The July/August 2025 issue of the Journal of Environmental Health (Volume 88, Number 1), published by the National Environmental Health Association.
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Environmental Health To build, sustain, and empower an effective environmental health workforce Volume 88, No. 1 July/August 2025 Journal of
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ABOUT THE COVER
Environmental public health operates at the
What People in the United States Are Asking About Per- and Polyfluoroalkyl Substances in Their Drinking Water Based on Online Search Behaviors.................................... 8
intersection of the environment and human health. The purpose of this
Special Report: Hurricanes, Pathogenic Diseases, and Health Disparities .................................... 16
issue’s cover article, “Identifying Char- acteristics of Local Governmental Environmental Public Health Programs,” was to determine factors that govern- mental environmental public health profession- als consider when making decisions about their programs and workforce, including matters of structure, stang, and funding for local depart- ments. Across all programs—except emergency preparedness—there was general agreement that a bachelor’s degree in a field of science should be the minimum education necessary for sta¢. Further, over 50% of respondents recommended either state or national registration as a mini- mum requirement for the seven core programs. There are important commonalities across envi- ronmental public health programs that provide a basis for guidelines that can be widely accepted and scalable to the size and setting of environ- mental public health departments. See page 20. Cover images © iStockphoto: weis kanda sihite
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Identifying Characteristics of Local Governmental Environmental Public Health Programs........................................................................................................................ 20
Building Capacity: Building Capacity Using Voice-to-Text .......................................................... 30
ADVANCEMENT OF THE PRACTITIONER
Environmental Health Calendar ...............................................................................................32
JEH Quiz #1............................................................................................................................... 33
Spotlight on NEHA Resources: Recreational Waters .................................................................. 35
JEH Author, Title, and Subject Index: Volume 87 ..................................................................... 36
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President’s Message: I Stand on the Shoulders of Giants .......................................................................... 6
Hedgerow Software ..............................................47 HS GovTech.......................................................... 48 Inspect2GO ............................................................ 2 NEHA CP-FS Study Guide .....................................7 NEHA Credentials ................................................ 19 NEHA Endowment Foundation Donors .............. 29 NEHA Membership ................................................ 4 NEHA/AAS Scholarship Fund Donors ................. 34 NSF......................................................................... 5
Special Listing ........................................................................................................................... 40
In Memoriam............................................................................................................................. 42
NEHA News .............................................................................................................................. 44
NEHA 2025 and 2026 AEC....................................................................................................... 45
NEHA Member Spotlight .......................................................................................................... 46
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July/August 2025 • Journal of Environmental Health
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Volume 88 • Number 1
YOUR ASSOCIATION
Open Access
PRESIDENT’S MESSAGE
I Stand on the Shoulders of Giants
Larry A. Ramdin, MPH, MA, REHS/RS, CP-FS, HHS, CHO
I am humbled and honored to serve as your president. The presidents who served before—from Herbert A. Jewett to CDR Anna Khan—have all prepared a way for me and guided our organization from its beginnings in 1937 to today. We have seen numerous practice changes as we have adopted hazard analysis critical con- trol point (HACCP) processes and accepted model codes for food safety, swimming pools, and body art. We played a vital role in the elimination of smallpox and rejoiced in 1978 when smallpox was declared eradicated. Past- President Vince Radke was part of that pro- gram. We also faced and are dealing with new diseases such as West Nile virus, the spread of numerous tickborne illnesses, and the emer- gence of new vectors in places they were not seen before due to changing weather patterns. A transition from paper to electronic report- ing, increased data sharing, and the list goes on. We as a profession have always responded to the changes and have embraced them. I was born in Trinidad in the island nation of Trinidad and Tobago, an area that gifted the world with steel drums. I attended Presenta- tion College San Fernando in Trinidad where I developed a love for biology. After leaving high school, I was oered a job interview at a bank, but working indoors and wearing a tie was not something that appealed to me. I applied for a job in a municipal Aedes aegypti control program as a field technician, going to people’s homes locating mosquito foci and treating them. The job was fun and I enjoyed what I did—going to a new environment each day, getting to know my town, meeting new people, and exploring a variety of living condi-
a future generation of public health and envi- ronmental health practitioners could acquire the skill and certification needed to do their jobs. That is the foundation for my belief that information is useless unless it is shared. Bell inspired us daily with a quotation from Dale Carnegie’s book, How To Win Friends and Influence People . One quote has stuck with me and has guided my approach to practice and life: “I shall pass this way but once; any good, therefore, that I can do or any kindness that I can show to any human being, let me do it now. Let me not defer nor neglect it, for I shall not pass this way again.” I was first introduced to the National Envi- ronmental Health Association (NEHA) and the Journal of Environmental Health through the stacks that were in the classroom. The environmental health practice in the Carib- bean was dierent from what I encountered in the U.S., where there is significant special- ization and duties distributed among several agencies. The environmental public health practitioner in the Caribbean is expected to have a wide knowledge, and their duties include environmental sanitation (duties nor- mally conducted by the Department of Public Works), water quality monitoring, mosquito control programs, emergency preparedness and response, meat and food inspection. milk sanitation and hygiene, healthy housing, and onsite wastewater, to name just a few. I migrated to the U.S. and became a mem- ber of NEHA. I have earned several creden- tials from NEHA: the Registered Environmen- tal Health Specialist/Registered Sanitarian (REHS/RS), the Certified Professional–Food Safety (CP-FS), and the Healthy Housing
Let us all work together to
claim our space and gain the recognition we deserve.
