The PFAS Health Study has five main components over two phases. Each component aims to inform the following components in the study. Each component has protocols.

Phase I - Systematic Literature Review

Scientific studies have investigated a range of possible health outcomes resulting from exposure to PFAS. During Phase I we conducted a systematic review to examine the evidence on the human health effects related to PFAS exposure reported in scientific literature. A systematic review assesses the current evidence for a research question using specific methods to collect and evaluate research studies.

Your can read the findings of the systematic review on the Reports tab.

Phase I - Study Protocols for Phase II

The PFAS Health Study aims to investigate the exposure levels and potential health effects of PFAS in areas of known contamination in the communities of Williamtown, Oakey, and Katherine, Australia. During Phase I we developed the study protocols for the PFAS Health Study Phase II epidemiological study.

 Phase II Research Protocols (345KB PDF)

Phase II – Focus Groups Study

The first component of Phase II of the PFAS Health Study was a series of focus group discussions in Oakey, Williamtown, and Katherine between January and August 2018. The main aim of this study was to understand participants’ views and experiences of PFAS contamination in their local area, with a focus on participants’ health concerns. Focus group discussions facilitate discussion of public knowledge, underlying attitudes, perceptions and opinions and are well suited to exploring a range of views on community topics.

The findings from the Focus Groups Study are available on the Reports tab.

 Focus Groups Study Research Protocol (260KB PDF)

Phase II – Cross-sectional Survey and Blood Serum Study

The PFAS Health Study tested blood specimens of people living or working in an area contaminated with PFAS and compared them to people not living in those areas. The Study also conducted a survey of these same people to understand the blood test results, along with health effects and other concerns.

People who had their blood collected through the Australian Government Department of Health Voluntary Blood Testing Program for PFAS and agreed to participate in the ANU-led study were invited to particpate in October 2019. Participants were be able to complete a paper copy of the survey and mail it to the study team, or complete it online.

The study began in November 2016 with the Voluntary Blood Testing for PFAS.

The findings from the Cross-sectional Survey and Blood Serum Study are available on the Reports tab.

 Cross-sectional Survey and Blood Serum Study Research Protocol (1MB PDF)
 Cross-sectional Survey and Blood Serum Study Summary (345KB PDF)

Read more about Voluntary blood testing for PFAS on the Department of Health website.

Phase II – Data Linkage Study

The data linkage study will examine whether adverse health outcomes potentially linked with PFAS exposure are more common among people who have lived in areas contaminated with PFAS compared to those who have never lived in those areas. Data linkage brings together information about individuals across multiple datasets. Researchers only have access to these data after identifying details have been removed.

The study will use routinely-collected data. Routinely-collected data are data collected for purposes other than research, such as information collected by hospitals or for Government services.

The findings from the Data Linkage Study are available on the Reports tab.

 Data Linkage Study Research Protocol (1.21MB PDF)
 Data Linkage Study Summary (281.3KB PDF)

What is the PFAS Health Study?

The PFAS Health Study is investigating the exposure levels and potential health effects of PFAS in three towns that have high levels of PFAS contamination of the environment—Oakey (Qld), Williamtown (NSW) and Katherine (NT). To find out if the health of these communities has been affected by PFAS, we will compare the results with information from people who live in similar towns that do not have high levels of PFAS in the environment— Dalby (QLD), Kiama and Shellharbour (NSW), and Alice Springs (NT). Each of these comparison towns is matched to an exposed town based on socioeconomic factors, such as income, employment and education levels, and the remoteness of the area. Participants of the study will be asked to complete a survey and provide a blood serum sample for testing PFAS levels and a range of biomarkers.

Limitations of PFAS blood testing

Blood testing for PFAS currently has no diagnostic or prognostic value for individuals and cannot be used to guide clinical management. This means that a blood test cannot determine if PFAS levels in a person’s blood will make them sick now or later in life, or if any current health problems are related to the PFAS levels found in their blood. There are no ‘normal’ or ‘abnormal’ ranges and most Australians are expected to have detectable levels of PFAS in their blood due to the widespread use of this chemical in a range of applications and products. The value of blood testing is limited to assessing exposure at the population level. A blood test can measure the level of PFAS in a person’s blood and can tell a person how their blood levels compare with the levels seen in the general Australian population.

