Carcinogenicity of occupational exposure as a firefighter

Per- and polyfluoroalkyl substances (PFAS) and microRNA: An epigenome-wide association study in firefighters

The occupation of firefighting is classified as a Group 1 carcinogen. Increased cancer risk among firefighters may be partly attributable to increased occupational exposure to a range of chemicals, including per- and polyfluoroalkyl substances (PFAS). Some PFAS are known and suspect human carcinogens. Investigating epigenetic response to these PFAS exposures in firefighters may help to identify biological pathways of specific cancers, and previously unidentified health outcomes that are associated with PFAS. We therefore investigated the associations of serum PFAS concentrations with miRNA expression in firefighters. Serum samples collected from 303 firefighters from 6 sites across the USA were analyzed for 9 PFAS along with miRNA expression. Covariate-adjusted linear regression was used to estimate associations between log PFAS and miRNA expression, with false discovery rate (FDR) set to 0.05 for significance, and an exploratory cutoff of FDR q < 0.20. Gene set enrichment analysis (GSEA) was performed using miRTarBase's miRWalk pathways. Age, race-ethnicity, BMI, fire department, and sex were controlled for in all models. At FDR<0.05, the linear isomer of perfluorooctane sulfonic acid (PFOS) was inversely associated with miR-128-1-5p expression (Beta = -0.146, 95 % CI -0.216, -0.076). At a relaxed FDR of 0.20, we observed inverse associations for the sum of branched isomers of PFOS (Sm-PFOS) with 5 miRNAs (let-7d-5p, let-7a-5p, miR-423-5p, let-7b-5p, miR-629-5p). Several pathways were enriched for multiple PFAS, including those correlated with certain cancers, blood diseases, thyroid disorders, autoimmune disorders, and neurological outcomes. Some PFAS in firefighters were found to be associated with alteration of miRNA consistent with increased risk for a range of chronic diseases.

Assessment of cancer biomarkers in the Grenfell firefighter cohort study

Firefighters are exposed to a diverse range of harmful substances, including polycyclic aromatic hydrocarbons, benzene, and other carcinogens. These toxic compounds induce DNA damage, often causing the formation of DNA adducts and other lesions that can contribute to the development of various diseases, including cancer. Recent advancements in molecular diagnostics have shown that circulating cell-free DNA (cfDNA) in plasma is a valuable biomarker for detecting DNA damage and disease states. In this study, we explored whether changes in the quantity and quality of plasma cfDNA might reveal DNA lesions or serve as early markers for diseases such as cancer in UK firefighters. Whilst there are few published epidemiological studies of risk of cancer in UK firefighters, there are none on molecular markers in this population. All the 685 firefighters who participated in the study were employed by the London Fire Brigade in 2017; many of them also attended the Grenfell Tower fire, the most devastating fire to occur in the UK in modern history. In this exploratory analysis, we sought to gain insights into the potential long-term health impacts of toxic smoke exposure on these first responders by analysing both the concentration of cfDNA present and specific genetic alterations in cfDNA. Using next-generation sequencing and a panel that detects pathogenic DNA variants linked to various cancers, we analysed a subset of 261 firefighters. Our findings revealed that 11 firefighters carried pathogenic DNA variants associated with cancer, but we found no association between fire smoke exposure and the presence of these variants.

Differences in serum concentrations of per-and polyfluoroalkyl substances by occupation among firefighters, other first responders, healthcare workers, and other essential workers in Arizona, 2020-2023

BACKGROUND

Certain occupations have greater risk for per- and polyfluoroalkyl substances (PFAS) exposure because of PFAS use in occupation-associated materials.

OBJECTIVE

We sought to assess whether PFAS concentrations differed by occupation among certain Arizona workers and whether concentrations differed over time by occupation.

METHODS

Serum concentrations for 14 PFAS were measured among 1960 Arizona Healthcare, Emergency Responder, and Other Essential Worker Study participants. Samples were collected at enrollment and periodically during July 2020-April 2023. Occupational categories included firefighters, other first responders, healthcare workers, and other essential workers. We fit multilevel regression models for each PFAS to estimate differences in geometric mean concentrations or odds of PFAS detection at enrollment by occupational category. For participants with ≥1 serum sample, we evaluated for yearly longitudinal differences in PFAS concentrations by occupational category. We used other essential workers for comparison, and adjusted for age, sex, race and ethnicity, year, and residential county.

RESULTS

Adjusting for covariates, firefighters had higher perfluorohexanesulfonic acid (PFHxS), branched and linear perfluorooctanesulfonic acid (PFOS), and perfluoroheptanesulfonic acid (PFHpS) concentrations than other essential workers (geometric mean ratios 95% CIs: 1.26 [1.11-1.43]; 1.18 [1.06-1.32]; 1.19 [1.08-1.31]; and 1.19 [1.01-1.39], respectively). Healthcare workers had higher odds of detection of branched perfluorooctanoic acid (Sb-PFOA) and perfluorododecanoic acid (PFDoA) than other essential workers, adjusting for covariates (odds ratios 95% CIs: 1.35 [1.01-1.80]; 2.50 [1.17-5.34], respectively). During the 3-year study, we detected declines in PFAS concentrations among other essential workers; few longitudinal differences in concentrations by occupation were detected.

IMPACT STATEMENT

Using data from a large prospective cohort of frontline workers in Arizona, we compared serum concentrations of 14 per-and polyfluoroalkyl substances (PFAS) among firefighters, other first responders, healthcare workers, and other frontline essential workers. We found that firefighters have higher concentrations of certain PFAS chemicals and the odds of detecting other PFAS chemicals are higher among healthcare workers compared with people in other occupations. Our findings highlight the importance of further action to reduce PFAS exposure within highly exposed occupational groups, such as firefighters, and the need to expand evaluation of exposure among other occupations, including healthcare workers.

Special Issue: Firefighters' Occupational Exposures and Health Risks

Firefighters are occupationally exposed to a complex mixture of hazardous agents [...].

The Fire Fighter Cancer Cohort Study: Protocol for a Longitudinal Occupational Cohort Study

BACKGROUND

Firefighters are at an increased risk of cancer and other health conditions compared with the general population. However, the specific exposures and mechanisms contributing to these risks are not fully understood. This information is critical to formulate and test protective interventions.

OBJECTIVE

The purpose of the Fire Fighter Cancer Cohort Study (FFCCS) is to conduct community-engaged research with the fire service to advance the evaluation and reduction of firefighter exposures, along with understanding and mitigating effects leading to an increased risk of cancer and other health conditions. This involves establishing a long-term (>30 years) firefighter multicenter prospective cohort study.

METHODS

The structure of the FFCCS includes a fire service oversight and planning board to provide guidance and foster communication between researchers and fire organizations; a data coordinating center overseeing survey data collection and data management; an exposure assessment center working with quantitative exposure data to construct a firefighter job exposure matrix; and a biomarker analysis center, including a biorepository. Together, the centers evaluate the association between firefighter exposures and toxic health effects. Firefighter research liaisons are involved in all phases of the research. The FFCCS research design primarily uses a set of core and project-specific survey questions accompanied by a collection of biological samples (blood and urine) for the analysis of biomarkers of exposure and effect. Data and samples are collected upon entry into the study, with subsequent collection after eligible exposures, and at intervals (eg, 1-2 years) after enrollment. FFCCS data collection and analysis have been developed to evaluate unique exposures for specific firefighter groups; cancer risks; and end points in addition to cancer, such as reproductive outcomes. Recruitment is carried out with coordination from partnering fire departments and eligible participants, including active career and volunteer firefighters in the United States.

RESULTS

The FFCCS protocol development was first funded by the US Federal Emergency Management Agency in 2016, with enrollment beginning in February 2018. As of September 2024, >6200 participants from >275 departments across 31 states have enrolled, including recruit and incumbent firefighters. Biological samples have been analyzed for measures of exposure and effect. Specific groups enrolled in the FFCCS include career and volunteer structural firefighters, women firefighters, trainers, fire investigators, wildland firefighters, firefighters responding to wildland-urban interface fires, and airport firefighters. Peer-reviewed published results include measurement of exposures and the toxic effects of firefighting exposure. Whenever possible, research results are provided back to individual participants.

CONCLUSIONS

The FFCCS is a unique, community-engaged, multicenter prospective cohort study focused on the fire service. Study results contribute to the evaluation of exposures, effects, and preventive interventions across multiple sectors of the US fire service, with broad implications nationally.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/70522.

Development of National profile for occupational safety and health services in Iran (IRANOSH): a mixed-method study focusing on input and process indicators

BACKGROUND

This study introduces a protocol for developing anational profile for occupational safety and health services (NPOSH), tailored for Iran (IRANOSH). Itfocuses on basic information, structure, programs, and human resources, highlighting challenges and practicesin the context of OSH services.

METHODS

Forty-six NPOSH indicators were identified through content analysis of literature and categorized into ten domains and six types. The NPOSH framework was customized for Iran (IRANOSH) following an initial focus group discussion. Quantitative data were collected by 2,317 occupational health inspectors from820,846 workplaces across Iran, including3,734,249 workers. The quantitative and qualitative indicators were further discussed in a second focus group.

