High Alert Institute



PFAS and Your Health: Determining the Impact

by | Dec 28, 2022

PFAS and Your Health: Determining the Impact

Co-authors: Allison A. Sakara, NP, MSN, RN, PHRN, and Alyssa Middleton, PhD 

“You cannot get through a single day without having an impact on the world around you. What you do makes a difference, and you have to decide what kind of difference you want to make.”

― Dr. Jane Goodall

“Determinants of Health are the socioeconomic, environmental, and behavioral factors that research over many decades has shown to be strong influences on health.”― Elizabeth H. Bradley

Determinants of Health are known environmental, social, behavioral, and societal factors that impact health and disease. These factors affect us all – as individuals and as groups – where we work, play, learn, worship, and live. When defining environmental determinants of health (EDH), the World Health Organization presents us with the view of an “intersection of environment and public health.” Biological, chemical, and physical factors that surround us, along with our related behaviors, are the conditions that create EDHs. And among the ever-growing list of contaminants that play a role are PFAS substances (per- or poly-fluoroalkyl substances).

PFAS contamination is virtually everywhere, disrupting our sense of safety at every level. The threat to adults, children, and infants is a reality that has no boundaries. Our previous articles in this series have detailed the risks and impacts of PFAS in the air, soil, water, and food. We also have examined occupational PFAS exposure and its health implications. In this article, we will discuss PFAS as an EDH – exposure from commonly used products in our personal environments and the health implications for ourselves and our children.

PFAS is found in many consumer products, such as stain- and water-repellent fabrics, building materials, furnishings, cleaning products, and cookware. In addition to exposure from PFAS that is inhaled and ingested, studies have also shown that PFAS is absorbed through the skin. We previously described PFAS absorption in adults wearing PFAS-containing work clothes and protective equipment. But those are far from the only sources of textile exposure. The scientific literature has demonstrated that adults and children exposed to any clothing or bedding with PFAS-containing flame/stain retardants will absorb PFAS through their skin, leading to elevated blood PFAS levels.

Skin exposure to PFAS has been a topic of several recent studies of children. In one study, infants were shown to absorb PFAS from car seats. PFAS substances in the seat cushion material dissolved into the infant’s sweat and were absorbed through the skin, resulting in elevated PFAS levels in the infant’s blood. Studies of school-age children wearing school uniforms treated with flame retardants or stain repellents measured PFAS, leeched from the uniforms into the children’s sweat. As with the infant studies, the PFAS blood levels were also elevated in children wearing PFAS-contaminated uniforms.

Unfortunately, PFAS absorption is not limited to direct contact with fabrics and work-related skin contact with PFAS-containing products. People working with PFAS-contaminated particulates, soil, and dust are well known to absorb PFAS by inhalation, incidental ingestion, and through the skin from airborne contamination. Studies of communities in PFAS-polluted regions have found that adults and children absorb PFAS from the soil when enjoying hobbies like gardening. Other studies have shown PFAS absorption from PFAS-contaminated household dust.

Our pets both suffer the health effects of PFAS and add to the PFAS exposure suffered by the humans who care for them. PFAS bioaccumulation by animals and birds results from PFAS in the air, water, soil, and food. Studies have shown that pet food not only becomes contaminated directly from PFAS-containing ingredients but also by leeching of PFAS from pet food packaging. These same bioaccumulation mechanisms result in additional PFAS contamination through pet dander, pet urine, and pet excrement. Studies have shown that pet caretakers and owners absorb PFAS from pet waste when cleaning litter boxes, changing pen bedding, and cleaning bird cages. Other studies have shown PFAS absorption from the PFAS-contaminated pet dander and contributions to household dust.

PFAS exposure has been linked to a multitude of diseases and health issues, including cancer, thyroid disease, birth defects, endocrine disruption, miscarriage, preeclampsia, asthma, diabetes, and high cholesterol. While some of these illnesses occur after short-term exposure to high levels of PFAS, many result from bioaccumulation or long-term exposure to low-level PFAS contamination. Research has demonstrated that the risk of trauma-induced adult posttraumatic stress injury (PTSI), child posttraumatic stress (CPTS), depression, and other mental illnesses resulting from continued environmental health threats is the same as the risk resulting from an immediate danger like a natural disaster, active shooter or terminal illness.

Mitigating the risk of PFAS exposure through individual choices may seem daunting, but in-roads are possible. Informed product choices can reduce exposure to PFAS compounds. The simple act of selecting one carpet versus another for no additional dollars can reduce this source of indoor PFAS pollution and reduce the market for such products. The same is true for products from car seats to clothing to cookware. Making non-PFAS choices and raising awareness of this problem, as individuals and as groups, will benefit the environment and empower us. Empowerment is key to building mental and emotional resilience. And together, we can deter this environmental determinant of health.


About the Authors:

Allison A. Sakara, NP, MSN, RN, PHRN, is a nurse practitioner with decades of experience in pediatrics, hematology/oncology, and disaster response. Allison is the Co-Founder & Executive Director of the High Alert Institute, a 501c3 not-for-profit educational public charity dedicated to providing disaster readiness education and resources to unserved and underserved communities, industries, and charitable organizations in an All Hazards, One Health/One Nature, One Framework paradigm. Learn more about the High Alert Institute at www.HighAlertInstitute.org


Alyssa Middleton, Ph.D., has over 20 years of experience working with cancer patients and their families and conducting cancer research. She is the co-author of Five Bugles Institute’s PFAS remediation and replacement educational program. Learn more about Five Bugles Institute’s research at www.fivebuglesinstitute.com/pfas


Griffin Works offers Pawsitive Interactions with Service Dogs During Response Operations©, an audience-customized training that breaks down barriers by offering hands-on handling training and demonstrations with working service dogs for fire departments, EMS agencies, and public safety organizations.

