Phase II: Water & Toenail Collection Instructions

Upon receiving your Phase II package, please remember to keep it away from children and pets!

If you’ve just received your package, carefully open the outermost packaging, making sure not to lose or discard any materials inside the shipping box. Your package will include two separate kits, one marked “Blood Collection Kit” and one marked “Water & Toenail Collection Kit”, along with two ice packs and three sheets of paper.

To prepare for collecting your water and toenail samples, you will need the following items:

Your kit labeled “Water & Toenail Collection Kit”
Your Phase II checklist for your reference
Your toenails (with about 3 weeks of growth since they were last trimmed)
Toenail clippers from your own supplies (not included in the kit), preferably stainless steel, but any nail clippers will suffice

This page contains two sets of instructions, one for collecting water and one for collecting toenail samples. Both sets of instructions are provided here because the materials required for both collections are included in the “Water & Toenail Collection Kit” kit, and the samples will be returned to us in the same box.

The Toenail Collection Instructions, located after this introduction, will explain how to clip and collect your toenails.
The Water Collection Instructions, located further down, will explain how to collect your water samples.

We recommend starting with your toenail collection since your toenails should have at least 3 weeks of growth since they were last trimmed. If you need to wait for your toenails to grow, please wait to collect your water samples as well. This way, we can minimize the time between your water collection and our testing.

These are the materials that you will find and use in your water & toenail collection kit:

(A) Water & Toenail Collection Box
(B) Labeled 0.5-Liter Water Collection Bottle
(C) Labeled 0.25-Liter Water Collection Bottle
(D) Labeled 2” x 3” Toenail Collection Envelope
(E) Resealable Plastic Bag
(F) Large Absorbent Pad
(G) Biohazard Bag
(H) FedEx Clinical Pak with Return Shipping Label
(I) Pair of Nitrile Gloves (latex free)

Toenail Collection Instructions

Please do not trim your toenails for at least 3 weeks before collection to ensure we have enough sample to test. If you’ve recently trimmed your nails, please wait an additional 3 weeks before beginning the toenail collection process.

Once your toenails have at least 3 weeks of growth, please follow the steps detailed below. You can also refer to the video at the bottom of the toenail collection section for a summary of the steps. If you have any further questions, please visit our FAQ page by clicking here.

Materials Needed:

(A) Water & Toenail collection box
(D) Labeled 2”x3” toenail collection envelope
(G) Biohazard bag
Sheet of paper to catch your toenail clippings
Toenail clippers from your own supplies (not included in the kit), preferably stainless steel, but any nail clippers will suffice
Pen (not included in the kit) preferably with permanent ink, but any will work

STEP 1: Prepare Your Toenails and Envelope

If you have nail polish on your toenails, please remove it before clipping your nails. Use nail polish remover and then wash your toenails with soap and water before clipping.

If your toenails don’t have any nail polish, please wash them with soap and water before clipping.

Before you trim your toenails, please record the time and date that you are collecting your toenail samples on the label of your 2″x3″ manila envelope (D) with a pen.

STEP 2: Trim Your Toenails

Lay down a sheet of paper to catch all your toenail clippings. Use your nail clippers to trim all ten toenails, making sure they all fall on the paper.

STEP 3: Collect Your Toenails Clippings

Carefully transfer the toenails clippings from the sheet of paper into the small manila envelope (D). Close the envelope with the clasp.

STEP 4: Return Materials to the Kit

Place the secured manila envelope (D) containing your toenail clippings into the 6″ x 9″ Biohazard bag (G) and seal the bag. Place the sealed bag back into the Water & Toenail Collection kit (A), so you don’t misplace it while collecting the water samples.

***Visual Summary of Toenail Collection Instructions***

VIDEO SUMMARY OF THE TOENAIL COLLECTION INSTRUCTIONS

If you have collected your toenail samples and returned them to the Water & Toenail collection kit, thank you for completing the toenail collection portion of Phase II of the St. Louis Baby Tooth – Later Life Health study! Your participation is greatly appreciated. You can now proceed with the water collection instructions below.

Water Collection Instructions

Once you have collected your toenail clipping and returned them to the Water & Toenail Collection kit, you can get started on your water collection!

