"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.