Part of the National Domestic Preparedness Consortium and home to the National Emergency Response and Recovery Training Center, TEEX has been leading homeland security training since 1998. The major TEEX programs include fire and rescue, infrastructure and safety, law enforcement, economic and workforce development, and homeland security. As a member of The Texas A&M University System, TEEX is unique in its ability to access a broad range of emerging research and technical expertise. Beginning with course design and development all the way through hands-on instruction and national certification testing, TEEX delivers comprehensive training through both classroom and hands-on instruction and as online courses.

The National Child Traumatic Stress Network (NCTSN) was created by Congress in 2000 as part of the Children’s Health Act to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. This unique network of child-serving professionals, caregivers and young adults, researchers, and national partners is committed to changing the course of children’s lives by improving their care and moving scientific gains quickly into practice across the U.S. The NCTSN is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinated by the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS). 

The Emergency Management Institute (EMI) is part of the Department of Homeland Security’s Federal Emergency Management Agency (FEMA). The EMI provides national leadership in developing and delivering training to ensure that individuals and groups having key emergency management responsibilities possess the requisite skills to effectively perform their jobs.

The High Alert Institute maintains a list of reviewed courses provided by governments, universities and professional organizations. This list is geared towards the non-emergency management person who participates in disaster planning, preparedness, response, recovery or mitigation as part of their job responsibilities.

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Koi need forever homes, too! For pond enthusiasts, freshwater exotic and ornamental fish may not be available through pet stores or rescues in their area. The High Alert Institute Aquatic Pet Shelter Rehoming Program will be happy to assist you in stocking your new pond or adding a new finned friend to your school. Coming soon – when you adopt a Koi from the High Alert Institute Aquatic Pet Shelter Rehoming Program, we can arrange for delivery to your door anywhere in the continental United States.

Have you always wanted a Koi pond but don’t have the space one? Sponsor a Koi in our community shelter pond and we send you photos of your sponsored animal. Coming soon are live Koi Cameras above and below the water to enjoy your sponsored Koi anytime.

Dumping of freshwater non-native species and exotic aquatic pets into wild habitats is a man-made disaster that is truly preventable. The Institute’s Aquatic Pet Welfare Partnership works to raise awareness and reduce the impact on healthy ecosystems through education, as well as rescue and rehoming. Joined by champions of animal welfare and environmental stewardship, this  association of aquatic pet rescue operations and aquatic pet shelters across the United States aims to save our finned friends and preserve our waterways together.

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Disasters are defined as situations in which needs exceed or overwhelm available resources. Some disasters affect an entire community, while other disasters impact individuals and families. Crises of physical or psychological health can be very personal disasters.
The therapeutic value of pets during illness, trauma, and recovery is well established. And Koi fish may be well suited for people who are not able to provide verbal pet commands or physically care for pets like dogs and cats. Koi ponds are also a source of beauty and peace, providing an ideal setting for quiet reflection or meditation.
We are working to partner with pond installers and aquatic pet rescues/shelters to offer free or reduced-cost ponds with rehomed Koi fish to people seeking this type of pet therapy.

Disasters disrupt life and impact our sense of personal, family, and community safety. Survivors and responders alike often are not aware of the emotional, psychological or spiritual challenges that they may face from disaster onset through recovery. With two decades of experience training responders and communities to prepare for the behavioral health aspects of disasters, we will continue to provide education and a curated list of resources to groups or individuals.

Non-medical factors that impact overall health are termed Social Determinants of Health or SDoH. Noise pollution, poor air quality, and poor water quality are three environmental factors known to have a strong link to overall health. And the same environmental factors that impact humans impact their pets and other animals in their care. We continue to assist in advocacy, education, and technology development to mitigate the impact of SDoH on humans and animals alike.

Our efforts in shelter and rescue are the main focus of our environmental stewardship, reducing the environmental impact of non-native aquatic animals being dumped into public waterways. The High Alert Institute also assists innovators with the design, development, and evaluation of green and renewable energy technologies. Reducing the carbon footprint associated with disaster preparedness, response, and recovery furthers our continued mission to mitigate risk and improve resilience.

We partner with public and private organizations, sharing resources and fostering partnerships to improve disaster preparedness, response, and recovery, and mitigation.

The High Alert Institute team has over a century of combined research experience in medical, nursing, behavioral health, and disaster sciences. Our team provides support to researchers and technology developers through comprehensive literature searches and reviews, as well as failure mode database searches and adjudicated reviews.

When disaster strikes, most aquatic pet owners have limited options to secure the safety of their pets. Sheltering in place may not be possible if there is no power to provide aeration and “pet-friendly” shelters do not include ponds or aquariums. Our goal is to provide an option for aquatic pet owners in need of rescue and shelter for their finned friends.

Our goal is to share our two decades of disaster readiness experience with animal welfare organizations, shelters, caretakers, and pet owners, as they implement contingency  plans for natural and manmade disasters.

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