RESULTS

Quantitative findings show the target population for occupational safety and health (OSH) services was estimated to be 34% of the country's population. Small workplaces comprised 98% of all workplaces including 40% of workers. Access to OSH structures indicates one OSH center per 154 workers and 33 workplaces, one OSH engineeringcompany per 12,447 workers and 2,736 workplaces, and one OSH medical examination center per 3,404 workers and 748 workplaces. Access to OSH human resources involves one OSH inspector for every 354 workplaces and 1,612 workers and one occupational medicine specialist for every 3,270 workplaces and 14,877 workers.Qualitative findings show that thekey OSH programs in Iran include targeted inspections, occupational medical examinations, and monitoring of occupational exposures focusing on difficult and hazardous occupations in medium to large workplaces. Small workplaces present the most significant challenge and priority. A pronounced shortage of human resources hampers service provision, making developing OSH services for these settings a top priority.

CONCLUSIONS

Implementing an OSH self-assessment system through trade unions is proposed to bridge OSH service gaps. Additionally, expanding the PHC system to incorporate OSH structures within public organizations is essential for improving service delivery. Customizing the NPOSH framework for other countries with various health system contexts is recommended. Updating this study and comparing current findings with other data sources will help validate the current findings.

Geographic patterns in wildland fire exposures and county-level lung cancer mortality in the United States

BACKGROUND

Emissions from wildfire plumes are composed of modified biomass combustion by-products, including carcinogens. However, studies of the association between wildland fires (WF; includes wildfires, prescribed burns, and resource management fires) exposure and lung cancer are scant. We evaluated geographic patterns in these exposures and their association with lung cancer mortality (LCM) rates across the conterminous United States (US).

METHODS

We extracted data from the Monitoring Trends in Burn Severity program (1997-2003) and derived county-level exposure metrics: WF density by area, WF density by population, the ratio between total burned land area and county area, and the ratio between total burned land area by population. We obtained sex-specific, county-level LCM rates for 2016-2020 from the National Center for Health Statistics. Counties with fewer than 10 cases were suppressed. To account for cigarette smoking, we first modeled residual values from a Poisson regression between cigarette smoking prevalence and sex-specific, age-adjusted LCM rates. We then used Lee's L statistic for bivariate spatial association to identify counties with statistically significant (p < 0.05) associations between WF exposures and these residuals. In a sensitivity analysis, we applied a false discovery rate correction to adjust for multiple comparisons.

RESULTS

We observed geographic variation in bivariate associations between large WFs and subsequent LCM rates across US counties while accounting for ever cigarette smoking prevalence. There were positive (high WF exposures and high LCM rate) clusters for males and females in counties within the mid-Appalachian region and Florida, and modest differences across WF metrics in the cluster patterns were observed across the Western US and Central regions. The most positive clusters were seen between WF density by area and LCM rates among women (n = 82 counties) and a similar geographic pattern among men (n = 75 counties). Similar patterns were observed for males and females in the western US, with clusters of high WF exposures and low LCM rates. After adjusting for multiple comparisons, a positive cluster pattern among both sexes persisted in Kentucky and Florida with area-based exposure metrics.

DISCUSSION

Our analysis identified counties outside the western US with wildfires associated with lung cancer mortality. Studies with individual-level exposure-response assessments are needed to evaluate this relationship further.

Urology on a changing planet: links between climate change and urological disease

Urological diseases and their varied forms of management warrant special attention in the setting of climate change. Regarding urological cancers, climate change will probably increase the incidence and severity of cancer diagnoses through exposures to certain environmental risk factors, while simultaneously disrupting cancer care delivery and downstream outcomes. Regarding benign urological diseases, a burgeoning body of work exists on climate-related heat waves, dehydration, urolithiasis, renal injury and infectious and vector-borne diseases. Adding to the potential effect on disease pathogenesis, many patients with urological diseases undergo high-tech, resource-intensive interventions, such as robotic surgery, and entail intensive longitudinal assessments over many years. These features incur a considerable carbon footprint, generate substantial waste, and can introduce vulnerabilities to climate-related weather events. Links exist between planetary health (the health of humans and the natural systems that support our health), climate change and urological disease and urological care providers face many challenges in the era of anthropogenic climate change. The next steps and priorities for research, management, and health care delivery include identification and prioritization of health care delivery strategies to minimize waste and carbon emissions, while supporting climate resilience. Examples include supporting telemedicine, limiting low-value care, and building resilience to minimize impacts of climate-related disasters to prepare for the challenges ahead.

Addressing the need for individual-level exposure monitoring for firefighters using silicone samplers

BACKGROUND

Firefighters are occupationally exposed to hazardous chemical mixtures. Silicone passive sampling devices capture unique exposures over time with minimal impact to the participant and allow for the analysis of a broad chemical space.

OBJECTIVE

Silicone dog tags were worn by firefighters while on- and off-duty to measure individual exposures, identify potential occupational exposures, and assess their relation to occupational variables including fire response frequency, rank, and years as a firefighter.

METHODS

Fifty-six firefighters were recruited from two fire departments with relatively high and low call volumes in the Kansas City metropolitan area to wear two different silicone dog tags as passive samplers while on- and off-duty. Each dog tag was worn for a cumulative 30-day exposure period. Extracts of the dog tags were analyzed with gas chromatography, mass spectrometry methods for 43 flame retardants (FRs), 21 volatile organic compounds (VOCs), 42 polychlorinated biphenyls (PCBs), and 63 polycyclic aromatic hydrocarbons (PAHs).

RESULTS

Ninety-two total chemicals were detected, with eight chemicals not previously reported in firefighter exposure studies. Based on the magnitude and frequency of increased exposure in on-duty dog tags, relative to paired off-duty dog tags, five PBDEs and sec-butylbenzene were identified as potential occupational exposures; sec-butylbenzene and PBDE 49 have not previously been reported in firefighter exposure studies to the authors' knowledge. Multivariate analyses for these six compounds indicated that firefighter rank, fire response rates, and years in the fire service were poor indicators of increased occupational exposure. The greatest on-duty exposures to PBDEs were found in the low-call volume department among operational firefighters. Dog tags from firefighters at the high-call volume department accounted for 75% of PCB detections; one particular fire response may have contributed to this. Additionally, there was measurable similarity in total chemical exposure profiles between paired on- and off-duty tags for some firefighters.

IMPACT

This study used personal silicone passive samplers in the configuration of dog tags worn around the neck to quantify firefighter occupational exposure in on-duty samples relative to paired off-duty samples for several chemical categories: flame retardants, VOCs, and PCBs. Five PBDEs and sec-butylbenzene were identified as potential occupational exposures, however their prevalence in on-duty tags was not associated with frequency of fire responses, firefighter rank, or years the firefighter has been in the fire service. Additionally, similarity between chemical exposures in on- and off-duty tags from the same firefighter invites further investigation into individual behaviors influencing occupational and para-occupational exposures.

Differential metabolic profiles by Hispanic ethnicity among male Tucson firefighters

INTRODUCTION

Firefighters face regular exposure to known and probable human carcinogens, such as polycyclic aromatic hydrocarbons (PAHs), benzene, and formaldehyde, leading to an increased risk of various cancers compared to the general population. Hispanic and black firefighters are at increased risk of additional cancers not elevated in non-Hispanic white firefighters, yet biological pathways underlying these differences are unknown.

OBJECTIVES

The study objectives were to evaluate differences in the urinary metabolome between Hispanic and non-Hispanic firefighters, pre-and post-fireground exposure.

METHODS

To investigate the metabolic patterns, we employed a comprehensive metabolomics pipeline that leveraged liquid chromatography coupled with high-resolution mass spectrometry. We applied linear mixed effects regression to identify the differential metabolites at an FDR < 0.05 among 19 Hispanic and 81 non-Hispanic firefighters. We also performed overrepresentation analysis using Mummichog to identify enriched pathways at FDR < 0.05.

RESULTS

Out of 175 features in HILIC(-) mode and 1847 features in RP(+) mode, we found 26 and 276 differential urinary features, respectively, when comparing Hispanic and non-Hispanic firefighters. We noted pathway enrichment in tryptophan and galactose metabolism. However, post-exposure, we did not observe differences in the metabolomic response by ethnicity despite differing fireground exposures.

CONCLUSION

Dysregulation in the tryptophan and galactose pathway is an important contributor to cancer risks and may explain the increased cancer risk among Hispanic firefighters.

Evaluating the ingress of total polycyclic aromatic hydrocarbons (PAHs) specifically naphthalene through firefighter hoods and base layers

Structural firefighters are exposed to an array of polycyclic aromatic hydrocarbons (PAHs) as a result of incomplete combustion of both synthetic and natural materials. PAHs are found in both the particulate and vapor phases in the firefighting environment and are significantly associated with acute and chronic diseases, including cancer. Using a fireground exposure simulator (FES) and standing mannequins dressed in four different firefighter personal protective equipment (PPE) conditions, each with varying levels of protective hood interface and particulate-blocking features, the efficacy of the hoods was assessed against the ingress of PAHs (specifically, naphthalene). The authors also explored the effectiveness of a 100% cotton turtleneck at further attenuating the amount of naphthalene reaching the surface of the mannequin's neck. Air samples were collected at the breathing zone, abdomen, and thigh heights from the 6 ft-2 in mannequins used in this study. Naphthalene was the most abundant PAH (55% of the total PAH concentrations) in the FES and existed primarily in the vapor phase (92% vapor in the breathing zone). Additionally, bulk base layer and under the base layer polytetrafluoroethylene (PTFE) filter samples (used as skin surrogates) were collected from the neck region of the mannequins and analyzed for PAHs. A larger percentage of naphthalene was collected on the filter under the traditional knit hoods than on the cotton base layer, suggesting a small protective effect of the base layer against solid-phase naphthalene. Previous studies investigating naphthalene by employing air sampling under PPE have found a larger protective effect of base layers against the ingress of naphthalene vapor. PAHs that exist primarily as particulate in the fire environment were largely not detected on the base layers or PTFE filters under the gear. Further research is needed that involves more sensitive methods and non-static human subjects.

