investigation
• NC PFAS Testing Network :  Statewide research collaboration  established to help answer questions about exposure to PFAS chemicals throughout NC.
• EPA:  Per- and Polyfluoroalkyl Substances (PFAS)
• EPA:  Final PFAS National Primary Drinking Water Regulation
• Food and Drug Administration:  Per- and Polyfluoroalkyl Substances