Let’s talk about PFAS: Inconsistent public awareness about PFAS and its sources in the United States

T. Allen Berthold; Audrey McCrary; Stephanie deVilleneuve; Michael Schramm

doi:10.1371/journal.pone.0294134

Peer Review History

Original SubmissionJuly 12, 2023
15 Aug 2023 Decision Letter - Linglin Xie, Editor PONE-D-23-21851Let's talk about PFAS: Inconsistent public awareness about PFAS and its sources in the United StatesPLOS ONE Dear Dr. deVilleneuve, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Sep 29 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 3. Please include a copy of Table 6 which you refer to in your text on page 18. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The article has measured the awareness of PFAS within the general US population. However, there are major questions noticed. 1. The online distribution of surveys could already contribute bias to represent the general US population on socioeconomics, education, and other factors. Please discuss this potential bias. 2. One of the major finding of the article is recognized community exposure as predicting factor regarding the level of public knowledge and awareness of PFAS. Although a higher awareness of PFAS could increase information-seeking behavior, what is the application of this finding in promoting the general population awareness of PFAS? 3. Detailed validation would be beneficial to look into the respondent who reported “yes” to the “Has your community been exposed to PFAS?” Are they from similar communities? Has anyone reported “no” to this question from the same communities? Reviewer #2: In this study, Berthold et al. evaluated the general public’s awareness of PFAS contamination. They found that about half of respondents had never heard of PFAS. The respondents who are aware of PFAS community exposure were more likely to have knowledge of PFAS. They conclude that PFAS information and health risks need to be better communicated to the public to help increase awareness. This study provides a general picture of public awareness of PFAS contamination, which would have effects on social and regulatory changes in the use of PFAS. I have several questions as following: 1. The authors mentioned that the quality control checks were performed by Qualtrics. Could the authors provide detailed information about how the quality control was performed. How many surveys were received, how many surveys were used in the study. If some surveys were not used, please explain the reasons. Please provide the URL of Qualtrics used in the method part. 2. In this study, the author found that almost half of the respondents had never heard of PFAS and do not know what it is. Whether it is because the areas where these people live are not contaminated by PFAS or because they lack the education on PFAS contamination? 3. For the people who are aware of community exposure to PFAS, do the authors know how they learned about this information. This can help to better promote the PFAS information. 4. It is reasonable that people who are aware of PFAS exposure are more likely to know more about PFAS. As mentioned in the study, the percentage of people who are aware of PFAS exposure but have limited knowledge about PFAS was 20%. It is important for this population to learn about PFAS since they live in the area where PFAS exposure is higher. The author should discuss this point. 5. In the discussion, could the author add several sentences about how to increase the public awareness about PFAS contamination in drinking water, especially in higher exposure area? 6. There are some typos, such as line 339 “that”. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0294134.r001
Revision 1
11 Sep 2023 Author Response Journal Requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Authors’ response: We have updated the style of the manuscript to meet PLOS ONE’s requirements. 2. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. Authors’ response: We have made the suggested additions to clarify IRB approval methods and consent requirements. The changes are reflected in the Methods section, lines 166-171, and reads as follows: “The Texas A&M University Institutional Review Board (TAMU IRB) reviewed the study protocol and survey instrument prior to distribution. TAMU IRB deemed the study to be exempt from formal review. Written informed consent was obtained from all participants in the first question of the survey instrument.” 3. Please include a copy of Table 6 which you refer to in your text on page 18. Authors’ response: The reference to Table 6 on page 18 was a typo. We have corrected the text to refer to Table 5. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Authors’ response: As suggested, we have added captions for the Supporting Information files and updated the in-text citations to match. Comments to the Author: Reviewer #1: 1. The online distribution of surveys could already contribute bias to represent the general US population on socioeconomics, education, and other factors. Please discuss this potential bias. Authors’ response: We agree that there is general inherent bias in conducting internet research, as it excludes a portion of the population without internet access from the potential sample selection. We have added the following text in the Discussion section to acknowledge this limitation: “Additionally, the use of an online survey instrument creates inherent bias against portions of the U.S. population who may not have internet access. An estimated 7%, or nearly 23 million Americans, do not use the internet [68]. Therefore, the sample obtained from this survey may not be generalizable to this portion of the population that is not accessible via internet-based survey instruments.” 2. One of the major finding of the article is recognized community exposure as predicting factor regarding the level of public knowledge and awareness of PFAS. Although a higher awareness of PFAS could increase information-seeking behavior, what is the application of this finding in promoting the general population awareness of PFAS? Authors’ response: The application of this finding for which methods would best raise awareness of PFAS in the general population is outside of the scope of this study. Our instrument was designed to be exploratory in nature since the scientific community has no base measure of awareness within the U.S. population. The data we collected from our respondents is meant to inform the need for future work, which could focus on the determining the best way to apply this finding. We broadly discuss potential avenues for raising public awareness with support from other studies throughout the manuscript, but we feel it is outside of the scope of our data to make definitive conclusions on how best to promote PFAS awareness. 