Source-resolved black carbon and PM2.5 exposures during wildfires and prescribed burns

Changes in climate and land-use have significantly increased both the frequency and intensity of wildland fires globally, exacerbating the potential for hazardous impacts on human health. A better understanding of particle exposure concentrations and scenarios is crucial for developing mitigation strategies to reduce the health risks. Here, PM2.5 and black carbon (BC) concentrations were monitored during wildland fires between 2022 and 2024, in fire-prone areas in Catalonia (NE Spain), by means of personal monitors (AirBeam2 and Micro-aethalometers AE51 and MA200). Results revealed that exposures to combustion aerosols (PM2.5 and BC) were significant and comparable during wildfires and prescribed burns (mean PM2.5 during wildfires = 152 μg/m3 vs. 110-145 μg/m3 for prescribed burns). Overall, BC/PM2.5 ratios showed a large variability as a function of the monitoring scenario, indicating varying contributions from mineral aerosols to the emissions mix originating from fire management and extinction tasks. Specifically, mop-up tasks (final extinction tasks involving stirring top soil using handheld tools) were identified as a significant contributor to PM2.5 exposures, with 1-min PM2.5 peak concentrations reaching up to 1190 μg/m3. These results may be especially valuable for emissions modelling. Source apportionment of multi-wavelength BC datasets provided deeper insights into emissions and their impact on exposure profiles: line operators (who control the fire perimeter) were predominantly exposed to biomass burning smoke BCbb (61%) when compared to BC from fossil-fuel combustion (BCff = 39%), while torchers (in charge of initiating technical fires using fossil-fuel drip-torches) were predominantly exposed to BCff (77% vs. 23% BCbb). These findings highlight the value of portable monitors in the assessment of wildfire emissions and impacts on human exposure and environment. The combination of these tools, reporting data in real-time and with high time-resolution, is key to the design and implementation of effective mitigation strategies for environmental and health concerns related to wildland fires.

Characteristics of heavy metals in the hair of firefighters: concentration dynamics and elemental interactions

Heavy metal pollution poses a major threat to human health. Firefighters, a high-risk occupational group, are regularly exposed to airborne heavy metals and fly ash. Consequently, detailed investigations into their heavy metal exposure levels are essential. This study evaluated the heavy metal exposure of 14 firefighters across five stages before and after firefighting, with a focus on concentration trends and element interactions. The concentration order was Zn > Cu > Fe > Pb > Mn > Cr > As > Ni > Cd > Co. Comparisons with health reference values and other regions indicated that while most metals were within reference ranges, Zn concentrations were elevated. The elevated Zn concentrations may result from its attachment to hair through chemisorption and absorption from airborne particles and fly ash during combustion. Heavy metal concentrations in the hair of firefighters increased after firefighting, and continued firefighting missions may further accumulate heavy metals in the body. However, concentrations decreased after a period of firefighting. Correlation analysis revealed that, except for Zn, metals exhibited synergistic interactions, with correlations strengthening significantly after firefighting. Variation in heavy metals reflects long-term pollutant exposure, and Zn in hair may serve as a biomarker of fire-related exposure.

Health effects of repeated exposures during wildland firefighting: a data-linkage cohort study from Alberta, Canada

INTRODUCTION

Very little is known about the effects on the health of work as a wildland firefighter over repeated fire seasons. In Alberta, where the fire season runs from 1 March to 31 October, the great majority of firefighters are hired seasonally. We examined whether there was a dose-response relationship between hours of firefighting and ill-health.

METHODS

A cohort was established linking employment records from Alberta Wildfire to administrative health data and cancer records. The employment records contained information on each deployment for all firefighters with employment from 1998 to 2022. Health records had details of diagnoses recorded at all physician consultations for the same period. Cancer records included diagnostic information for all confirmed cancers in the province. Exposure indices (hours worked) were related to health outcomes, with relative risk estimated by multilevel Poisson regression, using data lagged by 10 years for cancer outcomes.

RESULTS

Of 16,816 firefighters with employment records, 12,731 were matched on name, age, and sex in health records and were living in Alberta at the end of at least one fiscal year. One in three had only been employed for one fire season with 10% employed in 10 or more years. The overall mean cumulative exposure was 795 h with 568 h of sustained attack (SA). In multivariable regression, adjusted for age, sex, and inferred First Nation origin, the risk of chronic obstructive pulmonary disease (COPD) and pneumonia increased with hours of firefighting on foot and decreased with fighting less complex fires or holding a permanent appointment. Hours of firefighting in the year of health report were protective for cardiovascular disease (CVD) and mental ill-health but the risk of injury from external causes increased with firefighting hours. The risk of COPD, pneumonia, and asthma increased with cumulative hours over multiple fire seasons of SA firefighting and decreased with cumulative hours fighting less complex fires. Risks of CVD and mental ill-health were also positively related to cumulative hours of SA. No increase in risk was found with cancer incidence (all cancers, bladder cancer, lung cancer, skin: melanoma or nonmelanoma), with exposures unlagged or lagged by 10 years.

CONCLUSION

Wildland firefighters were found to be at increased risk of lung conditions, both acutely in the year of firefighting and in subsequent years. No increased risk was found for cancer.

Evaluation of Passive Silicone Samplers Compared to Active Sampling Methods for Polycyclic Aromatic Hydrocarbons During Fire Training

Firefighters are occupationally exposed to many chemicals, including polycyclic aromatic hydrocarbons (PAHs), which are formed by the incomplete combustion of organic matter during fire response and training activities. However, due to the harsh environments in which firefighters work, as well as consideration for time and physical safety while wearing bulky equipment, traditional active sampling methods may not be feasible to measure PAH exposures. Silicone passive samplers offer an alternative approach to assess exposure during fire responses and live fire training due to their heat resistance and ease of deployment in remote or time-limited environments. In this study, the primary objective was to investigate and determine the statistical strength of the relationship between active air sampling methods and passive silicone samplers for PAHs. In this study, silicone wristbands were paired with active sampling devices in a series of burn experiments to compare PAH measurements. Silicone-based measurements correlated strongly with active air samples for the dominant PAHs found, naphthalene and phenanthrene; however, detection was limited in the wristbands when air concentrations were low in active samples. In situations where PAH levels are expected to be high and the potential for contaminant loss via off-gassing is low, silicone samplers may be a useful tool for industrial hygienists to measure PAHs in fire and other emergency responses in extreme environments.

Air, Skin, and Biological Monitoring of French Fire Instructors' Exposure to Particles/PAHs During Controlled Fire and Mitigation Strategies

Occupational exposure as a firefighter was recently classified as carcinogenic to humans by the IARC. Fire instructors' exposure to carcinogenic PAHs is a major concern, and studies that have tried to assess the determinants of their exposure are scarce. An air and biomonitoring study was conducted in fire instructors performing simulated training exercises in enclosed containers. Air samples were collected, as well as urine samples from 22 firefighting instructors, and skin wipes were collected from FFs' skin at the end of the exercises. PAH metabolites (1-hydroxypyrene, 3-hydroxybenzo(a)pyrene, 2/3-hydroxyfluorene, and 2/3-hydroxyphenanthrene) were measured in urine samples at three sampling times (beginning of shift, end of shift, and next morning). Airborne PAHs were dominated by low molecular weight compounds (naphthalene), and levels were as high as 67 µg·m-3 close to the containers, decreasing at higher distances. Skin contamination was observed both on the neck/face and hands/wrists of fire instructors and pilots. Ten times lower skin contamination was observed when nitrile undergloves were worn. High internal exposure was measured, with 1-hydroxypyrene and 3-hydroxybenzo(a)pyrene levels frequently exceeding maximum recommended values in occupational settings (up to 2.8 µmol/mol creatinine for 1-OHP, 14 µmol/mol creatinine for ΣOH-PAH, and 1.0 nmol/mol creatinine for 3-OHBaP), whereas benzene exposure was revealed to be very low. These types of exposure were found to derive both from dermal absorption (combustion products deposited on the skin) and inhalation (when removing SCBA outside the containers). Several recommendations are proposed in order to reduce both exposure routes (nitrile undergloves and half-masks in the vicinity of containers), harmonise decontamination (PPEs) and cleaning procedures, and prevent the dermal absorption of PAH from turnout gear. This study emphasises the complex PAH exposure profiles of fire instructors and characterises the main drivers of exposure, highlighting the need for better mitigation strategies.

Grenfell Tower Fire: Toxic Effluents and Assessment of Firefighters' Health Impacts

OBJECTIVE

This study assesses the health symptoms and longer-term health outcomes of firefighters who attended the Grenfell Tower fire.

METHODS

All available data sources were analyzed, including databases published by the Public Inquiry, the Firefighter Cancer and Disease Registry, incident logs, and sickness reports up to 3 years postfire.

RESULTS

More than three times as many firefighters who reported exposure to smoke during the fire also reported digestive and respiratory diseases following the fire, compared with those not reporting exposure to smoke. Other more complex relationships are reported among smoke exposure, immediate health symptoms, and longer-term health outcomes.

CONCLUSIONS

The incident's urgency led professional firefighters to operate without respiratory protection equipment, resulting in debilitating health effects.