tions. I immediately knew this was the space I wanted to be in for the rest of my working life. While vacationing in Barbados, I saw a notice in the newspaper inviting applications to the public health inspection program at Bar- bados Community College and was encour- aged by my Barbadian hosts, Lorna and Chris- topher Edwards, to apply to the program. As an indecisive young adult, it took me 3 years to decide to apply and once I stepped on the path, there was no looking back. Hinkitch Irvin Bell, the program coordina- tor and a retired chief public health inspec- tor, took me under his wings and guided me through the program. It was here that I truly understood the breadth and depth of the environmental health practice, although at that time the term environmental health was just being introduced to describe our profes- sion. Bell was not only a mentor but also an inspiration. He was one of the first in Barba- dos to earn the Public Health Certificate from the Royal Society of Public Health and to become the first Fellow of the Royal Society of Health in Barbados. He also taught public health inspection classes at his home so that
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Volume 88 • Number 1
https://doi.org/10.70387/001c.142104
Specialist (HHS). I am also a Certified Health Ocer (CHO) in Massachusetts. Further, I hold a master of public health and a master of arts in public administration. I was invited to join the board of the Mas- sachusetts Environmental Health Associa- tion (MEHA) and became its president. As its education chair, I refocused our quarterly meetings to focus on practice-ready oer- ings, sharing information that environmental public health practitioners can implement in practice immediately. While attending the NEHA 2015 Annual Educational Conference (AEC) & Exhibi- tion in Orlando, Florida, I witnessed Dr. David Dyjack, our new executive director, address the association for the first time. I knew that the regional vice-president (RVP) of Region 9 was stepping down, and I wanted to be part of Dr. Dyjack’s new vision for NEHA. I discussed the vacancy with Pat- rick Maloney, a past Region 9 RVP and my friend and mentor, who encouraged me to run and guided my candidacy. I was elected to the board in 2016. I committed to serving two terms as Region 9 RVP, and then I ran
for national oce in 2022 and was elected as second vice-president. I was instrumental in getting the online Community site set up. I look forward to fur- ther engagement with our members. I want to look at new and emerging environmental health challenges and to turn our focus away from regulation to a more scientific approach to what we do. We need to pursue enhanced marketing programs that inform our com- munities and bring greater recognition to the practice of environmental public health. I look forward to further engagement with all our partners, which will create a space for early practitioners to learn from or connect with seasoned practitioners to get advice or be mentored by them. NEHA is made up of not only the board of directors and its executive director, sta, and technical advisors but also its member- ship. There are many opportunities available to support and participate in the advance- ment of your profession. Please avail yourself of those opportunities. We as a profession are doers, not talkers. We solve problems and move on to the next one. We do not spend
enough time claiming what we have done, nor do we get the recognition for our work, which could be the reason for us being a hid- den profession. So, let us all work together to claim our space and gain the recognition we deserve. If you have an idea, please feel free to reach out to me. As I close this column, I leave you with the words of Henry Wadsworth Longfel- low taken from his poem, The Ladder of St. Augustine . These words are an apt description of our profession and our association: “The heights by great men reached and kept were not attained by sudden flight but they, while their companions slept, were toiling upward in the night.” I would like to thank every environmental health professional for all you do daily, not for recognition but for the satisfaction that we are keeping our communities safe. Thank you again for the opportunity to serve as your president.
