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Hwang J, Peng Z, Najar FZ, Xu C, Agnew RJ, Xu X, Yang Z, Ahsan N. Urine proteome profile of firefighters with exposure to emergency fire-induced smoke: A pilot study to identify potential carcinogenic effects. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 927:172273. [PMID: 38583625 DOI: 10.1016/j.scitotenv.2024.172273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
Firefighters are frequently exposed to a variety of chemicals formed from smoke, which pose a risk for numerous diseases, including cancer. Comparative urine proteome profiling could significantly improve our understanding of the early detection of potential cancer biomarkers. In this study, for the first time, we conducted a comparative protein profile analysis of 20 urine samples collected from ten real-life firefighters prior to and following emergency fire-induced smoke. Using a label-free quantitative proteomics platform, we identified and quantified 1325 unique protein groups, of which 45 proteins showed differential expressions in abundance in response to fire-smoke exposure (post) compared to the control (pre). Pathway analysis showed proteins associated with epithelium development (e.g., RHCG, HEG1, ADAMTSL2) and Alzheimer's disease (SORL1) were significantly increased in response to smoke exposure samples. A protein-protein-network study showed a possible link between these differentially abundant proteins and the known cancer gene (TP53). Moreover, a cross-comparison analysis revealed that seven proteins-ALDH1A1, APCS, POMC, COL2A1, RDX, DDAH2, and SDC4 overlapped with the previously published urine cancer proteome datasets, suggesting a potential cancer risk. Our findings demonstrated that the discovery proteomic platform is a promising analytical technique for identifying potential non-invasive biomarkers associated with fire-smoke exposure in firefighters that may be related to cancer.
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Affiliation(s)
- Jooyeon Hwang
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX, USA; Southwest Center for Occupational and Environmental Health, University of Texas Health Science Center, Houston, TX, USA; Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
| | - Zongkai Peng
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
| | - Fares Z Najar
- High-Performance Computing Center, Oklahoma State University, Stillwater, OK, USA
| | - Chao Xu
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Robert J Agnew
- Fire Protection & Safety Engineering Technology Program, College of Engineering, Architecture and Technology, Oklahoma State University, Stillwater, OK, USA
| | - Xin Xu
- Shanghai Anti-doping Laboratory, Shanghai University of Sport, Shanghai, China
| | - Zhibo Yang
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA
| | - Nagib Ahsan
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, USA; Mass Spectrometry, Proteomics and Metabolomics Core Facility, Stephenson Life Sciences Research Center, The University of Oklahoma, Norman, OK, USA.
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Mitchell J, Hwang J, Larson P, Mandal S, Agnew RJ. Preliminary analyses of accumulation of carcinogenic contaminants on retired firefighter ensembles. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024; 21:213-219. [PMID: 38416517 DOI: 10.1080/15459624.2023.2296628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Personal protective equipment (PPE) is designed to protect firefighters from hazards encountered on the fire scene, including heat and products of combustion. Decontamination practices for firefighter turnout gear have been developed to remove combustion products and other contaminants from the fabric of structural firefighting ensembles (i.e., turnout or bunker gear). Chronic exposures to residual polycyclic aromatic hydrocarbons (PAH) are a contributing cause of firefighter cancers. To identify and quantify residual contamination of PAH, samples were taken from two individual decommissioned structural firefighting ensembles and analyzed by layer (outer canvas shell, moisture barrier, and the thermal protective liner) for (1) textile integrity via field emission scanning electron microscopy and (2) quantity of PAH contamination by high-pressure liquid chromatography with ultraviolet/fluorescence detection. The results of these analyses show the presence of the PAH compounds pyrene (35% of the total mass of PAH), phenanthrene (21%), benzo(a)pyrene (14%), and benzo(a)anthracene (14%) which present a risk for dermal absorption. The data also revealed that PAH penetration through the layers of the firefighting ensemble was strongly inhibited by the moisture barrier layer.