Health effects

While PFAS can persist in humans, animals and the environment, currently there is limited evidence of significant impacts on human health from exposure to PFAS chemicals. The Environmental Health Standing Committee (enHealth) issued revised guidance statements in 2019 to reflect the most current evidence relating to PFAS, including that PFAS exposure has been associated with mildly elevated levels of cholesterol, effects on kidney function and effects on the levels of some hormones. However, these effects are small and generally within ranges seen in the general population.

Avoiding PFAS exposure as a part of the precautionary principle

As a precaution, governments in Australia recommend that exposure to PFAS be minimised wherever possible while further research is undertaken on the potential health effects of PFAS exposure.

Information for GPs in Williamtown, Oakey and Katherine

Study participants in Williamtown, Oakey and Katherine have previously had a blood test for PFAS levels through the Australian Government Voluntary Blood Testing Program (VBTP) and have received their results during a post-test GP consultation. We have invited these participants to complete a survey about their health and wellbeing and potential exposure to PFAS. We have also sought permission to test their stored blood serum for biomarkers to better understand how PFAS levels influence specific biochemicals such as, blood lipids, and markers of liver, kidney and thyroid function. 

This testing will be undertaken in early 2021 and results will be sent directly to participants. If participants consent, we will also send a copy of their results to their GP, for their records. If the participant’s results are outside the laboratory reference ranges we will recommend that they follow-up with their GP. 

It is important to note that the blood serum samples being tested will be between 18 months and 4 years old. 

Information for GPs in Alice Springs, Dalby, Kiama and Shellharbour

Residents will be randomly selected, through Services Australia, to participate in the study. In mid-2020 they will be invited to complete a survey about their health and wellbeing and potential exposure to PFAS and have a blood test for PFAS serum levels and a range of biomarkers.

Participants will be directed to a local pathology collection centre to have their blood taken. They are not required to consult with their GP prior to the test.

Blood serum samples will be stored until the end of the study period, before being tested in early 2021. Results of the tests will be sent directly to participants in early to mid-2021. If participants provide written consent at the time of blood collection, we will also send a copy of their results to their GP, for their records. If a participant’s biomarker results are outside of the laboratory reference ranges, we will recommend that they follow-up with their GP.

Further advice for GPs

While participants in the PFAS health study from comparison areas will not be required to see their GP, we understand that some individuals may wish to discuss their potential participation in the PFAS study or their results with their GP. 

Similarly while participants of the PFAS health study from the Investigation areas had their blood specimens taken some time ago, they may return to their GP for further consultation following the receipt of their results from their additional biomarker tests completed as part of the study.

The following additional advice may assist GPs:

• Frequently asked questions (148.58 KB, PDF)
• Pre-test consultation advice for GPs (181.44 KB, PDF)
• Post-test consultation advice for GPs (168.58 KB, PDF)

The information from the PFAS Health Study informs our understanding of the effects of PFAS on health. Overall, there was clear evidence of elevated blood serum concentrations of PFAS in residents and workers in the PFAS-affected communities and increased psychological distress in the three exposed communities.

The evidence for other adverse health outcomes was generally limited. For most health outcomes studied, we did not find evidence that health was worse in PFAS-affected communities than non-affected communities. Rates of some adverse outcomes were higher among people in individual PFAS areas, but this does not necessarily mean that PFAS was the cause. Overall, our findings were consistent with previous studies that have not conclusively identified causative links between PFAS and adverse health outcomes. The association between higher PFAS levels and elevated cholesterol levels was consistent with the previous evidence. Study findings emphasise the importance of support for communities where environmental contamination has occurred. The PFAS Health Study can be used to guide future research efforts on PFAS and health.

 PFAS Health Study Overall Summary (PDF 276KB). This report was released in December 2021.