Multi-Cancer Early Detection Tests: State of the Art and Implications for Radiologists

Multi-cancer early detection (MCED) tests are already being marketed as noninvasive, convenient opportunities to test for multiple cancer types with a single blood sample. The technology varies-involving detection of circulating tumor DNA, fragments of DNA, RNA, or proteins unique to each targeted cancer. The priorities and tradeoffs of reaching diagnostic resolution in the setting of possible false positives and negatives remain under active study. Given the well-established role of imaging in lesion detection and characterization for most cancers, radiologists have an essential role to play in selecting diagnostic pathways, determining the validity of test results, resolving false-positive MCED test results, and evaluating tradeoffs for clinical policy. Appropriate access to and use of imaging tests will also factor into clinical guidelines. Thus, all clinicians potentially involved with MCED tests for cancer screening will need to weigh the benefits and harms of MCED testing, including consideration of how the tests will be used alongside or in place of other screening options, how diagnostic confirmation tests should be selected, and what the implications are for policy and reimbursement decisions. Further, patients will need regular support to make informed decisions about screening using MCED tests in the context of their personal cancer risks, health-related values, and access to care.

Epigenetic Modifications Associated With Wildland-Urban Interface (WUI) Firefighting

Wildland-urban interface (WUI) firefighting involves exposure to burning vegetation, structures, and other human-made hazards, often without respiratory protection. Response activities can last for long periods of time, spanning multiple days or weeks. Epigenetic modifications, including microRNA (miRNA) expression and DNA methylation, are responsive to toxicant exposures and are part of the development of cancers and other diseases. Epigenetic modifications have not been studied in relation to WUI fires. Firefighters (n = 99) from southern California, including 79 firefighters who responded to at least one WUI fire, provided blood samples at baseline and approximately 10 months later. We quantified the relative abundance of 800 miRNAs in blood samples using the nCounter Human v3 miRNA expression panel and blood leukocyte DNA methylation throughout the genome via the Infinium EPIC array. We used linear mixed models to compare the expression of each miRNA across time and DNA methylation at each locus, adjusting for potential confounders. In the miRNA analysis among all firefighters, 65 miRNAs were significantly different at follow-up compared to baseline at a false discovery rate of 5%. Results were similar when restricted to firefighters with a recorded WUI fire exposure during the interim period, although only 50 were significant. Expression of miRNA hsa-miR-518c-3p, a tumor suppressor, was significantly associated with WUI fire response (fold change 0.77, 95% CI = [0.69, 0.87]). In the DNA methylation analysis, no statistically significant changes over time were identified. In summary, WUI fire exposures over a wildfire season altered miRNA expression but did not substantially impact DNA methylation.

Perceptions of Cancer Risk and Gear Decontamination Among Aircraft Rescue and Firefighting Firefighters: Insights from a Mixed Methods Study

OBJECTIVES

The aims of the study are to characterize Aircraft Rescue and Firefighting (ARFF) firefighters' perceptions of occupational exposure, health impacts, and decontamination practices and describe barriers to effective gear cleaning.

METHODS

A convergent parallel mixed methods design was employed, collecting and analyzing quantitative survey data ( n = 81) and qualitative focus group data ( n = 52) from ARFF firefighters at three Florida airports.

RESULTS

ARFF firefighters expressed concerns about chronic exposure to hazardous materials and perceived a heightened cancer risk. Despite acknowledging the importance of gear decontamination, they reported infrequent cleaning behaviors due to persistent contamination and barriers, including lack of a second set of gear. Firefighters' perceived norms emerged as the primary predictor of gear-cleaning behavior.

CONCLUSIONS

Targeted interventions and policies are needed to address the unique challenges faced by ARFF firefighters in reducing occupational exposure risks and improving gear decontamination practices.

Cotton undergarments as a tool for polycyclic aromatic hydrocarbons whole body dosimetry of firefighters

Firefighters are exposed to a variety of hazardous substances during firefighting activities. Fire smoke contains polycyclic aromatic hydrocarbons (PAHs) some of which have been shown to cause cancer in humans. To assess dermal exposure of firefighters during real-life firefighting, a whole-body dosimetry method was applied to determine the PAH that settles on the skin despite firefighters wearing personal protective equipment (PPE). In total, 17 firefighters wore cotton undergarments (shirts, trousers, gloves, socks, and balaclavas) under their PPE during firefighting missions. After firefighting, fabric pieces were analyzed for 16 US-EPA PAHs and benzo[e]pyrene. Detailed information about the fire missions was solicited from firefighters via a questionnaire. Seventy percent of firefighters provided their undergarments and PAHs were analyzed in 309 punched-out fabric pieces. PAHs were quantified in 27 out of the 309 fabric pieces (8.7%). Generally, PAH concentrations were higher after firefighting in residential buildings compared to exposure levels after fighting vehicle or outdoor fires. Phenanthrene and pyrene were the predominant compounds and were observed up to 657 and 244 ng/g, respectively. Benzo[a]pyrene (B[a]P) was detected in 10 fabric pieces (3.2%) up to 103 ng/g, but all levels were below 1,000 ng/g, the threshold limit of B[a]P according to European Consumer Goods Regulation (European Commission Regulation (EU) 2018/1513). It was demonstrated that firefighting PPE can be an effective shield against dermal exposure to carcinogenic substances. Thus, all measured PAH concentrations in the fabric pieces were below the threshold limit of 1,000 ng/g of each PAH, which is allowed in consumer goods in the European Union for clothing worn on the skin However, individual dermal exposures cannot be completely avoided during firefighting missions. The use of undergarments, gloves, socks, and balaclavas for whole-body dosimetry, which are worn under the PPE, can be useful in assessing whether hazardous substances penetrate the firefighters' PPE.

A Theory-Guided Qualitative Exploration of Occupational Influences on Firefighters' Dietary Behaviors

BACKGROUND

Firefighters face many inherent occupational health hazards and increased risk for several cancers, making peak health essential. However, cardiac events and stroke continue as leading causes of on-duty deaths. Healthy diets promote prevention of cardiovascular disease and cancers. While some dietary interventions have been undertaken, sustained improvements have not been observed. Understanding firefighters' occupational influences on dietary behavior is vital for implementation of effective interventions to improve nutrition.

METHODS

The Theoretical Domains Framework (TDF) guided this qualitative study. Nine focus groups of firefighters who work 24-hour shifts and one interview with a fire administrator (N = 34) were conducted in 2018 across South Carolina, United States.

FINDINGS

Predominant TDF domains of influence for workplace dietary behaviors included social/professional role and identity; social influences; environmental context and resources; knowledge; beliefs about consequences; memory, attention, and decision processes; and emotion. Four emergent themes mapped to TDF domains: "We are family": Firefighters feel a strong identity in their work and with peers; "If you are a firefighter, you've got a second job": Firefighters experience many limitations in personal and workplace resources; "That kills us": Firefighters were knowledgeable about most all occupational health and safety risks except dietary risks; and "You're tired, wore out": Occupational stress influenced nutritional choice making.

CONCLUSIONS

Firefighters experience many barriers to healthy eating while at work due to unique occupational influences. The findings from this study highlighted specific behavioral domains and barriers to be intervened upon that may increase the likelihood of long-term adoption of healthier dietary practices by firefighters.

Factors Related to Firefighters' Food Behaviors at the Fire Station: A Quantitative Study

OBJECTIVE

Using a cross-sectional correlational study, the purpose was to quantitatively investigate factors associated to firefighters' food behaviors while on duty at the fire station.

METHODS

Two hundred and fifty-two (252) firefighters (males, 96%; age, 39 ± 11 years) completed an online questionnaire assessing diet and exploring factors that could be associated to firefighters' food behaviors at the fire station.

RESULTS

First regression analysis showed that level of education, years of experience, self-perceived nutrition knowledge, autonomous motivation, and accessibility to unhealthy foods were the best predictors of healthy food score. Second regression analysis revealed that body mass index, autonomous motivation, and meals interrupted by emergency calls were the best predictors of fast-food score.

CONCLUSIONS

This study highlights the various factors associated with firefighters' food behaviors at the fire station.

The Emission Characteristics and Health Risks of Firefighter-Accessed Fire: A Review

The exacerbation of wildfires caused by global warming poses a significant threat to human health and environmental integrity. This review examines the particulate matter (PM) and gaseous pollutants resulting from fire incidents and their impacts on individual health, with a specific focus on the occupational hazards faced by firefighters. Of particular concern is the release of carbon-containing gases and fine particulate matter (PM2.5) from forest fires and urban conflagrations, which exceed the recommended limits and pose severe health risks. Firefighters exposed to these pollutants demonstrate an elevated risk of developing pulmonary and cardiovascular diseases and cancer compared to the general population, indicating an urgent need for enhanced protective measures and health management strategies for firefighters. Through a meticulous analysis of the current research findings, this review delineates future research directions, focusing on the composition and properties of these pollutants, the impacts of fire-emitted pollutants on human health, and the development of novel protective technologies.

Examination of Firefighting as an Occupational Exposure Criteria for Lung Cancer Screening

PURPOSE

Firefighting is known to be carcinogenic to humans. However, current lung cancer screening guidelines do not account for occupational exposure. We hypothesize that firefighting is an independent risk factor associated with the development of high-risk lung nodules on low-dose CT (LDCT).

METHODS

Members of a firefighter's union underwent LDCT at a single institution between April 2022 and June 2023 within a lung cancer screening program. Results were interpreted by designated chest radiologists and reported using the Lung-RADS scoring system. Demographic and radiographic data were recorded, and summary statistics are reported.