We would like you to collect water samples that ideally represent the water entering your home, without any additional water treatment measures that you may have, such as filtration or softening. We will provide further instructions on how to bypass any at-home water treatment systems before collecting your samples. We will also provide instructions in the case you are unsure of what treatment systems you have or are unable to bypass some of these systems.

Precautions When Collecting Samples

We are measuring PFAS chemicals that are common in many household items, so it’s important to avoid these types of products when you are collecting a sample of your water.

When collecting your water sample, avoid:

Wearing Gore-Tex treated or other waterproof apparel, including boots.
Fast food packaging (such as wrappers for sandwiches or burgers and microwave popcorn bags) in close proximity to where you will be collecting the water sample.
Touching the inside of the lid or the threads at the top of the sampling bottles. Please minimize the amount of time that bottles are open.

Materials needed:

(A) Water & Toenail Collection Box
(B) Labeled 0.5-Liter Water Collection Bottle (closed)
(C) Labeled 0.25-Liter Water Collection Bottle (closed)
(E) Resealable Plastic Bag
(F) Large Absorbent Pad
(G) Biohazard Bag
(H) FedEx Clinical Pak with Return Shipping Label
(I) Pair of Nitrile Gloves (latex-free)
Pen (not included in the kit) preferably with permanent ink, but any will work

Please follow the steps below to collect your water samples. We recommend reading all instructions before beginning the collection process. There is also a video summarizing these steps at the bottom of this page. If you have any questions that are not answered in the steps or video below, please check our FAQ by clicking here. For further assistance in collecting water samples, please contact:

Elsie Sunderland, ems@seas.harvard.edu, 617-496-0858
Mona Dai, monadai@g.harvard.edu

Questions about the study or about blood or toenail collection should be directed to slbt@hsph.harvard.edu or 617-432-0041.

After collecting your water samples, please take a brief survey about the samples you collected by clicking here. The survey should take less than five minutes to complete and you will have an opportunity to provide feedback and further detail on your samples.

STEP 1: Select Your Sampling Location

Choose an indoor or outdoor faucet from which to collect your water sample. To ensure that the sample is representative of the water entering your home, do your best to bypass any additional water treatment measures that you may have in place. These may include:

Water softening units, activated carbon filters, or reverse osmosis systems that are typically installed near the water meter, in the basement, or in a utility room.
Neutralizing filters that are usually installed after the pressure tank and before any other treatment systems.
Point-of-use filters, such as Brita faucet filters, that are often found under your sink or on your faucet.

Please note that you do not need to bypass the sediment cartridge filter typically located in the basement and plumbed just after the water pressure tank.

Use the following guidelines to help you choose your sampling location:

If you do NOT have whole house water treatment, choose a faucet that is used often for drinking or cooking water, such as a kitchen tap.
- If you have a point-of-use filter (under the sink or on the faucet), you will need to either: (1) collect water that doesn’t go through the filter, or (2) select another faucet without treatment.
If you have whole house water treatment, you will need to either: (1) bypass the water treatment, or (2) collect all water samples from an untreated tap, like an outdoor tap or a spigot in your basement.
- If you collect the water sample from an outdoor faucet so that you can bypass water treatment, do NOT fill the water sample containers using a garden hose or other irrigation device as these plastic devices may contain PFAS.
If you don’t know what type of water treatment systems your home has or can’t avoid them, please do your best to avoid the ones that you can. We understand that bypassing water treatment systems may be especially difficult if you live in an apartment or condo. You will be able to provide more information about your sampling location in our brief survey in Step 5.

STEP 2: Prepare to Collect Your Samples

Once you have chosen your sampling location, please make sure you have your:

(B) larger 0.5-Liter water bottle (labeled)
(C) smaller 0.25-Liter water bottle (labeled)
(E) resealable plastic bag
(I) pair of nitrile gloves (latex free)
Pen (not included in the kit) preferably with permanent ink, but any will work

Please keep the bottles closed until you are ready to collect your samples.

At your chosen sampling location, turn on the cold water and let it run for at least 10 minutes.

If you are collecting your water sample from a spigot in your basement, you may need to connect your spigot to a hose and let the water drain outside or in a sink. Disconnect the hose before collecting your sample.

Once the water has run for 10 minutes, slow the flow to a thin, pencil-sized stream.

Put on the gloves (I) and leave them on until you have finished filling and bagging both water bottles (B) & (C).