lramdin@neha.org
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July/August 2025 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
Open Access
Abstract Per- and polyfluoroalkyl substances (PFAS) are a human health concern associated with increased incidence of specific cancers, reproductive health eects, immune eects, and developmental eects on children, among other issues. One study found that 45% of municipal water in the U.S. contains at least ≥1 PFAS; according to the Centers for Disease Prevention and Control, nearly all people in the U.S. have measurable amounts of PFAS in their blood (U.S. Environmental Protection Agency, 2024a). Many people first turn to the internet for health- related questions. For public health communicators to successfully educate communities about PFAS exposure from water supplies, it is helpful to know what questions people are already asking online about PFAS. For this research, we used a search engine analytics tool called Semrush to identify common questions asked and to inform subsequent outreach messages. Using Semrush, we categorized the type of questions and search terms online that information seekers used related to PFAS in their water and ranked the questions and search terms based on search volume. Overall, the highest search volume was related to how to reduce risk for exposure to PFAS, followed by general questions about PFAS in water. These insights on search terms can help health professionals create informational resources tailored to address what people want to know about PFAS. Keywords: per- and polyfluoroalkyl substances, PFAS, human health concerns, public health communication, online search behaviors What People in the United States Are Asking About Per- and Polyfluoroalkyl Substances in Their Drinking Water Based on Online Search Behaviors
and Disease Registry, 2024), with previous research results finding that 97% to 100% of human blood samples tested contain PFAS (Lewis et al., 2015). Although there is a growing understand- ing of the sources of water contamination and how PFAS contaminants can aect the environment and personal health, large research gaps remain. Among the general public, awareness of personal exposure to PFAS remains low (Berthold et al., 2023), and little research has been conducted to identify best practices for communicating PFAS information to the public to improve awareness. Additionally, 85% of people in the U.S. rely on public water, and thus we focus this research on public exposure to PFAS from municipal water supplies (U.S. Geological Survey, 2019). Further, as press coverage and public interest in PFAS increase, people are searching for additional information about PFAS (Google Trends, n.d.). Given that individuals frequently use internet searches as an initial step to seek information about health threats (Powell et al., 2011), it is important to understand what PFAS-related search terms people might use so that outreach messages align with com- mon concerns as indicated by search terms (Kidd et al., 2019). In our study, we used Google search data to explore the use of PFAS-related keywords and questions by individuals conducting internet searches. Timothy E. Holland, MA Nelson Institute for Environmental Studies, University of Wisconsin–Madison Bret R. Shaw, PhD Department of Life Science Communication and Division of Extension, University of Wisconsin–Madison Rachel Hutchins, MSc Department of Communication Arts, University of Wisconsin–Madison Lyn M. van Swol, PhD Department of Communication Arts, University of Wisconsin–Madison Gavin K. Dehnert, PhD Wisconsin Sea Grant, Aquatics Science Center, University of Wisconsin–Madison
Introduction According to the U.S. Environmental Pro- tection Agency (U.S. EPA), there are nearly 15,000 per- and polyfluoroalkyl substances (PFAS), which are the synthetic chemicals that are widely used in many manufactured products and are highly resistant to break- down in the environment (National Institute
of Environmental Health Sciences, 2025; U.S. Environmental Protection Agency [U.S. EPA], 2024a). PFAS have a long half-life, are found ubiquitously in the environment, and have been linked to adverse human health eects (U.S. EPA, 2024b, 2025). Nearly all people in the U.S. have measurable amounts of PFAS in their blood (Agency for Toxic Substances
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https://doi.org/10.70387/001c.142101
Recently, limited research has begun to explore how public agencies and other orga- nizations are informing the public about PFAS exposure (Ducatman et al., 2022; Har- clerode et al., 2021; National Academies of Sciences, Engineering, and Medicine, 2022; PFAS Exchange, 2021). Ducatman et al. (2022) reviewed o cial health communica- tion messages from federal, state, and local agencies and found that PFAS messaging often fails to adequately inform communities about the potential health risks associated with PFAS exposure by avoiding causal state- ments about the potential negative health impacts of PFAS and instead focusing on the uncertainty of exposure and the fact that research is ongoing. Further, communication often fails to “provide actionable informa- tion” (Ducatman et al., 2022) about what the public can do to reduce exposure. When communicating water health risks, including risks from PFAS exposure, frequent and transparent communication to consum- ers is paramount (Ryan, 2021). Eective methods for increasing awareness of current research include issuing press releases, pub- lishing open-access materials as sources of information, and gaining media attention— all of which increases awareness among both scientific and nonscientific audiences (Fuoco et al., 2023). Multiple researchers have called for high-level social science research that equips public health communicators with how to more strategically inform vulnerable populations, especially when the research being communicated is ongoing and when policies and solutions are in the process of being created and implemented (Berthold et al., 2023; Bruton & Blum, 2017; Harclerode et al., 2021). The first step toward developing eective outreach is to understand the audi- ence’s current questions about PFAS. We draw on the model of communica- tion accommodation theory (CAT) to answer this call. CAT states that audience recep- tion of messages is more positive when the messaging aligns with the audience’s under- standing of an issue and their linguistic preferences (Giles, 2016). In the context of PFAS communication, this model suggests that outreach professionals would benefit from understanding the terminology used and questions asked by search engine users because the internet is often the first stop for information-seeking. Given that the internet