RESULTS

1347 individuals underwent lung cancer screening, with a median age of 51 years (IQR 42-58), including 56 (4.2%) females. Overall, 899 (66.7%) were never smokers, 345 (25.6%) were former smokers, and 103 (7.7%) were current smokers. There were 41 firefighters (3.0%) who had high-risk (Lung-RADS 3 or 4) nodules requiring intervention or surveillance, of which 21 (1.5%) were Lung-RADS 3 and 20 (1.5%) that were Lung-RADS 4. Of the firefighters with high-risk nodules, only 6 (14.6%) were eligible for LDCT based on current screening guidelines. There were 7 high-risk nodules (0.5%) that required procedural intervention, 6 (85.7%) of which were from the non-screening eligible cohort. There were also 20 never-smoking firefighters (57.1%) with high-risk nodules that were non-screening eligible.

CONCLUSION

Firefighting, even in the absence of smoking history, may be associated with the development of high-risk lung nodules on LDCT. Carefully selected occupational exposures should be considered in the development of future lung cancer screening guidelines.

A review of occupational exposures to carcinogens among wildland firefighters

Wildfires can negatively impact the health and well-being of wildland firefighters through a variety of exposure pathways. Many studies have measured acute health effects from occupational exposure to pollutants in wildfire smoke; however, research specifically examining cancer risks from exposure to carcinogens is limited. This review aimed to better understand cancer risk in this occupation by assessing the existing evidence of exposures and summarizing measured concentrations of carcinogens among wildland firefighters. A systematic search was conducted to identify scientific papers using the following databases: Medline(OVID), Embase(OVID), PsycINFO(OVID), Cochrane Library, CINAHL(EBSCOHost), EconLit(EBSCOHost), Scopus, Agricultural and Environmental Science Collect(ProQuest), and NIOSHTIC-2. Forty-nine papers were identified that met eligibility criteria. Across the papers, 31 carcinogens were identified and quantified using a variety of assessment methods. Papers measured particulate matter (N = 26), polycyclic aromatic hydrocarbons (N = 12), volatile organic compounds (N = 14), crystalline silica (N = 5), black carbon (N = 4), asbestos (N = 3), radionuclides (N = 7), and metals (N = 2). Most papers measured inhalation exposures through traditional air sampling methods, but a subset of exposures to polycyclic aromatic hydrocarbons (N = 8), as well as heavy metals (N = 1), were measured through urinary biomarkers and naphthalene was measured using dermal wipe samples (N = 2). Although the heterogeneity of exposure assessment methods made direct comparison of concentrations difficult, the papers provide consistent evidence that wildland firefighters are regularly exposed to carcinogens. All wildland fire personnel should continue to implement recommended mitigation strategies and support new mitigations to reduce exposure to carcinogens on the job.

Breast Cancer-Related Chemical Exposures in Firefighters

To fill a research gap on firefighter exposures and breast cancer risk, and guide exposure reduction, we aimed to identify firefighter occupational exposures linked to breast cancer. We conducted a systematic search and review to identify firefighter chemical exposures and then identified the subset that was associated with breast cancer. To do this, we compared the firefighter exposures with chemicals that have been shown to increase breast cancer risk in epidemiological studies or increase mammary gland tumors in experimental toxicology studies. For each exposure, we assigned a strength of evidence for the association with firefighter occupation and for the association with breast cancer risk. We identified twelve chemicals or chemical groups that were both linked to breast cancer and were firefighter occupational exposures, including polycyclic aromatic hydrocarbons, volatile aromatics, per- and polyfluoroalkyl substances, persistent organohalogens, and halogenated organophosphate flame retardants. Many of these were found at elevated levels in firefighting environments and were statistically significantly higher in firefighters after firefighting or when compared to the general population. Common exposure sources included combustion byproducts, diesel fuel and exhaust, firefighting foams, and flame retardants. Our findings highlight breast-cancer-related chemical exposures in the firefighting profession to guide equitable worker's compensation policies and exposure reduction.

Occupational Exposure of On-Shift Ottawa Firefighters to Flame Retardants and Polycyclic Aromatic Hydrocarbons

Firefighters can be exposed to complex mixtures of airborne substances, including hazardous substances released during structural fires. This study employed silicone wristbands (SWBs) as passive samplers to investigate potential exposure to polycyclic aromatic hydrocarbons (PAHs) and flame retardants (FRs). SWBs were deployed at different areas of four fire stations, in four truck cabins, and at an office control location; they were also donned outside the jackets of 18 firefighters who responded to fire calls. Overall, office areas had significantly lower PAHs than fire station areas. Vehicle bays and truck cabins had significantly higher concentrations of low molecular weight (LMW) PAHs than sleeping and living room areas. For organophosphate ester flame retardants (OPFRs), tri-n-butyl phosphate (TnBP) and tris(1-chloro-2-propyl) phosphate (TCPP) were detected in all the samples; 2-ethylhexyl diphenyl phosphate (EHDPP) was more frequently detected in the fire station areas. Triphenyl phosphate (TPP) concentrations were highest in the truck cabin and office areas, and tris(1,3-dichloro-2-propyl)phosphate (TDCPP) was highest in truck cabins. Thirteen of 16 PAHs and nine of 36 OPFRs were detected in all the SWBs worn by firefighters, and tris (2-butoxyethyl) phosphate (TBEP) was the predominant OPFR. Levels of LMW PAHs were significantly lower when firefighters did not enter the fire. LMW PAHs, HMW (high molecular weight) PAHs, and EHDPP were significantly elevated when heavy smoke was reported. This work highlights the potential for occupational exposure to PAHs and flame retardants in some fire station areas; moreover, factors that may influence exposure during fire suppression. Whilst firefighters' occupational exposure to PAHs is likely related to fire suppression and exposure to contaminated gear and trucks, exposure to OPFRs may be more related to their presence in truck interiors and electronics.

The risk of insomnia by work schedule instability in Korean firefighters

BACKGROUND

Firefighters are exposed to shift work, as well as unpredictable emergency calls and traumatic events, which can lead to sleep problems. This study aimed to investigate the risk of insomnia by work schedule instability in Korean firefighters.

METHODS

This study used the Insomnia Severity Index to assess the insomnia in firefighters. The work schedule stability was classified with the frequency of the substitute work and the timing of notification for work schedule changes. Logistic regression analysis was used to assess the adjusted odds ratio of insomnia by work schedule stability with covariates including sex, age, education, smoking, alcohol, caffeine intake, shift type, job, and underlying conditions.

RESULTS

Of the 8,587 individuals, 751 (8.75%) had moderate to severe insomnia (Insomnia Severity Index ≥ 15). The prevalence of insomnia was statistically significantly higher as the frequency of substitute work increased: <1 time per month (6.8%), 1-2 times (9.5%), 3-5 times (13.4%), and more than 5 times (15.7%) (p < 0.001). Additionally, the prevalence of insomnia was statistically significantly higher when the timing of the schedule change notification was urgent or irregular: no change or several weeks before (5.4%), several days before (7.9%), one day before or on the day (11.2%), irregularly notification (11.6%) (p < 0.001). In comparison to the group with good frequency of the substitute work/good timing of schedule change notification group, the adjusted odds ratios of insomnia were 1.480 (95% confidence interval [CI]: 1.237-1.771) for Good/Bad group, 1.862 (95% CI: 1.340-2.588) for Bad/Good group, and 1.885 (95% CI: 1.366-2.602) for Bad/Bad group.

CONCLUSIONS

Work schedule instability was important risk factor of insomnia in firefighters. It suggests that improving the stability of work schedules could be a key strategy for reducing sleep problems in this occupational group.

Relative genotoxicity of polycyclic aromatic hydrocarbons inferred from free energy perturbation approaches

Utilizing molecular dynamics and free energy perturbation, we examine the relative binding affinity of several covalent polycyclic aromatic hydrocarbon - DNA (PAH-DNA) adducts at the central adenine of NRAS codon-61, a mutational hotspot implicated in cancer risk. Several PAHs classified by the International Agency for Research on Cancer as probable, possible, or unclassifiable as to carcinogenicity are found to have greater binding affinity than the known carcinogen, benzo[a]pyrene (B[a]P). van der Waals interactions between the intercalated PAH and neighboring nucleobases, and minimal disruption of the DNA duplex drive increases in binding affinity. PAH-DNA adducts may be repaired by global genomic nucleotide excision repair (GG-NER), hence we also compute relative free energies of complexation of PAH-DNA adducts with RAD4-RAD23 (the yeast ortholog of human XPC-RAD23) which constitutes the recognition step in GG-NER. PAH-DNA adducts exhibiting the greatest DNA binding affinity also exhibit the least RAD4-RAD23 complexation affinity and are thus predicted to resist the GG-NER machinery, contributing to their genotoxic potential. In particular, the fjord region PAHs dibenzo[a,l]pyrene, benzo[g]chrysene, and benzo[c]phenanthrene are found to have greater binding affinity while having weaker RAD4-RAD23 complexation affinity than their respective bay region analogs B[a]P, chrysene, and phenanthrene. We also find that the bay region PAHs dibenzo[a,j]anthracene, dibenzo[a,c]anthracene, and dibenzo[a,h]anthracene exhibit greater binding affinity and weaker RAD4-RAD23 complexation affinity than B[a]P. Thus, the study of PAH genotoxicity likely needs to be substantially broadened, with implications for public policy and the health sciences. This approach can be broadly applied to assess factors contributing to the genotoxicity of other unclassified compounds.