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Affiliation(s)
- Jake Mitchell
- Fire Protection and Safety Engineering Technology Program, Oklahoma State University, Stillwater, Oklahoma
| | - Jooyeon Hwang
- Department of Occupational and Environmental Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas
| | - Preston Larson
- Samuel Roberts Nobel Microscopy Laboratory, University of Oklahoma, Oklahoma City, Oklahoma
| | - Sumit Mandal
- Department of Design, Housing, and Merchandising, Oklahoma State University, Stillwater, Oklahoma
| | - Robert J Agnew
- Fire Protection and Safety Engineering Technology Program, Oklahoma State University, Stillwater, Oklahoma
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Bralewska K. Air pollution inside fire stations: State-of-the-art and future challenges. Int J Hyg Environ Health 2024; 255:114289. [PMID: 37976582 DOI: 10.1016/j.ijheh.2023.114289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
Firefighters are frequently exposed to products of combustion and pyrolysis. Exposure to these substances occurs not only during fires but also at fire stations, particularly where fire equipment and fire uniforms are stored after firefighting operations. The aims of this study were to review the research on the concentrations of various air pollutants in fire stations, identify the limitations and strengths of such research, identify research gaps and related future challenges, and highlight potential solutions for reducing firefighter exposure to air pollution at fire stations. A total of 32 articles published in international journals during 1987-2023 were selected for analysis. The most frequently studied pollutants in fire stations were polycyclic aromatic hydrocarbons, particulate matter, and diesel particulate matter. Research was most often conducted on changing rooms and garages. Firefighting equipment, personal protective equipment, fire trucks, and combustion tools were identified as the main sources of pollution at fire stations. Recommendations aimed at reducing the concentration of pollutants in fire stations were mainly concerned with the systematic decontamination of equipment and the introduction of ventilation solutions that would remove exhaust fumes from garages. This in-depth literature review indicates a lack of comprehensive research on the state and quality of air at fire stations. It also highlights the emerging need for more knowledge on the concentrations of air pollutants in fire stations, health exposure related to these substances, and an analysis of the effectiveness of the proposed solutions.
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Affiliation(s)
- Karolina Bralewska
- Institute of Safety Engineering, Fire University (formerly Main School of Fire Service), 52/54 Slowackiego Street, Warsaw, 01-629, Poland.
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4
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Keir JLA, Papas W, Wawrzynczak A, Aranda-Rodriguez R, Blais JM, White PA. Use of silicone wristbands to measure firefighters' exposures to polycyclic aromatic hydrocarbons (PAHs) during live fire training. ENVIRONMENTAL RESEARCH 2023; 239:117306. [PMID: 37797669 DOI: 10.1016/j.envres.2023.117306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023]
Abstract
Firefighters experience exposures to carcinogenic and mutagenic substances, including polycyclic aromatic hydrocarbons (PAHs). Silicone wristbands (SWBs) have been used as passive samplers to assess firefighters' exposures over the course of a shift but their utility in measuring short term exposures, source of exposure, and correlations with other measurements of exposure have not yet been investigated. In this study, SWBs were used to measure the concentrations of 16 priority PAHs inside and outside of firefighters' personal protective equipment (PPE) while firefighting. SWBs were placed on the wrist and jacket of 20 firefighters conducting live fire training. Correlations were made with matching data from a sister project that measured urinary concentrations of PAH metabolites and PAH concentrations from personal air samples from the same participants. Naphthalene, acenaphthylene and phenanthrene had the highest geometric mean concentrations in both jacket and wrist SWB, with 1040, 320, 180 ng/g SWB for jacket and 55.0, 4.9, and 6.0 ng/g SWB for wrist, respectively. Ratios of concentrations between the jacket and wrist SWBs were calculated as worker protection factors (WPFs) and averaged 40.1 for total PAHs and ranged from 2.8 to 214 for individual PAHs, similar to previous studies. Several significant correlations were observed between PAHs in jacket SWBs and air samples (e.g., total and low molecular weight PAHs, r = 0.55 and 0.59, p < 0.05, respectively). A few correlations were found between PAHs from SWBs worn on the wrist and jacket, and urinary concentrations of PAH metabolites and PAH concentrations in air samples. The ability of the SWBs to accurately capture exposures to various PAHs was likely influenced by short sampling time, high temperatures, and high turbulence. Future work should further examine the limitations of SWBs for PAH exposures in firefighting, and other extreme environments.