produces a tremendous amount of data daily and that 95% of adults in the U.S. have access to the internet (Pew Research Center, 2024), assessing the content of common searches could help health communicators apply the CAT model strategy of communication align- ment when developing outreach materials and thereby increase audience receptivity. Insights gained from knowing what types of information people seek can then be cou- pled with strategic communications plans to develop and test public health messaging and inform outreach professionals, with the goal of increasing the eectiveness of PFAS messaging. Tailoring informational needs via audience-centered communications strate- gies can increase message relevance, eec- tiveness, and retention (Hawkins et al., 2008; Kidd et al., 2019). To better serve their con- stituencies, public health communicators can benefit from knowing the type and volume of questions being asked about PFAS in drink- ing water. With this knowledge, outreach professionals can focus the content of their messages on what is most relevant to their audience by answering the questions their constituents are likely searching for. Search engine optimization (SEO) research has shown that one of the two factors that best predict if an internet user will visit a website from their search is how closely the website’s information relates to the user’s question (Lewandowski & Kammerer, 2021). Fur- thermore, PFAS are commonly referred to by dierent words: scientific terms for groups of chemicals (e.g., PFAS), specific chemical terms (e.g., PFOS [perfluorooctanesulfonic acid]), and colloquial terms (e.g., forever chemicals) (Cao & Ng, 2021). If users exclusively use colloquial terms in their searches, their search results might exclude credible websites that instead use more scientific terms. Therefore, our first research question (RQ1) identified the use volume associated with PFAS-related keywords and determined which keywords are used most frequently by U.S. Google users. Google has a search engine market share of 87.8% in North America (StatCounter, 2025), making its data largely descriptive of what types of information peo- ple are searching for online. After identifying which terms are used the most by Google users, our study then determined the types of questions Google users are asking regarding the most used keyword categories. Therefore,
the second research question (RQ2) analyzed the types of questions U.S. Google users are asking related to PFAS in their water supplies. Methods To answer RQ1, a list of keywords associated with PFAS was gathered from a consortium of water researchers to ensure our study cap- tured a comprehensive list of related key- words. This list was referenced with and com- plemented by the related keywords provided via Semrush, an analytical service that cre- ates usable information from Google search and Web analytics data. The term used with the highest monthly volume within Google searches was used for the analysis of RQ2. To answer RQ2, Semrush was used to obtain a list of the most frequently asked questions for specific keywords of interest for U.S. users on Google’s search engine. Semrush’s SEO tool was used to review the volume of questions asked about PFAS and water-related keywords. Keyword research is an SEO tool that provides insights into what keywords Google users search for and what information they access based on their search behaviors. Semrush provides avail- able information about keywords of interest by using third-party data providers to col- lect Google search engine data (Semrush, 2025). The volumes of searches within our study are the monthly average searches over a recent 1-year period. Data were captured on July 3, 2024, and included the previ- ous 12 months of search queries related to PFAS in drinking water for U.S. Google users. Because this study focuses on PFAS in drinking water, “PFAS and water” was used as a combined keyword to ensure the context of PFAS questions were related to drinking water. The keyword combination of “PFAS and water” was reviewed to answer RQ2: What are people asking about PFAS in their drink- ing water in the United States? After collect- ing the top 100 questions related to PFAS and water, the first author analyzed the types of questions present within the Semrush list and developed five thematic question categories: 1.What is/are (keyword/s) 2.How to filter or avoid (keyword/s) 3.How to test for (keyword/s) 4.What water products contain (keyword/s) 5.What geographic locations contain (keyword/s)
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ADVANCEMENT OF THE SCIENCE
The first and third authors then indepen- dently coded each question and placed each question into one of the five categories. The independent coding of each of the ques- tions resulted in the following Krippendor’s alpha: PFAS and water = 0.965 (Marzi et al., 2024). These results show high internal con- sistency and agreement among coders. As only 15% of people in the U.S. rely on pri- vate water sources (U.S. Geological Survey, 2019), most questions pertaining to private water and PFAS contamination did not rise to our attention because of the lower ques- tion volume. Any remaining questions related to private water supplies from wells were removed from the list. This filtering of ques- tions resulted in a final list of 97 questions related to PFAS and water.
FIGURE 1
Search Terms Related to Per- and Polyfluoroalkyl Substances and Average Monthly Search Volumes, July 2024
PFAS
110,000
Forever Chemicals
18,100
PFOA
14,800
Results
PFOS
9,900
Keyword Identification Figure 1 shows the list of the analyzed key- words. Semrush showed that the highest vol- ume of questions was centered around the keyword PFAS, followed by the colloquial term forever chemicals. More technical PFAS names (e.g., PFOS, PFNA, PFHxS) were not found in high-volume searches. The volume of searches for PFAS was 6-times higher than searches for forever chemicals and 7-times higher than the third-highest volume key- word PFOA [perfluorooctanoic acid]. PFAS was chosen for our analysis to answer RQ2 based on its much higher search volume compared with alternative terms (Figure 1). Analysis of Search Questions In July 2024, the average monthly U.S. Google search volume over the previous 12 months for PFAS and water combined was 8,840. Within those searches, almost one half (48.9%) of questions were inquiries to understand how to filter/remove PFAS from water. This category included questions such as: how to filter PFAS from water, if specific brands of filters remove PFAS, and does boiling water remove PFAS? The next highest category of questions was general questioning about PFAS in water, at 26.8% of questions. Examples of questions in this category included: what are PFAS in water and how does PFAS get into water? The third- highest category, with 16.7% of questions, was about which water contains PFAS; these questions centered on commercially available
0
20,000
40,000
60,000
80,000
100,000
120,000
Search Volume
Note. PFAS = per- and polyfluoroalkyl substances; PFOA = perfluorooctanoic acid; PFOS = perfluorooctanesulfonic acid.
FIGURE 2
Percentage of Search Volume for Per- and Polyfluoroalkyl Substances (PFAS) and Water Question Categories
1.9%
5.7%
Questions How to Filter PFAS From Water What Is PFAS What Contains PFAS How to Test for PFAS Where PFAS Are
16.7%
48.9%
26.8%
Note. The total search volume was 8,840/month. The volume represents the average number of monthly searches in the U.S. based on data collected from the prior 12 months in July 2024.