Environmental contamination with polycyclic aromatic hydrocarbons and contribution from biomonitoring studies to the surveillance of global health

This work presents an integrated overview of polycyclic aromatic hydrocarbons' (PAHs) ubiquity comprising environmental contamination in the air, aquatic ecosystems, and soils; characterizes the contamination in biota; and identifies main biomonitors and human exposure to PAHs and associated health risks. Urban centers and industrial areas present increased concentrations in the air (1344.4-12,300 versus 0.03-0.60 ng/m3 in industrial/urban and rural zones) and soils (0.14-1.77 × 106 versus 2.00-9.04 × 103 versus 1.59-5.87 × 103 ng/g in urban, forest, and rural soils), respectively. Increased concentrations were found in coastal zones and superficial waters as well as in sediments (7.00 × 104-1.00 × 109 ng/g). Benzo(a)pyrene, a carcinogenic PAH, was found in all environmental media. Mosses, lichens, tree leaves, bivalves, cephalopods, terrestrials' snails, and honeybees are good biomonitors of biota contamination. More studies are needed to improve characterization of PAHs' levels, distribution, and bioaccumulation in the environmental media and assess the associated risks for biota and human health. Actions and strategies to mitigate and prevent the bioaccumulation of PAHs in the environment and trophic chains toward the WHO's One-Health Perspective to promote the health of all ecosystems and human life are urgently needed.

Impact of firefighter hood design on range of motion, noise production and hearing

Firefighter hoods must provide protection from elevated temperatures and products of combustion while simultaneously being comfortable and limiting interference with firefighting movement or completion of fireground activities. This study was to quantify the impact of hood design (traditional knit hood vs. several models of particulate-blocking hoods) on wearability measures such as range of motion, noise production and hearing threshold. Firefighters' perceptions of wearability were also collected. In a controlled laboratory environment, 24 firefighters performed movement and hearing tests. Wearing particulate-blocking hoods resulted in decreased rotational range of motion, and thicker hoods reduced hearing ability. Design, but not necessarily the number of layers, affected noise production by the hood during head movement.Practitioner summary: Particulate-blocking hoods resulted in reduced rotational range of motion relative to the traditional design and the no-hood condition. Hoods with additional layers resulted in decreased hearing ability. Noise production was increased in designs of particulate-blocking hoods with a membrane-based blocking layer independent of the number of layers.

Percutaneous Absorption of Fireground Contaminants: Naphthalene, Phenanthrene, and Benzo[a]pyrene in Porcine Skin in an Artificial Sweat Vehicle

Firefighters face significant risks of exposure to toxic chemicals, such as polycyclic aromatic hydrocarbons (PAHs), during fire suppression activities. PAHs have been found in the air, on the gear and equipment, and in biological samples such as the skin, breath, urine, and blood of firefighters after fire response. However, the extent to which exposure occurs via inhalation, dermal absorption, or ingestion is unclear. In this study, three PAHs, naphthalene, phenanthrene, and benzo[a]pyrene, were applied to porcine skin in vitro in an artificial sweat solution to better gauge firefighters' dermal exposures while mimicking their sweaty skin conditions using an artificial sweat dosing vehicle. Multiple absorption characteristics were calculated, including cumulative absorption, percent dose absorbed, diffusivity, flux, lag time, and permeability. The absorption of the PAHs was greatly influenced by their molecular weight and solubility in the artificial sweat solution. Naphthalene had the greatest dose absorption efficiency (35.0 ± 4.6% dose), followed by phenanthrene (6.8 ± 3.2% dose), and lastly, benzo[a]pyrene, which had the lowest absorption (0.03 ± 0.04% dose). The lag times followed a similar trend. All chemicals had a lag time of approximately 60 min or longer, suggesting that chemical concentrations on the skin may be reduced by immediate skin cleansing practices after fire exposure.

Perceptions of Exposure and Mask Use in Wildland Firefighters

Wildland firefighters are exposed to airborne particulates, polycyclic aromatic hydrocarbons (PAHs), and other hazardous substances. Respiratory protection is indicated, but information is lacking on the tasks and conditions for which mask wearing should be advised. Studies to assess respiratory protection in wildland firefighters were carried out in western Canada in 2021 and 2023. Sampling pumps measured airborne exposures and urinary 1-hydroxypyrene (1-HP) was assayed to indicate PAH absorption. Participants in 2021 reported the time for which they wore the mask during each task. In 2023, the use of masks was reported, and firefighters rated the smoke intensity. In 2021, 72 firefighters were monitored over 164 shifts and, in 2023, 89 firefighters were monitored for 263 shifts. In 2021, mask wearing was highest for those engaged in initial attack and hot spotting. Urinary 1-HP at the end of rotation was highest for those reporting initial attack, working on a prescribed fire and mop-up. In 2023, firefighter ratings of smoke intensity were strongly associated with measured particulate mass and with urinary 1-HP, but masks were not worn more often when there was higher smoke intensity. The data from the literature did not provide a clear indication of high-exposure tasks. Better task/exposure information is needed for firefighters to make informed decisions about mask wearing.

Size-resolved particulate matter inside selected fire stations and preliminary evaluation of the effectiveness of washing machines in reducing its concentrations

The study aimed to determine and compare the mass concentration and size distribution of particulate matter (PM) at two Polish fire stations, one equipped with a washing machine intended for the decontamination of uniforms (FSN) and the other not equipped with this type of device (FSC), to assess the effectiveness of washing machines in reducing PM concentrations inside fire stations and estimate PM doses inhaled by firefighters while performing activities in truck bays and changing rooms during one work shift. The average PM concentrations at the FSN were 18.2-28.9 µg/m3 and 27.5-37.3 µg/m3, while at FSC they were 27.4-37.9 µg/m3 and 24.6-32.8 µg/m3 in the truck bays and changing rooms, respectively. At each measurement point, most of the PM mass (65-75%) was accumulated as fine particles. The dominance of fine particles in the total mass of PM results in high values of PM deposition coefficients (0.59-0.61) in three sections of the respiratory tract at each monitoring site. This study initially indicates the effectiveness of washing machines in reducing the concentration of fine particles and demonstrates the necessity, as well as directions for further research in this area.

Assessing the Impact of Pre-Soaking to Enhance Laundering Efficacy of Firefighter Turnout Gear

Firefighters are exposed to hazardous chemicals at fire scenes, including polycyclic aromatic hydrocarbons (PAHs) among many others, which pose significant health risks. Current laundering practices are ineffective at removing persistent contaminants from turnout gear, necessitating further research to optimize cleaning methods. This study explores the impact of presoaking prior to the laundering process and the factors that can affect its effectiveness, including the presoaking duration and detergent concentration, in PAH removal when laundering. For this, contaminated fabric swatches were subjected to various presoaking durations (1, 3, and 12 h) and detergent concentrations (99:1 and 90:10 water-to-detergent ratios) before undergoing bench-scale washing. The cleaning efficacy was assessed for 16 PAH compounds, including both low-molecular-weight (LMW) PAHs and high-molecular-weight (HMW) PAHs. Moreover, the removal mechanisms of PAHs from turnout gear were fundamentally explained using partition coefficients and standard affinities with different parameters during washing. The results demonstrate that 3 h and 12 h of presoaking lead to 2.8 and 4.3 times greater HMW PAH removal, respectively. After 12 h of presoaking in a 90:10 water-to-detergent ratio, 97% of the LMW PAHs and 78% of the HMW PAHs were removed, compared to only an 11% removal of the HMW PAHs with a 99:1 ratio. Additionally, direct washing with a 90:10 ratio achieved comparable efficacy to that of presoaking with the same water-to-detergent ratio, indicating the crucial role of detergent concentration during laundering. These findings offer valuable insights for optimizing firefighter safety practices, emphasizing the role of presoaking and the appropriate methods to perform presoaking to mitigate firefighters' occupational exposure risks to toxic substances and ensure gear reliability.

Cancer Prevention Among Firefighters: Examining Lifestyle, Screening Behavior, and Beliefs

BACKGROUND

Firefighters are at increased risk of developing cancer due to occupational exposures, but they may also face increased risk due to their lifestyle, such as the quality of their diet and physical activity. Cancer beliefs and screening behavior could also influence their cancer risk. The current study aimed to identify individual differences associated with lifestyle behaviors, cancer screening, and cancer beliefs among firefighters; to describe the strategies firefighters use to adapt to their work schedule; and to describe topics firefighters believe are the most important to address in their workplace.

METHODS

Career firefighters (N = 171) in a medium-sized U.S. city completed an online survey.

FINDINGS

Logistic regression analyses identified age, education, racial identity, years of fire service, perceived stress, and rank as predictors of responses to items addressing cancer screening, lifestyle behaviors, and cancer beliefs. Although results varied, age, education, and racial identity were associated with most of the outcomes. Strategies related to sleep such as getting the right amount and napping, exercise, and getting family/roommate support were selected as the top adaptive strategies for work. Sleep, mental health/well-being, and work-life balance were selected most often as the most important topics to address in the fire service, with topics related to reducing occupational exposures receiving less attention.

CONCLUSIONS/APPLICATION TO PRACTICE

The findings suggest individual differences, such as age, education, and racial identity, should be considered when developing occupational health interventions for firefighters. Interventions related to mental health, work-life balance, and sleep may be desired most by those in the fire service.