PFAS Health Study Frequently Asked Questions

 PFAS Health Study FAQ (PDF 192KB)

PFAS Health Study Systematic Literature Review

This review examined 221 scientific publications into the human health effects of exposure to perfluoroalkyl and polyfluoroalkyl substances, known collectively as PFAS. The key findings were:

• Sufficient evidence that higher levels of PFOS or PFOA in a person’s blood are associated with higher blood cholesterol levels.
• Limited evidence that higher levels of PFAS in the blood are associated with higher levels of uric acid in the blood.
• Limited evidence that high PFAS levels in the blood are associated with reduced kidney function and chronic kidney disease.
• Limited evidence in a small number of relevant studies that PFAS is associated with kidney and testicular cancers.
• Limited evidence that higher levels of PFAS in the blood are associated with lower levels of antibodies than usual following vaccination against some vaccine-preventable infections.

 PFAS Health Study Systematic Review (PDF 1.7MB). This review was released in May 2018.

PFAS Health Study Focus Groups Study

The primary aim of the Focus Groups Study was to gather a range of social and health-related experiences and perceptions from current residents and workers exposed to PFAS in Katherine, Oakey and Williamtown. Focus groups discussions were conducted between January and August 2018, with a total of 180 participants across the three regions, including 69 participants from Aboriginal communities in Katherine. Participants:

• were concerned about the potential health risks from exposure to PFAS, particularly for their families and children
• were worried about cancers and aggravation of existing health conditions
• discussed the psychological stress and anxiety they experienced as a result of living in an area with PFAS contamination, along with the associated uncertainty about health and financial implications
• indicated that they would like greater transparency and support in their interactions with government representatives.

 PFAS Focus Groups Report (PDF 1.1MB) This report was released in March 2019.

The Focus Groups Report was used in the development of a poster for the Aboriginal communities in Katherine (PDF 2.7MB) which was presented in May 2019.

PFAS Health Study Blood Serum Study

The Blood Serum Study examined blood PFAS levels, biochemical markers of health and exposure to PFAS in 2,587 people living or working in PFAS Management Areas in Katherine, Oakey and Williamtown, and 702 people living in three similar comparison communities without known environmental PFAS contamination—Alice Springs, NT, Dalby, Qld, and Kiama and Shellharbour, NSW. The key findings were:

• Average blood serum concentrations of PFOS and PFHxS (the main types of PFAS in firefighting foam) were higher in residents and workers of PFAS Management Areas than in residents of comparison communities, which was not observed for PFOA.
• The main risk factors for elevated blood concentrations of PFAS were the length of residence in an exposed community, at least weekly consumption of bore water or certain locally grown foods, and occupational exposure to firefighting foams.
• A higher concentration of PFAS in blood serum was associated with elevated blood cholesterol levels in participants from Williamtown and uric acid levels (a marker of kidney function) in participants from Williamtown and Katherine. However, these differences were small and unlikely to be important to health.

 PFAS Health Study Blood Serum Study Report (PDF 3.3MB) This report was released in December 2021.

PFAS Health Study Cross-sectional Survey

The Cross-sectional Survey investigated the exposure history, physical health, and mental health of 917 people living or working in PFAS Management Areas and 801 people living in the three comparison communities. We compared the prevalence of self-reported physical and mental health outcomes between exposed and comparison communities. We also examined associations between self-reported health outcomes and blood serum levels of PFAS. The key findings were:

• People who lived or worked in PFAS Management Areas were more likely to self-report various health outcomes than participants from comparison communities. Participation in the survey was voluntary, however, so survey findings may not accurately reflect the experience of the whole community.
• Participants from PFAS Management Areas reported higher levels of psychological distress than participants in comparison communities.
• PFAS concentrations in blood serum were largely not associated with a higher prevalence of self-reported health outcomes, nor were associations consistently observed across the three exposed communities.

 PFAS Health Study Cross-sectional Survey Report (PDF 3.4MB). This report was released in December 2021.

PFAS Health Study Data linkage study

The PFAS Data Linkage Study used historical health records collected overall several decades to examine whether rates of adverse health outcomes were higher among people who had lived in a PFAS Management Area than among people who had lived in comparison areas (areas not known to have PFAS contamination). We conducted three separate studies investigating a total of 48 health outcomes: Study 1 investigated maternal and infant (perinatal) health outcomes; Study 2 examined childhood development; and Study 3 investigated cancer and death from specific causes. The key findings were: 

• For most health outcomes, there was no evidence that rates were higher in the PFAS Management Areas relative to comparison areas or there was insufficient data to draw conclusions.
• We observed higher rates of some adverse health outcomes in individual (but not all) PFAS areas, but we could not reasonably rule out that these were due to chance or caused by factors other than exposure to PFAS.