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water products. Examples of questions in this category included: are PFAS in bottled water and questions about specific brands of bottled and sparkling water. The fourth category, with 5.7% of questions, was how to test water for PFAS. The fifth category, with 1.9% of ques- tions, was about where PFAS are, with ques- tions such as are there PFAS in my water and what states have PFAS in their water? See Figure 2 for percentages of all categories and Table 1 for a full list of the analyzed questions. Discussion This study focuses on internet search behav- ior by reviewing terms most commonly used when people search for information about PFAS in water supplies. Our study’s aim is to support public health messaging to inform public and commercial water consumers (rather than private well water consumers, who may ask dierent types of questions). In the context of drinking water, the more frequent search categories showed more focused questioning, revealing that people are especially interested in receiving informa- tion about risk mitigation and how to avoid exposure (e.g., as in specifically how to filter water to remove PFAS). Based on descriptive inferences from these large data sets, public health communicators can develop their communication strategies with higher confidence in their decisions about what people want to know about a particular topic, such as PFAS, and thereby develop con- tent that is perceived positively by their audi- ence, in alignment with the CAT central tenet of communication alignment (Giles, 2016). Once communicators understand what their audience is interested in knowing and the words that the audience use, communicators can emphasize high-volume words to increase the relevance of their educational resources and to promote trac to their websites. Search results show that when people ask questions about PFAS and water, the most common concern is how to filter PFAS from their water. The variation in high-volume questions shows that there is considerable uncertainty among individuals regarding best practices for filtering PFAS from water, including questions about if boiling water removes PFAS from water and the eective- ness of common commercial filters. Our study recommends that public outreach focuses on communicating the current sci-
TABLE 1
Search Volume for Questions Related to Per- and Polyfluoroalkyl Substances (PFAS) and Water
Question
Search Volume
What is PFAS in water
1,600
How to remove PFAS from water
590 480 320 320 260 210 210 210 170 170 170 170 140 140 140 140 110 110 110
What are PFAS in water
Do water filters remove PFAS
How to remove PFAS from water at home
Which bottled water does not have PFAS
Does boiling water remove PFAS
Does zero water filter remove PFAS
How to remove PFAS from water at-home
Can PFAS be filtered out of water
How to filter PFAS from water
Does bottled water have PFAS
What sparkling water does not have PFAS
How do PFAS get into water
Does zero water remove PFAS
What water filters remove PFAS
How to test for PFAS in water
How to test for PFAS in water at home
How to test water for PFAS
Are PFAS in bottled water
What is PFAS in drinking water
90 90 90 90 70 70 70 70 70 50 50 50 50 50 50 50 50 40
What water filter will remove PFAS
Does Fiji Water have PFAS
Does Waterloo Sparkling Water have PFAS
Can you filter PFAS out of water
How to get PFAS out of water
How to get rid of PFAS in water Are there PFAS in bottled water Does bottled water contain PFAS Can PFAS be removed from water
Do refrigerator water filters remove PFAS
Does boiling water get rid of PFAS
Does distilling water remove PFAS
How to remove PFAS in drinking water
What water filter removes PFAS
Does Kirkland Sparkling Water have PFAS
What states have PFAS in water
Can water filters remove PFAS
continued on page 12
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entific uncertainty about the health risks of long-term exposure and the magnitude of risk, as well as focuses on applied self-ecacy information that households can easily incor- porate into their everyday routines, such as specific knowledge on which filtration sys- tems do and do not remove PFAS (Frewer, 2004; Lee & You, 2020). As we did not assess the degree to which existing PFAS messaging provides such infor- mation, future research should explore these questions. For example, researchers could assess if public health communicators are spending more time explaining what PFAS are and little time giving advice on how to remove PFAS; if this situation is found to be true, then this communication strategy would reflect a misalignment between what internet users want and what the highest trac websites oer featuring information about PFAS in drinking water in the U.S, according to our results. Reverse osmosis filtration systems have been found to be the most eective, while other commercially available filters vary greatly in their ability to filter PFAS (Herkert, 2020). Yet reverse osmosis filters are expen- sive, which could lead internet users to think about other strategies for avoiding PFAS, such as using cheaper pitcher filters or buying bottled water. Based on interest and search volume, a significant portion of questions involve what types of water products contain PFAS, including questions about common brands of sparkling and bottled water. Thus, if families cannot obtain expensive filtration systems or change less-expensive filters on a regular basis, then it is useful to get informa- tion about types of commercially available water that are safe to consume. This state- ment is particularly true for communities that are highly aected by PFAS contamina- tion, and thus are most likely to seek infor- mation about PFAS (Berthold et al., 2023) but least likely to be served by existing PFAS messaging (Ducatman et al., 2022). Addition- ally, Chow et al. (2021) found that 39% of tested bottled water contained some form of PFAS, demonstrating that information about best purchasing practices would be helpful to immediately reduce PFAS exposure. This study presents a novel use of Google data using Semrush analytical software to gain insights about the types of questions internet information seekers are actively searching for regarding PFAS in their drinking water supply.