A Scoping Review of Firefighters' Health Behaviors and Chronic Diseases

Objectives:Due to exposure to carcinogenic agents, firefighters are at increased risk for chronic diseases (e. g., cancer). It is unclear how much research has focused on firefighters' health behaviors that also could also contribute to firefighters' disease risk. In this scoping review, we aimed to (1) determine how much research has examined firefighters' health behaviors and (2) determine how many studies have assessed the association between health behaviors and chronic diseases.Methods:We searched electronic databases (e. g., PubMed/MEDLINE). We included studies if they measured at least one health behavior (diet, tobacco use, physical activity, sleep, alcohol consumption), regardless of assessing chronic diseases. We noted if the study included chronic diseases and if it examined an association between health behavior and chronic disease.Results:Overall, 126 articles were included that measured at least one health behavior. Physical activity and diet were the most studied health behaviors. About half of the studies included a chronic disease. Of those studies, 26 examined associations between the health behavior(s) and chronic diseases.Conclusions:There is a growing literature examining health behaviors among firefighters. This information can inform intervention development.

Characterization of fire investigators' polyaromatic hydrocarbon exposures using silicone wristbands

BACKGROUND

Exposures to polyaromatic hydrocarbons (PAHs) contribute to cancer in the fire service. Fire investigators are involved in evaluations of post-fire scenes. In the US, it is estimated that there are up to 9000 fire investigators, compared to approximately 1.1 million total firefighting personnel. This exploratory study contributes initial evidence of PAH exposures sustained by this understudied group using worn silicone passive samplers.

OBJECTIVES

Evaluate PAH exposures sustained by fire investigators at post-fire scenes using worn silicone passive samplers. Assess explanatory factors and health risks of PAH exposure at post-fire scenes.

METHODS

As part of a cross-sectional study design, silicone wristbands were distributed to 16 North Carolina fire investigators, including eight public, seven private, and one public and private. Wristbands were worn during 46 post-fire scene investigations. Fire investigators completed pre- and post-surveys providing sociodemographic, occupational, and post-fire scene characteristics. Solvent extracts from wristbands were analyzed via gas chromatography-mass spectrometry (GC-MS). Results were used to estimate vapor-phase PAH concentration in the air at post-fire scenes.

RESULTS

Fire investigations lasted an average of 148 minutes, standard deviation ± 93 minutes. A significant positive correlation (r=0.455, p<.001) was found between investigation duration and PAH concentrations on wristbands. Significantly greater time-normalized PAH exposures (p=0.039) were observed for investigations of newer post-fire scenes compared to older post-fire scenes. Regulatory airborne PAH exposure limits were exceeded in six investigations, based on exposure to estimated vapor-phase PAH concentrations in the air at post-fire scenes.

DISCUSSION

Higher levels of off-gassing and suspended particulates at younger post-fire scenes may explain greater PAH exposure. Weaker correlations are found between wristband PAH concentration and investigation duration at older post-fire scenes, suggesting reduction of off-gassing PAHs over time. Exceedances of regulatory PAH limits indicate a need for protection against vapor-phase contaminants, especially at more recent post-fire scenes.

Characterization of Wildland Firefighters' Exposure to Coarse, Fine, and Ultrafine Particles; Polycyclic Aromatic Hydrocarbons; and Metal(loid)s, and Estimation of Associated Health Risks

Firefighters' occupational activity causes cancer, and the characterization of exposure during firefighting activities remains limited. This work characterizes, for the first time, firefighters' exposure to (coarse/fine/ultrafine) particulate matter (PM) bound polycyclic aromatic hydrocarbons (PAHs) and metal(loid)s during prescribed fires, Fire 1 and Fire 2 (210 min). An impactor collected 14 PM fractions, the PM levels were determined by gravimetry, and the PM-bound PAHs and metal(loid)s were determined by chromatographic and spectroscopic methodologies, respectively. Firefighters were exposed to a total PM level of 1408.3 and 342.5 µg/m3 in Fire 1 and Fire 2, respectively; fine/ultrafine PM represented more than 90% of total PM. Total PM-bound PAHs (3260.2 ng/m3 in Fire 1; 412.1 ng/m3 in Fire 2) and metal(loid)s (660.8 ng/m3 versus 262.2 ng/m3), distributed between fine/ultrafine PM, contained 4.57-24.5% and 11.7-12.6% of (possible/probable) carcinogenic PAHs and metal(loid)s, respectively. Firefighters' exposure to PM, PAHs, and metal(loid)s were below available occupational limits. The estimated carcinogenic risks associated with the inhalation of PM-bound PAHs (3.78 × 10-9 - 1.74 × 10-6) and metal(loid)s (1.50 × 10-2 - 2.37 × 10-2) were, respectively, below and 150-237 times higher than the acceptable risk level defined by the USEPA during 210 min of firefighting activity and assuming a 40-year career as a firefighter. Additional studies need to (1) explore exposure to (coarse/fine/ultrafine) PM, (2) assess health risks, (3) identify intervention needs, and (4) support regulatory agencies recommending mitigation procedures to reduce the impact of fire effluents on firefighters.

Cancer odds among Ohio firefighters: data from the Ohio Cancer Incidence Surveillance System (OCISS) 1996-2019

Objectives

The objective of the current case-control study was to examine the odds of cancer among firefighters in the state of Ohio and compare the odds of being a firefighter versus police or the general population across different cancer types.

Methods

Cancer cases were examined from the Ohio Cancer Incidence Surveillance System (OCISS) between 1996 and 2019. Occupation status was classified as firefighter, police or general population. Logistic regression models were run to calculate ORs to determine the odds of being a firefighter compared with police or the general population across different cancer types. Models were adjusted for gender, race, age at cancer diagnosis and year of cancer diagnosis.

Results

Among the 906 164 cancer cases, 3397 were firefighters and 3341 were police. Firefighters were more likely to be men, white, non-Hispanic, married and a mean age of 66 at the time of cancer diagnosis. Firefighters had increased odds of cancer of the brain (OR=1.40, 95% CI: 0.99 to 1.99) and thyroid (OR=1.53, 95% CI: 1.05 to 2.23) compared with police and oesophageal (OR=1.83, 95% CI: 1.43 to 2.33), skin (OR=1.23, 95% CI: 1.06 to 1.42), brain (OR=1.37, 95% CI: 1.08 to 1.73) and thyroid (OR=1.52, 95% CI: 1.18 to 1.96) compared with the general population. They had decreased odds of pancreas, lung and bronchus and bladder compared with both police and the general population. Similar patterns were observed among male firefighters.

Conclusions

The current study demonstrated increased odds of several different types of cancer among Ohio firefighters compared with other individuals within the OCISS, which may be associated with differences in risk factors, including occupational exposures. The results align with evidence that firefighting is a cancer risk factor. This study is strengthened by the ability to also compare firefighters to police with regards to the odds of cancer. This supports future hypothesis-driven studies examining how specific occupational exposures are associated with increased cancer risk among Ohio firefighters.

Biomonitoring of polycyclic aromatic hydrocarbons exposure and short-time health effects in wildland firefighters during real-life fire events

Human biomonitoring data retrieved from real-life wildland firefighting in Europe and, also, worldwide are scarce. Thus, in this study, 176 Portuguese firefighters were biomonitored pre- and post- unsimulated wildfire combating (average:12-13 h; maximum: 55 h) to evaluate the impact on the levels of urinary polycyclic aromatic hydrocarbons hydroxylated metabolites (OHPAH; quantified by high-performance liquid chromatography with fluorescence detection) and the associated short-term health effects (symptoms, and total and differentiated white blood cells). Correlations between these variables and data retrieved from the self-reported questionnaires were also investigated. Firefighters were organized into four groups according to their exposure to wildfire emissions and their smoking habits: non-smoking non-exposed (NSNExp), non-smoking exposed (NSExp), smoking non-exposed (SNExp), and smoking and exposed (SExp). The most abundant metabolites were 1-hydroxynaphthalene and 1-hydroxyacenaphthene (1OHNaph + 1OHAce) (98-99 %), followed by 2-hydroxyfluorene (2OHFlu) (0.2-1.1 %), 1-hydroxyphenanthrene (1OHPhen) (0.2-0.4 %), and 1-hydroxypyrene (1OHPy) (0.1-0.2 %); urinary 3-hydroxybenzo(a)pyrene was not detected. The exposure to wildfire emissions significantly elevated the median concentrations of each individual and total OHPAH compounds in all groups, but this effect was more pronounced in non-smoking (1.7-4.2 times; p ≤ 0.006) than in smoking firefighters (1.3-1.6 times; p ≤ 0.03). The greatest discriminant of exposure to wildfire emissions was 1OHNaph + 1OHAce (increase of 4.2 times), while for tobacco smoke it was 2OHFlu (increase of 10 times). Post-exposure, white blood cells count significantly increased ranging from 1.4 (smokers, p = 0.025) to 3.7-fold (non-smokers, p < 0.001), which was accompanied by stronger significant correlations (0.480 < r < 0.882; p < 0.04) between individual and total OHPAH and total white blood cells (and lymphocytes > monocytes > neutrophils in non-smokers), evidencing the impact of PAH released from wildfire on immune cells. This study identifies Portuguese firefighters with high levels of biomarkers of exposure to PAH and points out the importance of adopting biomonitoring schemes, that include multiple biomarkers of exposure and biomarkers of effect, and implementing mitigations strategies.

