Date of Conferral

2-11-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Dr. Patrick Tschida

Abstract

This study involved evaluating whether cumulative exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) was associated with kidney cancer, bladder cancer, and adult leukemia among U.S. veterans. Pooled National Health and Nutrition Examination Survey (NHANES) data from 2005–2015 were analyzed for sample of 2,500 veterans with available serum PFAS measurements and physician-diagnosed cancer histories. This study employed a cross-sectional, correlational design grounded in a post-positivist paradigm. Inclusion required complete data for (a) serum PFAS concentrations, (b) kidney cancer, bladder cancer, and adult leukemia, and (c) covariates age, sex, race/ethnicity, smoking status, and body mass index. Cumulative PFAS was modeled as a continuous exposure in separate complex-samples logistic regressions for each outcome, adjusting for age, sex, race/ethnicity, smoking, and body mass index. Adjusted PFAS exposure was not associated with kidney cancer (AOR = 4.90; 95% CI [.68, 35.55]; p = .114) or bladder cancer (AOR = .98; 95% CI [.90, 1.06]; p = .624). PFAS exposure was modestly associated with adult leukemia (AOR = 1.16; 95% CI [1.00, 1.34]; p = .049). Findings suggest value in enhancing veteran hematologic surveillance and exposure mitigation while prioritizing future research using rare-event or penalized complex-survey models, expanded PFAS panels, and longitudinal designs to clarify causality and policy relevance. Grounded strictly in the study’s cross-sectional design and results (no significant associations for kidney or bladder cancer; a modest association for adult leukemia), the implications point to careful, incremental actions rather than causal conclusions.

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