 PFAS Health Study Data Linkage Study Report (PDF 1.9MB). This report was released in December 2021.

Publications

Banwell C, Housen T, Smurthwaite K, Trevenar S, Walker L, Todd K, Rosas M, & Kirk M. (2021). Health and social concerns about living in three communities affected by per- and polyfluoroalkyl substances (PFAS): A qualitative study in Australia. PLOS ONE, 16(1), e0245141. 10.1371/journal.pone.0245141. Law HD, Armstrong BK, D’Este C, Hosking R, Smurthwaite KS, Trevenar S, Lucas RM, Lazarevic N, Kirk MD & Korda RJ. (2023). Relative rates of cancers and deaths in Australian communities with PFAS environmental contamination associated with firefighting foams: A cohort study using linked data. Cancer Epidemiology, 82. 10.1016/j.canep.2022.102296. Lazarevic N, Smurthwaite KS, Batterham PJ, Lane J, Trevenar SM, D’Este C, Clements AC, Joshy AL, Hosking R, Gad I, Lal A, Law HD, Banwell C, Randall DA, Miller A, Housen T, Korda RJ & Kirk MK. (2023). Psychological distress in three Australian communities living with environmental per- and polyfluoroalkyl substances contamination. Science of the Total Environment, 874. 10.1016/j.scitotenv.2023.162503. Lazarevic N, Smurthwaite KS, D’Este C, Lucas RM, Armstrong B, Clements AC, Trevenar SM, Gad I, Hosking R, Law HD, Mueller J, Bräunig J, Nilsson S, Lane J, Lal A, Lidbury BA, Korda RJ & Kirk MD. (2023). Liver and cardiometabolic markers and conditions in a cross-sectional study of three Australian communities living with environmental per- and polyfluoroalkyl substances contamination. Environmental Research, 226. 10.1016/j.envres.2023.115621. Law HD, Randall DA, Armstrong BK, D'Este C, Lazarevic N, Hosking R, Smurthwaite KS, Trevenar SM, Lucas RM, Clements AC, Kirk MD, and Korda RJ. (2023). Relative Risks of Adverse Perinatal Outcomes in Three Australian Communities Exposed to Per-and Polyfluoroalkyl Substances: Data Linkage Study. International Journal of Environmental Research and Public Health, 20(19), p.6886. DOI: https://doi.org/10.3390/ijerph20196886. Law HD, Armstrong B, D'Estes C, Hosking R, Smurthwaite K, Trevenar S, Lazarevic N, Lucas R, Clements A, Kirk M, Korda R. (2024). Relative risks of childhood developmental vulnerabilities in three Australian communities with exposure to per- and polyfluoroalkyl substances: data linkage study. International Journal of Population Data Science, 9(1). doi: 10.23889/ijpds.v9i1.2180.

The PFAS Health Study survey is now closed

Study Information Forms for Williamtown, Oakey and Katherine residents

A copy of the Participant information Sheet and Consent Form for the PFAS Health Study Cross-sectional Survey and Blood Serum Study are available below.

 Participant information Sheet - VBTP - Adult (PDF 203 KB)

 Participant information Sheet - VBTP - Child (PDF 218KB)

 Consent Form - VBTP - Adult  (PDF 235KB)

 Consent Form - VBTP  - Child (PDF 235KB)

The Participant Information Sheet and Consent Form for additional biomarking reporting can be found below.

Participant Information Sheet- Adult

Participant Information Sheet- Child

Consent Form - Adult

Consent Form - Child

Study Information Forms for Alice Springs, Dalby and Kiama/Shellharbour region residents

A copy of the Consent Form for the PFAS Health Study Cross-sectional Survey and Blood Serum Study is available below.

Participant Information Sheet (PDF 179KB)

Consent Form (PDF 230KB)

The PFAS Health Study Survey

Adult Survey (PDF 1.06MB)

Child Survey (PDF 1.01MB)