Problems of operation of positive pressure ventilators on the basis of surveys of Polish officers of the State Fire Service

Positive pressure ventilators (PPV) used by 97.7% of officers of the National Fire Service in Poland, are characterized by work that is not in line with the expectations of the firefighters. In order to improve the technical and operational features of these devices, a survey was conducted among 25,000 eligible firefighters, identifying the application of these devices, problems in use and expected development directions. A total of 682 officers voluntarily completed the survey. Based on their findings, it was determined that ventilators are most often used to smoke out buildings after or during a fire. Mentioned problems when using these devices were mainly noise (78.2%), exhaust emissions (68.5%), and impediments to mobility through the device's relatively heavy weight (40.2%). Other inconveniences were mentioned by less than 20% of firefighters. Polish firefighters expect the development of these devices mainly in terms of the above-mentioned features (noise reduction (81.7%) and reduction of the weight and size of the ventilators (about 50%)). Other expectations relate to the improvement of smoke removal in buildings: increasing the efficiency of smoke removal (46.4%) and efficiency regarding the rate of smoke removal in a building by increasing the size of the incoming airflow from the building's surroundings (33.2%). About 15% of firefighters expect changes in the operation of the ventilator itself, that is, an increase in the effective operating time (electric ventilators) and an increase in the device's uptime. The aim of the article is to identify the issues encountered during the operation and to indicate the expected direction of development for PPV by users. This information can be used by engineers to initiate new development work on these devices.

Prevalence and predictors of colon and prostate cancer screening among volunteer firefighters: The United States Firefighter Cancer Assessment and Prevention Study

BACKGROUND

Although firefighters have increased risk for colon and prostate cancer, limited information exists on screening practices for these cancers in volunteer firefighters who compose two-thirds of the US fire service. We estimated the prevalence of colon and prostate cancer screening among volunteer firefighters using eligibility criteria from 4 evidence-based screening recommendations and evaluated factors influencing screening.

METHODS

We evaluated colon (n = 569) and prostate (n = 498) cancer screening prevalence in a sample of US volunteer firefighters using eligibility criteria from the US Preventive Services Taskforce (USPSTF), National Fire Protection Association, American Cancer Society, and National Comprehensive Cancer Network. We assessed associations with fire service experience, demographics, and cancer risk perception based on USPSTF guidelines.

RESULTS

For those eligible based on USPSTF guidelines, colon and prostate cancer screening prevalence was 51.7% (95% CI: 45.7, 57.8) and 48.8% (95% CI: 40.0, 57.6), respectively. Higher odds of colon and prostate cancer screening were observed with older age and with some college education compared to those with less education. Fire service experience and cancer risk perception were not associated with screening practices.

CONCLUSION

This is the first large study to assess colon and prostate cancer screening among US volunteer firefighters based on different screening guidelines. Our findings suggest gaps in cancer prevention efforts in the US volunteer fire service. Promoting cancer screening education and opportunities for volunteer firefighters by their fire departments, healthcare professionals, and public health practitioners, may help to address the gaps.

Evaluating workplace protection factors (WPFs) of different firefighter PPE interface control measures for select volatile organic compounds (VOCs)

Structural firefighters are exposed to a complex set of contaminants and combustion byproducts, including volatile organic compounds (VOCs). Additionally, recent studies have found structural firefighters' skin may be exposed to multiple chemical compounds via permeation or penetration of chemical byproducts through or around personal protective equipment (PPE). This mannequin-based study evaluated the effectiveness of four different PPE conditions with varying contamination control measures (incorporating PPE interface design features and particulate blocking materials) to protect against ingress of several VOCs in a smoke exposure chamber. We also investigated the effectiveness of long-sleeve base layer clothing to provide additional protection against skin contamination. Outside gear air concentrations were measured from within the smoke exposure chamber at the breathing zone, abdomen, and thigh heights. Personal air concentrations were collected from mannequins under PPE at the same general heights and under the base layer at abdomen and thigh heights. Sampled contaminants included benzene, toluene, styrene, and naphthalene. Results suggest that VOCs can readily penetrate the ensembles. Workplace protection factors (WPFs) were near one for benzene and toluene and increased with increasing molecular weight of the contaminants. WPFs were generally lower under hoods and jackets compared to under pants. For all PPE conditions, the pants appeared to provide the greatest overall protection against ingress of VOCs, but this may be due in part to the lower air concentrations toward the floor (and cuffs of pants) relative to the thigh-height outside gear concentrations used in calculating the WPFs. Providing added interface control measures and adding particulate-blocking materials appeared to provide a protective benefit against less-volatile chemicals, like naphthalene and styrene.

Distinct Prostate Cancer Survival Outcomes in Firefighters: A Population-Based Study

Introduction: Survival outcomes for prostate cancer among specific occupational groups prone to regular medical check-ups vis-à-vis the general population have been understudied. For firefighters, a demographic subject to rigorous medical evaluations, possessing above-average medical expertise, and exposed to specific carcinogens of interest, prostate cancer survival in the US has never been studied. Methods: We conducted a retrospective study, utilizing data from the Florida Cancer Data System spanning 2004 to 2014, coupled with firefighter certification records from the Florida State Fire Marshal's Office. Our study cohort consisted of 1058 prostate cancer cases among firefighters as well as prostate cases for the Florida general population (n = 150,623). We compared cause-specific survival between the two using Cox regression models adjusted for demographics and clinical characteristics, including PSA levels, Gleason scores, and treatment modalities. Results: Firefighters demonstrated a higher five-year cause-specific survival rate (96.1%, 95% CI: 94.7-97.1%) than the general population (94.2%, 95%CI: 94.1-94.3%). Overall, firefighters' diagnoses were established at younger ages (median age 63 vs. 67 in the general population), exhibited a higher proportion of localized stage cancers (84.7% vs. 81.1%), and had a greater utilization of surgery (46.4% vs. 37.6%), a treatment modality with a high success rate but potential side effects. In multivariable analysis, firefighters displayed a survival advantage for localized stage (adjusted hazard ratio [aHR] = 0.53; 95%CI: 0.34-0.82). However, for regional or distant stages, firefighters aged 65 and above exhibited a higher risk of death (aHR = 1.84; 95% CI: 1.18-2.86) than the general population. Conclusion: Firefighters experience enhanced prostate cancer survival, primarily in cases diagnosed at localized stages, likely due to increased PSA testing. Nonetheless, for regional or distant stage, survival among older firefighters' lags behind that of the general population. Further investigations are warranted to unravel factors influencing the development of aggressive disease beyond PSA and Gleason scores in this population, as well as to assess the impact of a higher rate of surgical treatment on firefighters' quality of life.

Cancer incidence trends in New York State and associations with common population-level exposures 2010-2018: an ecological study

The impact of common environmental exposures in combinations with socioeconomic and lifestyle factors on cancer development, particularly for young adults, remains understudied. Here, we leveraged environmental and cancer incidence data collected in New York State at the county level to examine the association between 31 exposures and 10 common cancers (i.e., lung and bronchus, thyroid, colorectal, kidney and renal pelvis, melanoma, non-Hodgkin lymphoma, and leukemia for both sexes; corpus uteri and female breast cancer; prostate cancer), for three age groups (25-49, 50-69, and 70-84 year-olds). For each cancer, we stratified by age group and sex, and applied regression models to examine the associations with multiple exposures simultaneously. The models included 642,013 incident cancer cases during 2010-2018 and found risk factors consistent with previous reports (e.g., smoking and physical inactivity). Models also found positive associations between ambient air pollutants (ozone and PM2.5) and prostate cancer, female breast cancer, and melanoma of the skin across multiple population strata. Additionally, the models were able to better explain the variation in cancer incidence data among 25-49 year-olds than the two older age groups. These findings support the impact of common environmental exposures on cancer development, particularly for younger age groups.

Baseline data and associations between urinary biomarkers of polycyclic aromatic hydrocarbons, blood pressure, hemogram, and lifestyle among wildland firefighters

Introduction

Available literature has found an association between firefighting and pathologic pathways leading to cardiorespiratory diseases, which have been linked with exposure to polycyclic aromatic hydrocarbons (PAHs). PAHs are highlighted as priority pollutants by the European Human Biomonitoring Initiative in occupational and non-occupational contexts.

Methods

This cross-sectional study is the first to simultaneously characterize six creatinine-adjusted PAHs metabolites (OHPAHs) in urine, blood pressure, cardiac frequency, and hemogram parameters among wildland firefighters without occupational exposure to fire emissions (> 7 days), while exploring several variables retrieved via questionnaires.

Results

Overall, baseline levels for total OHPAHs levels were 2 to 23-times superior to the general population, whereas individual metabolites remained below the general population median range (except for 1-hydroxynaphthalene+1-hydroxyacenaphtene). Exposure to gaseous pollutants and/or particulate matter during work-shift was associated with a 3.5-fold increase in total OHPAHs levels. Firefighters who smoke presented 3-times higher total concentration of OHPAHs than non-smokers (p < 0.001); non-smoker females presented 2-fold lower total OHPAHs (p = 0.049) than males. 1-hydroxypyrene was below the recommended occupational biological exposure value (2.5 μg/L), and the metabolite of carcinogenic PAH (benzo(a)pyrene) was not detected. Blood pressure was above 120/80 mmHg in 71% of subjects. Firefighters from the permanent intervention team presented significantly increased systolic pressure than those who performed other functions (p = 0.034). Tobacco consumption was significantly associated with higher basophils (p = 0.01-0.02) and hematocrit (p = 0.03). No association between OHPAHs and blood pressure was found. OHPAHs concentrations were positively correlated with monocyte, basophils, large immune cells, atypical lymphocytes, and mean corpuscular volume, which were stronger among smokers. Nevertheless, inverse associations were observed between fluorene and pyrene metabolites with neutrophils and eosinophils, respectively, in non-smokers. Hemogram was negatively affected by overworking and lower physical activity.

Conclusion

This study suggests possible associations between urinary PAHs metabolites and health parameters in firefighters, that should be further assessed in larger groups.