Search Volume for Questions Related to Per- and Polyfluoroalkyl Substances (PFAS) and Water TABLE 1 continued
Question
Search Volume
Can you boil PFAS out of water
40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30
Do Berkey water filters remove PFAS Do Brita water filters remove PFAS Do filters remove PFAS from water Does Pur water filter remove PFAS Does water filtration remove PFAS
How do you remove PFAS from drinking water
How to avoid PFAS in water How to reduce PFAS in water
How to remove PFAS from drinking water
What removes PFAS from water Which water filters remove PFAS
How to test PFAS in water
How to test your water for PFAS
Is PFAS in bottled water
How does PFAS get into water What are PFAS in drinking water Can boiling water remove PFAS Can you filter out PFAS from water Can you filter out PFAS out of water Can you filter PFAS out of your water Can you remove PFAS from water Do any water filters remove PFAS Do fridge water filters remove PFAS Do home water filters remove PFAS
Do water filters filter out PFAS
Do water filters filter PFAS
Do water filters get rid of PFAS
Do whole house water filters remove PFAS
Does a water filter remove PFAS
Does boiling water kill PFAS
Does boiling water remove PFAS chemicals Does Brita water filter remove PFAS Does Culligan water filter remove PFAS
Does my water filter remove PFAS
Does reverse osmosis remove PFAS from drinking water
How are PFAS removed from water How to filter out PFAS from water
How to filter out PFAS in water
continued
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ple use when searching for environmental pollutants. PFAS go by many names because the acronym refers to a group of chemical compounds. By understanding what terms people use, health communicators can infuse their content with keywords and specific information to ensure their content is rel- evant to their intended audience. Strategic implementation of keyword research can enable health communicators to streamline their informational output, and the intentional use of these data (including findings from our study) for content devel- opment about PFAS in drinking water can help increase the accessibility and reach of educational health content as well as its per- ceived usefulness. Communicators can create information for any communication platform and use the insights from keyword research to answer the questions they know are being asked most frequently as obtained from sta- tistics generated from Google, the dominant search engine in the U.S. and the world. Limitations The Semrush data used in our study focuses on nationally collected data and thus the data do not capture local, regional, or global dif- ferences between areas of varying degrees of PFAS exposure. This study was intended to provide a snapshot view of what questions people in the U.S. are asking about PFAS in their drinking water. Semrush can provide more locally or regionally focused results for greater site-specific insights; however, the results will be influenced by local and regional events and media coverage. Search engines other than Google were not exam- ined in our study. Our study also did not account for underserved populations that include individuals who might have limited or no internet access. Additionally, our study did not account for people who prefer to seek information in ways other than internet searches. We also did not examine inquiries related to PFAS in well water or exposure from sources outside of drinking water. Conclusion Our results suggest that people already per- ceive PFAS as something to avoid and are inquiring about how to reduce exposure rather than further investigating more detailed information about these substances and their health impacts. Future research could
Search Volume for Questions Related to Per- and Polyfluoroalkyl Substances (PFAS) and Water TABLE 1 continued
Question
Search Volume
How to filter PFAS from tap water How to remove PFAS from tap water Can I test my water for PFAS How to measure PFAS in water Does Dasani Water have PFAS Does distilled water have PFAS Does Mountain Valley Water have PFAS Does Poland Spring Water have PFAS Does purified water have PFAS Does Smartwater have PFAS Does sparkling water have PFAS Does spring water have PFAS Does zero water filter PFAS Is bottled water free of PFAS Is there PFAS in bottled water What are PFAS in sparkling water
30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30
Are there PFAS in my water Does my water have PFAS
Does NYC [New York City] water have PFAS
Is there PFAS in my water
Google users already are interested in topics when they use Google to seek answers to their questions. They are, by definition, already deliberating about PFAS and, as active infor- mation seekers, they are looking for answers. Exposure to new information has been found to increase information-seeking behaviors; searchers may conclude they need more infor- mation to inform their decisions (Hovick et al., 2020). Using results from this study, pub- lic health communicators can better address online information seekers’ questions about PFAS in drinking water by ensuring they can find the information they are looking for, espe- cially information regarding ecacy of filter- ing water or buying PFAS-free water. Further- more, even if a public health communicator wants to cover other information about PFAS they deem more important on the websites, our results show that web-based outreach must contain content that people are search- ing for, or those websites will not appear on organic Google searches.