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Affiliation(s)
- Jennifer L A Keir
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, Ontario, K1N 6N5, Canada; Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, Ontario, K1A 0K9, Canada
| | - William Papas
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, Ontario, K1A 0K9, Canada
| | - Adam Wawrzynczak
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, Ontario, K1A 0K9, Canada
| | - Rocio Aranda-Rodriguez
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, Ontario, K1A 0K9, Canada.
| | - Jules M Blais
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, Ontario, K1N 6N5, Canada.
| | - Paul A White
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, Ontario, K1N 6N5, Canada; Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, Ontario, K1A 0K9, Canada
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Marjerrison N, Grimsrud TK, Hansen J, Martinsen JI, Nordby KC, Olsen R, Veierød MB, Kjærheim K. Occupational exposures of firefighting and urinary tract cancer risk among men in the Norwegian Fire Departments Cohort. Occup Environ Med 2023; 80:659-666. [PMID: 37863650 DOI: 10.1136/oemed-2023-109003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/22/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES Increased risks of bladder cancer and mesothelioma were the strongest evidence for the recent reclassification of firefighting as carcinogenic (Group 1) by the International Agency for Research on Cancer. Our study aim was to develop indicators for specific firefighting exposures and examine associations with urinary tract cancer (UTC), including bladder cancer. METHODS We developed indicators for exposure from employment at a fire department or in firefighting jobs, to fire and smoke, and to diesel exhaust for men in the Norwegian Fire Departments Cohort (n=4250). Incident UTC cases were obtained from the Cancer Registry of Norway (1960-2021). Poisson regression was used to estimate incidence rate ratios (IRR) with cumulative exposures grouped into tertiles (reference: lowest exposed tertile) with 0-year, 10-year and 15-year lagging of exposures. RESULTS During 125 090 person-years of follow-up, there were 76 cases of UTC. IRRs were mostly non-significantly increased in the middle tertile and at or below 1 in the highest tertile for total duration of employment, number of fires attended and fire exposure score with and without lags. In the middle tertile for diesel exhaust exposure, UTC risk was elevated over twofold with 10-year (IRR 2.27, 95% CI 1.22 to 4.20) and 15- year (2.21, 1.18 to 4.16) lags, and near 1 in the highest tertile. Findings for bladder cancer were similar to those for UTC. CONCLUSIONS Dose-response associations between the exposure indicators and UTC were not observed. Future studies using the indicators with more cases are needed.
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Affiliation(s)
- Niki Marjerrison
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Johnni Hansen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | | | | | - Raymond Olsen
- National Institute of Occupational Health (STAMI), Oslo, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Fernandez AR, Treichel A, Myers JB, Bourn SS, Crowe RP, Gardner B. Evaluating Firefighter On-Scene Decontamination Practices Using a National Fire Records Management System. J Occup Environ Med 2023; 65:931-936. [PMID: 37550953 PMCID: PMC10662600 DOI: 10.1097/jom.0000000000002927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE This study describes firefighters' on-scene decontamination procedure use post-working fire and frequency of adherence to best practice. METHODS This retrospective analysis of working fires was conducted using records from the ESO Data Collaborative (Austin, TX) national research database from January 1, 2021, to December 31, 2021. Documentation of decontamination procedures was examined among records with smoke or combustion products exposure. Firefighter and incident characteristics were evaluated. Descriptive statistics and univariable odds ratios were calculated. RESULTS Among the 31,281 firefighters included in the study, 8.0% documented a fire-related exposure. Of those, 82% performed at least one on-scene decontamination procedure; 5% documented all decontamination procedures defined as best practices. The odds of documenting any decontamination procedure were significantly decreased among firefighters responding to incidents in rural areas compared with urban areas (odds ratio, 0.70). CONCLUSIONS Fire personnel may not be taking all necessary decontamination steps post-working fires.
