Protecting Public Health with PEATT: The PFAS Exposure Assessment Technical Tools

By Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Communities demand action and answers when their drinking water contains the potentially harmful, man-made chemicals per-and polyfluoroalkyl substances (PFAS). Although use of some of these chemicals has declined, increased water sampling over the past 10 years has revealed PFAS in numerous water sources.

The Centers for Disease Control and Prevention (CDC), the Agency for Toxic Substances and Disease Registry (ATSDR), and state and local health agencies are working to answer growing public concern about how PFAS affect health. ATSDR and its state health agency partners are currently investigating more than 40 PFAS-affected sites across the country.

To help measure PFAS levels in people’s bodies, CDC and ATSDR created a tool that state health departments can use.

PEATT: PFAS Exposure Assessment Technical Tools

CDC/ATSDR’s PFAS Exposure Assessment Technical Tools (PEATT) helps state, local, tribal, and territorial health departments with biomonitoring, which includes testing blood to determine levels of PFAS a person may have in their body.

Although biomonitoring cannot predict an individual’s risk for a specific health outcome, it increases our understanding of PFAS exposure. Community members who participate in biomonitoring not only learn about their PFAS blood levels, but also how their levels compare with other participants locally and nationally. Participants can share their test results with their healthcare providers, who then can monitor their health.

The PEATT contains the following tools:

  • Biomonitoring sampling and analysis protocol;
  • Exposure and health effects question bank;
  • Biomonitoring letters of interpretation, consent, and assent;
  • Risk communication materials;
  • Laboratory biomonitoring sample collection and analysis protocols; and
  • Reference to Environmental Protection Agency’s water sampling

The PEATT Pilot

With funds from CDC/ATSDR, the Association of State and Territorial Health Officials (ASTHO) awarded the Pennsylvania Department of Health (PADOH) and the New York State Department of Health (NYSDOH) each a grant to conduct a PEATT pilot exposure assessment in 2018.

PADOH and NYSDOH completed the pilot exposure assessments at the end of 2018 and provided feedback to CDC/ATSDR on the PEATT. PADOH and NYSDOH released reports in April and June 2019, respectively. The pilots assessed PFAS blood levels from selected residents in affected communities in Pennsylvania and New York, with the outcome of testing blood samples of 396 participants from May to November 2018.

NYSDOH and PADOH recommendations address challenges identified in the selection process, questionnaires, participant dropout, and participant result process. Further suggestions include providing more information and education on PFAS compounds, exposure sources, and health effects.

CDC/ATSDR will take lessons learned from each of these two separate pilot exposure assessments to improve the ongoing use of the PEATT.

Pennsylvania is expanding their exposure assessment to include urine, household dust, and tap water sampling with additional funds from CDC/ATDSR. The additional sampling allows the PEATT project to better align with the PFAS exposure assessments ATSDR is undertaking, as described in the National Defense Authorization Act (2018 and 2019). This additional biological and environmental sampling will allow the state to better characterize and understand PFAS exposures.

PFAS History

Since the 1950s, businesses have found multiple uses for PFAS. Numerous products contain these chemicals, including some cosmetics, nonstick cookware, water-repellent clothing, stain-resistant fabrics and carpets, firefighting foams, and items that are resistant to grease, oil, and water. With such widespread use, PFAS chemicals are in people and animals all over the world. Some studies have identified harmful PFAS health effects.

Potential PFAS Health Effects:

  • Impact growth, learning, and behavior in infants and older children
  • Decrease a woman’s ability to get pregnant
  • Interfere with the body’s natural hormones
  • Increase cholesterol
  • Affect immune system
  • Increase risk of cancer

PFAS move through soil and air, seep into the groundwater, and migrate to bodies of surface water. As a result, they are in water sources around the world. Some PFAS do not breakdown or decay and remain in the environment for decades.

Joint Public Health Efforts to Understand PFAS and Limit Exposure

Human exposure to PFAS is widespread and occurs through several routes, such as drinking contaminated water, eating contaminated food, and using consumer products that contain PFAS. Some PFAS are biologically persistent, but exposure may not be long lasting. CDC/ATSDR, in partnership with local, state, federal, tribal, and territorial health agencies, will continue to work across the country to learn more about exposure to PFAS and possible health effects. The PEATT is an example of how this joint effort can help protect public health and address concerns about PFAS exposure.

How to request PEATT

To request a copy of the PFAS Exposure Assessment Technical Tools, email

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