500mL — **Fill line for the 1/2-Liter water bottle**

STEP 3: Collect the 0.5-Liter Water Sample

Start with the larger 0.5-Liter water bottle (B). To collect the 0.5-liter water sample, follow these steps:

Open the bottle, being careful to not set the cap down or let anything touch the inside of the cap or the bottle.
Rinse the bottle by filling it about ¼ of the way full, putting the lid back on, shaking the bottle, taking the lid off, and pouring out the water. Repeat this process two more times.
After rinsing the bottle three times, fill the sample bottle to the top where the bottle begins to slope in (see the image on the right). Replace the lid and seal it firmly.
Put the bottle into the resealable plastic bag (E).

STEP 4: Collect the 0.25-Liter Water Samples

250mL bottle fill line — **Fill line for the 1/4-Liter water bottle**

Next fill the smaller 0.25-L water bottle (C). To collect this water sample, follow these steps:

Open the 0.25-Liter water bottle, being careful to not set the cap down or let anything touch the inside of the cap or the bottle.
Rinse the bottle by filling it about ¼ of the way full, putting the lid back on, shaking the bottle, taking the lid off, and pouring out the water. Repeat this process 2 more times.
After rinsing the bottle three times, fill the sample bottle to the top where the bottle begins to slope in (see the image on the right). Replace the lid and seal it firmly.
Put the filled bottle into the resealable plastic bag (E) with the other already filled 0.5-Liter water bottle.

STEP 5: After Sample Collection

Turn off the water and remove the gloves.

Using a pen (not included in the kit), please write the time and date that you collected your water samples on the labels of both the larger 0.5-L water bottle (B) and the smaller 0.25-L water bottle (C).

Now, please take the brief survey about your experience and the water samples you collected. The survey will take no longer than 5-10 minutes to complete and you will have the opportunity to provide feedback. Please click here to access the survey.

**Visual Summary of Repackaging Instructions for Water & Toenail Kit**

STEP 6: Package Samples

Place your sealed plastic bag (E) containing the two filled water bottles (B) and (C) inside your Water & Toenail collection box (A).
Your toenail clippings should already be in the 2” x 3” toenail collection envelope (D) inside the Biohazard bag (G) and inside the box. If not, please add them now.
Add the large absorbent pad (F) to the box.
Confirm that the following items are in the Water & Toenail collection box (A):
1. Your toenail clippings inside the 2” x 3” toenail collection envelope (D) inside the Biohazard bag (G).
2. Your two filled water bottles (B) & (C) inside the sealed plastic bag (E).
3. Your large absorbent pad (F).
Close the lid of the Water & Toenail collection box (A).
Place the full box inside the pre-labeled FedEx Envelope (H) and seal the envelope.

STEP 7: Ship Package

Your FedEx envelope is pre-labeled and paid for. Please bring the sealed FedEx envelope to your nearest FedEx drop box or FedEx location. You can find the location of your nearest FedEx by clicking here to visit the FedEx website.

If you are unable to take the package to a FedEx location, you can schedule a FedEx pickup on their website. FedEx will come to your home to collect the package. To schedule a pickup, please click here to complete the FedEx Ground Pick-Up Form on the FedEx website. You can also call FedEx and schedule your FedEx Ground Pickup on the phone by calling 1-800-463-3339. You will need the tracking number from the label that is already attached to your FedEx envelope.

VIDEO SUMMARY OF THE WATER COLLECTION INSTRUCTIONS

AFTER Your Water & Toenail Collection

If you’ve collected your toenail and water samples and sent them back to us, thank you for completing the water & toenail collection portion of Phase II of the St. Louis Baby Tooth – Later Life Health study! Your participation is greatly appreciated. If you did not take the brief (less than 5-minute) survey about the water samples you collected, please do so now by clicking here.

If you have not yet started or completed the blood collection portion, please click here to view the instructions for collecting those samples.
If you have already completed the blood collection portion, then you have completed all of Phase II!

To ensure that you receive our periodic newsletters updating you on the ongoing developments in Phase II, please keep your contact information up-to-date by filling out our update information form. You can access the form by clicking here.

Once again, thank you so much for your invaluable contribution to this study. We appreciate your participation and look forward to keeping you informed about the progress of this important research!