Our review of the questions internet users ask about PFAS in their water suggests that the information-seeking public seems to understand that consuming PFAS should be avoided because searchers’ questions are neg- atively framed and focus on avoidance. In our preliminary discussions for this article, we anticipated a greater focus on inquiries per- taining to specific adverse health outcomes from PFAS exposure. Our findings show, however, that most Google searchers do not ask about the specifics of health eects, but rather searchers inquire about avoiding or removing PFAS from items they want to con- sume. While toxicologists identify new forms of PFAS and the government works to estab- lish solutions to reduce and remove PFAS, the public must know best practices to reduce their exposure (Dauchy, 2019). Environmental toxicology outreach infor- mation can get technical very quickly; by conducting keyword research, health com- municators can identify the words most peo-
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July/August 2025 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
explore how Google data could be effective in identifying which stage of behavior change users are in based on how the questions they ask map onto the stages of change model in behavioral psychology. The stages of change, or the transtheoretical model of change, is a theoretical framework that helps describe behavior change in a series of 6 stages (Pro- chaska & DiClemente, 1983). Based on the categorical search volumes and referencing of the stages of change model (Prochaska & DiClemente, 1983), it might be shown that definitional questions about PFAS or forever chemicals (e.g., What are PFAS?) are asked by online information seekers in the precontemplation stage. Users quickly discover that PFAS harm human health and might begin asking how to avoid or filter PFAS from their
water, which would be an indication that they have entered the contemplation stage. This stage is where public health communicators can provide information to help communities enter the action stage with the best available knowl- edge to reduce PFAS exposure from drink- ing water supplies. Additional research could investigate how the content of PFAS education can be framed using high-volume keywords to increase personal relevance and elaboration (Sanner & Evans, 2019). Emphasis frames can manipulate the message content visually and/or contextually to emphasize the intended audi- ence’s interests (Cacciatore et al., 2015). With a distinct understanding of the target audience and descriptive data collected strate- gically, health communicators can emphasize related information to address their intended
audience’s interests, thereby further increas- ing the message’s effectiveness through align- ment with the audience. Future research will develop deeper insights based on more spe- cific audience groups that can be examined to increase the effectiveness of strategic com- munication campaigns and the influence of desired behavior change.
Acknowledgment: This study was financially supported by the Illinois-Indiana Sea Grant.
Corresponding Author: Bret Shaw, PhD, Pro- fessor, Department of Life Sciences Commu- nication and Division of Extension, Univer- sity of Wisconsin–Madison, 314 Hiram Smith Hall, 1545 Observatory Drive, Madison, WI 53706. Email: brshaw@wisc.edu
References
Agency for Toxic Substances and Disease Registry. (2024). Testing for PFAS . https://www.atsdr.cdc.gov/pfas/health-effects/blood-testing. html Berthold, T.A., McCrary, A., deVilleneuve, S., & Schramm, M. (2023). Let’s talk about PFAS: Inconsistent public awareness about PFAS and its sources in the United States. PLOS One , 18 (11), e0294134. https://doi.org/10.1371/journal.pone.0294134 Bruton, T.A., & Blum, A. (2017). Proposal for coordinated health research in PFAS-contaminated communities in the United States. Environmental Health , 16 , Article 120. https://doi.org/10.1186/ s12940-017-0321-6 Cacciatore, M.A., Scheufele, D.A., & Iyengar, S. (2015). The end of framing as we know it . . . and the future of media effects. Mass Communication and Society , 19 (1), 7–23. https://doi.org/10.1080/ 15205436.2015.1068811 Cao, Y., & Ng, C. (2021). Absorption, distribution, and toxicity of per- and polyfluoroalkyl substances (PFAS) in the brain: A review. Environmental Science: Processes & Impacts , 23 (11), 1623–1640. https://doi.org/10.1039/d1em00228g Chow, S.J., Ojeda, N., Jacangelo, J.G., & Schwab, K.J. (2021). Detec- tion of ultrashort-chain and other per- and polyfluoroalkyl sub- stances (PFAS) in US bottled water. Water Research , 201 , Article 117292. https://doi.org/10.1016/j.watres.2021.117292 Dauchy, X. (2019). Per- and polyfluoroalkyl substances (PFASs) in drinking water: Current state of the science. Current Opinion in Environmental Science & Health , 7 , 8–12. https://doi.org/10.1016/j. coesh.2018.07.004 Ducatman, A., LaPier, J., Fuoco, R., & DeWitt, J.C. (2022). Official health communications are failing PFAS-contaminated com- munities. Environmental Health , 21 (1), Article 51. https://doi. org/10.1186/s12940-022-00857-9