3. Detailed validation would be beneficial to look into the respondent who reported “yes” to the “Has your community been exposed to PFAS?” Are they from similar communities? Has anyone reported “no” to this question from the same communities? Authors’ response: This is a good idea for a new line of inquiry with this data. However, spatial validation at this scale was not pursued in this manuscript because it is not possible to replicate multiple answers at the ZIP code scale with the sample size of 1,100 responses. Spatial analysis was not the primary goal of this study and would be better pursued in a follow-up study that addresses these details with different research questions. Reviewer #2: In this study, Berthold et al. evaluated the general public’s awareness of PFAS contamination. They found that about half of respondents had never heard of PFAS. The respondents who are aware of PFAS community exposure were more likely to have knowledge of PFAS. They conclude that PFAS information and health risks need to be better communicated to the public to help increase awareness. This study provides a general picture of public awareness of PFAS contamination, which would have effects on social and regulatory changes in the use of PFAS. I have several questions as following: 1. The authors mentioned that the quality control checks were performed by Qualtrics. Could the authors provide detailed information about how the quality control was performed. How many surveys were received, how many surveys were used in the study. If some surveys were not used, please explain the reasons. Please provide the URL of Qualtrics used in the method part. Authors’ response: Thank you for this suggestion. We have added statements to clarify what type of quality control checks Qualtrics uses. As stated in the manuscript, the total sample size was 1,100 surveys using a demographic quota to obtain a statistically representative sample of the general U.S. population. We cannot provide the number of surveys sent out in total, because Qualtrics did not provide that data. The URL of the Qualtrics survey could not be added because it is no longer active. 2. In this study, the author found that almost half of the respondents had never heard of PFAS and do not know what it is. Whether it is because the areas where these people live are not contaminated by PFAS or because they lack the education on PFAS contamination? Authors’ response: This would be a good research question for a future study. What we know from our study is that people who are both unknowledgeable about PFAS and unaware of contamination in their community are unaware of PFAS overall. The survey instrument used does not delineate the cause of PFAS unawareness, therefore we believe it would be outside the scope of our study and data to attempt to address this question. 3. For the people who are aware of community exposure to PFAS, do the authors know how they learned about this information. This can help to better promote the PFAS information. Authors’ response: Thank you for this suggestion. This would have been good additional data to collect. However, that information was not collected with this study and is beyond the scope of our analysis. This is a question that could be pursued in a follow-up study that specifically samples communities with exposure. Other studies that investigate sources of information in exposed communities are discussed in lines 133-135 of the Introduction. This is briefly revisited in lines 443-445 of the Discussion. 4. It is reasonable that people who are aware of PFAS exposure are more likely to know more about PFAS. As mentioned in the study, the percentage of people who are aware of PFAS exposure but have limited knowledge about PFAS was 20%. It is important for this population to learn about PFAS since they live in the area where PFAS exposure is higher. The author should discuss this point. Authors’ response: This is a great point and should be included in the text. Subsequently, we added the following statement to our manuscript in lines 446-448 of the Discussion: “However, the results also show that 20% of the respondents who are aware of PFAS exposure in their drinking water also described themselves as having limited knowledge of PFAS. Therefore, it is important to emphasize education efforts in areas where community exposure is high”. 5. In the discussion, could the author add several sentences about how to increase the public awareness about PFAS contamination in drinking water, especially in higher exposure area? Authors’ response: This is not within the scope of this exploratory study. However, our intention is for this manuscript to inform future research studies focused on increasing awareness of PFAS exposure. 6. There are some typos, such as line 339 “that”. Authors’ response: Thank you for pointing this out. We have corrected grammar and typos where needed. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0294134.r002
26 Oct 2023 Decision Letter - Linglin Xie, Editor Let's talk about PFAS: Inconsistent public awareness about PFAS and its sources in the United States PONE-D-23-21851R1 Dear Dr. deVilleneuve, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Linglin Xie Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: (No Response) Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: (No Response) ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: All the comments have been addressed with explanation and edition. There is no further questions discovered from the manuscript. Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0294134.r003
Formally Accepted
7 Nov 2023 Acceptance Letter - Linglin Xie, Editor PONE-D-23-21851R1 Let’s talk about PFAS: Inconsistent public awareness about PFAS and its sources in the United States Dear Dr. deVilleneuve: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Linglin Xie Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0294134.r004

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