Reducing rural health disparities by empowering people to minimize PFAS exposure and improve cardiovascular health

ABSTRACT PFAS (per- and polyfluoroalkyl substances) are harmful environmental toxicants of growing public health PFAS (per- and polyfluoroalkyl substances) are environmental chemicals of growing public health concern. Most of the US population is exposed to PFAS, but few know about the health implications or how to reduce exposure. This problem is accentuated in marginalized communities (i.e. rural, people of color, low income) who are more likely to have higher exposure to harmful chemicals and chronic disease, and less likely to have adequate health care.1–4 PFAS contribute to cardiometabolic risk factors and cardiovascular disease, including cardiac toxicity, vascular disorder, hypertension, dyslipidemia, and congenital heart disease,5 as well as myriad other adverse health effects.1,6–9 Recently, the US National Academies developed clinical guidance to assist HCPs in monitoring individuals with high levels of PFAS for health conditions.1 However environmental health literacy (EHL) among individuals and health care providers (HCPs) is generally low.10–12 Our goal with this Phase I proposal is to work with rural residents and HCPs to develop an educational and actionable report-back (i.e., reporting of individual PFAS test results from a mail-in blood spot test) with clear and useful guidance for individuals and HCPs on how to reduce risk and monitor health conditions. We propose to create this urgently needed, accessible and scalable PFAS biomonitoring tool, designed for the patient-HCP setting, through these specific aims: Aim 1) Develop a personalized actionable PFAS blood test report-back intervention for individuals and their HCPs. Focus groups and key informant interviews will be conducted with 20 individuals and 10 HCPs in rural Nevada to discuss how best to present lab results and recommendations to reduce PFAS exposure and minimize health risks. Aim 2) Develop and pilot test a PFAS EHL survey, PFAS exposure questions, and usability of the report-back. We will develop and pilot test a PFAS EHL survey, add questions to our personalized exposure audit, and develop program evaluation questions on usability of the report. Aim 3) Assess whether the report-back intervention increases PFAS EHL, reduces risks and improves wellness in 110 rural study participants. We hypothesize that pre- and post-intervention surveys will show increased EHL, readiness to reduce PFAS exposure, actions to reduce risk, and wellness (i.e., decreased stress, better sleep). Given MM’s extensive experience in report-back/behavioral interventions, and the increasing customer and healthcare needs in getting PFAS testing, we are well-positioned to expand our service and reduce PFAS exposure by creating accessible, low-cost testing and report-back with a relatively quick turnaround time, in a way that supports clinicians in helping patients avoid cardiovascular and other PFAS-associated health effects. We will test this intervention in a Phase II randomized controlled trial to evaluate its efficacy/long-term effects in a larger population, including its use in a clinical setting for patients with high PFAS levels. Phase IIB will focus on scaling up and commercializing the mail-in test and report-back, including dissemination to rural, low income, and minority individuals.