Frewer, L. (2004). The public and effective risk communication. Toxicology Letters , 149 (1–3), 391–397. https://doi.org/10.1016/j. toxlet.2003.12.049 Fuoco, R.E., Kwiatkowski, C.F., Birnbaum, L.S., & Blum, A. (2023). Effective communications strategies to increase the impact of environmental health research. Environmental Health , 22 (1), Arti- cle 47. https://doi.org/10.1186/s12940-023-00997-6 Giles, H. (Ed.). (2016). Communication accommodation theory: Negotiating personal relationships and social identities across con- texts. Cambridge University Press. Google Trends. (n.d.). PFAS: Search trends in the U.S. Retrieved November 17, 2024, from https://trends.google.com/trends/explo re?date=all&geo=US&q=PFAS&hl=en Harclerode, M., Baryluk, S., Lanza, H., & Frangos, J. (2021). Pre- paring for effective, adaptive risk communication about per- and polyfluoroalkyl substances in drinking water. AWWA Water Sci- ence , 3 (5), e1236. https://doi.org/10.1002/aws2.1236 Hawkins, R.P., Kreuter, M., Resnicow, K., Fishbein, M., & Dijks- tra, A. (2008). Understanding tailoring in communicating about health. Health Education Research , 23 (3), 454–466. https://doi. org/10.1093/her/cyn004 Herkert, N.J., Merrill, J., Peters, C., Bollinger, D., Zhang, S., Hoff- man, K., Ferguson, P.L., Knappe, D.R., & Stapleton, H.M. (2020). Assessing the effectiveness of point-of-use residential drinking water filters for perfluoroalkyl substances (PFASs). Environ- mental Science & Technology Letters , 7 (3), 178–184. https://doi. org/10.1021/acs.estlett.0c00004 Hovick, S.R., Bigsby, E., Wilson, S.R., & Thomas, S. (2020). Infor- mation seeking behaviors and intentions in response to environ- mental health risk messages: A test of a reduced risk informa-
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References
tion seeking model. Health Communication , 36 (14), 1889–1897. https://doi.org/10.1080/10410236.2020.1804139 Kidd, L.R., Garrard, G.E., Bekessy, S.A., Mills, M., Camilleri, A.R., Fidler, F., Fielding, K.S., Gordon, A., Gregg, E.A., Kusmano, A.M., Louis, W., Moon, K., Robinson, J.A., Selinske, M.J., Shana- han, D., & Adams, V.M. (2019). Messaging matters: A systematic review of the conservation messaging literature. Biological Conser- vation , 236 , 92–99. https://doi.org/10.1016/j.biocon.2019.05.020 Lee, M., & You, M. (2020). Safety behaviors to reduce risk of using chemical household products: An application of the risk per- ception attitude framework. International Journal of Environmen- tal Research and Public Health , 17 (5), Article 1528. https://doi. org/10.3390/ijerph17051528 Lewandowski, D., & Kammerer, Y. (2021). Factors influencing view- ing behaviour on search engine results pages: A review of eye- tracking research. Behaviour & Information Technology, 40 (14), 1485–1515. https://doi.org/10.1080/0144929X.2020.1761450 Lewis, R.C., Johns, L.E., & Meeker, J.D. (2015). Serum biomark- ers of exposure to perfluoroalkyl substances in relation to serum testosterone and measures of thyroid function among adults and adolescents from NHANES 2011–2012. International Journal of Environmental Research and Public Health , 12 (6), 6098–6114. https://doi.org/10.3390/ijerph120606098 Marzi, G., Balzano, M., & Marchiori, D. (2024). K-Alpha Calcula- tor–Krippendor’s Alpha Calculator: A user-friendly tool for computing Krippendor’s Alpha inter-rater reliability coe¢- cient. MethodsX , 12 , Article 102545. https://doi.org/10.1016/j. mex.2023.102545 National Academies of Sciences, Engineering, and Medicine. (2022). Guidance on PFAS exposure, testing, and clinical follow-up . National Academies Press. https://www.ncbi.nlm.nih.gov/books/ NBK584691/ National Institute of Environmental Health Sciences. (2025). Perflu- oroalkyl and polyfluoroalkyl substances (PFAS) . https://www.niehs. nih.gov/health/topics/agents/pfc Pew Research Center. (2024, January 31). Internet, broadband fact sheet . https://www.pewresearch.org/internet/fact-sheet/internet- broadband/
PFAS Exchange. (2021). How to reduce your exposure to PFAS . https:// pfas-exchange.org/how-to-reduce-your-exposure-to-pfas/ Powell, J., Inglis, N., Ronnie, J., & Large, S. (2011). The characteris- tics and motivations of online health information seekers: Cross- sectional survey and qualitative interview study. Journal of Medical Internet Research , 13 (1), e20. https://doi.org/10.2196/jmir.1600 Prochaska, J.O., & DiClemente, C.C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51 (3), 390–395. https://doi.org/10.1037/0022-006X.51.3.390 Ryan, K. (2021). PFAS & public outreach: Risk communication best practices & lessons learned. Journal of New England Water Works Association , 135 (4). Sanner, B., & Evans, K. (2019). Deconstructing informa- tion elaboration: The critical role of framing and initial dia- logue. Small Group Research , 50 (4), 458–492. https://doi. org/10.1177/1046496419853019 Semrush. (2025). Where does Semrush data come from? https:// www.semrush.com/kb/998-where-does-semrush-data-come- from#:~:text=Data%20Collection,in%20the%20top%20100%20 positions StatCounter. (2025). Search engine market share in United States of America . StatCounter Global Stats. https://gs.statcounter.com/ search-engine-market-share/all/united-states-of-america U.S. Environmental Protection Agency. (2024a). PFAS explained . https://www.epa.gov/pfas/pfas-explained U.S. Environmental Protection Agency. (2024b). Our current under- standing of the human health and environmental risks of PFAS . https://www.epa.gov/pfas/our-current-understanding-human- health-and-environmental-risks-pfas U.S. Environmental Protection Agency. (2025). Research on per- and polyfluoroalkyl substances (PFAS) . https://www.epa.gov/ chemical-research/research-and-polyfluoroalkyl-substances-pfas U.S. Geological Survey. (2019). Domestic (private) supply wells . https://www.usgs.gov/mission-areas/water-resources/science/ domestic-private-supply-wells#overview
The Private Water Network is a virtual platform and community of professionals working to protect the public’s health from contaminants in private drinking water sources. It is the only network specifically for professionals who serve communities with private drinking water and septic systems. Learn more and join this network at www.neha.org/private- water-network.
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July/August 2025 • Journal of Environmental Health
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