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Kling HE, Koru-Sengul T, Solle NS, Louzado-Feliciano P, Lee DJ, Kobetz EN, Caban-Martinez AJ. Weight Status and Binge Drinking Among Male and Female Florida Firefighters. J Occup Environ Med 2023; 65:e565-e570. [PMID: 37253243 PMCID: PMC10524551 DOI: 10.1097/jom.0000000000002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of the study is to examine the association between weight status and binge drinking among Florida firefighters. METHODS Health survey data collected between 2015 and 2019 among Florida firefighters participating in the Annual Cancer Survey were analyzed for weight class (healthy, overweight, obese) and binge-drinking behaviors. Binary logistic regression models were fit and stratified by sex while controlling for sociodemographic and health characteristics. RESULTS Among 4002 firefighter participants, 45.1% binge drink, 50.9% are overweight, and 31.3% are obese. Among male firefighters, being overweight (adjusted odds ratio = 1.34; 95% confidence interval = 1.10-1.64) or obese (1.29; 1.04-1.61) was significantly associated with binge drinking compared with healthy weight counterparts. In female firefighters, being obese (2.25; 1.21-4.22) was significantly associated with binge drinking but being overweight was not. CONCLUSIONS Being overweight or obese is selectively associated with binge drinking among male and female firefighters.
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Affiliation(s)
- Hannah E. Kling
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Natasha Schaefer Solle
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Medicine and University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Paola Louzado-Feliciano
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - David J. Lee
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Erin N. Kobetz
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Medicine and University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
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8
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DeBono NL, Daniels RD, Beane Freeman LE, Graber JM, Hansen J, Teras LR, Driscoll T, Kjaerheim K, Demers PA, Glass DC, Kriebel D, Kirkham TL, Wedekind R, Filho AM, Stayner L, Schubauer-Berigan MK. Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification. Saf Health Work 2023; 14:141-152. [PMID: 37389311 PMCID: PMC10300491 DOI: 10.1016/j.shaw.2023.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Objective We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARCMonographs program. Methods A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses. Results Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14-2.20, 8%) for mesothelioma, 1.16 (1.08-1.26, 0%) for bladder cancer, 1.21 (1.12-1.32, 81%) for prostate cancer, 1.37 (1.03-1.82, 56%) for testicular cancer, 1.19 (1.07-1.32, 37%) for colon cancer, 1.36 (1.15-1.62, 83%) for melanoma, 1.12 (1.01-1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02-1.61, 40%) for thyroid cancer, and 1.09 (0.92-1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses. Conclusions There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.
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Affiliation(s)
- Nathan L. DeBono
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, USA
| | - Laura E. Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Judith M. Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, USA
| | - Johnni Hansen
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | | | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Deborah C. Glass
- School of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - David Kriebel
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, USA
| | - Tracy L. Kirkham
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Roland Wedekind
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Adalberto M. Filho
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Leslie Stayner
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics
| | - Mary K. Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
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Singh A, Zeig-Owens R, Cannon M, Webber MP, Goldfarb DG, Daniels RD, Prezant DJ, Boffetta P, Hall CB. All-cause and cause-specific mortality in a cohort of WTC-exposed and non-WTC-exposed firefighters. Occup Environ Med 2023; 80:297-303. [PMID: 36972975 PMCID: PMC10523283 DOI: 10.1136/oemed-2022-108703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To compare mortality rates in World Trade Center (WTC)-exposed Fire Department of the City of New York (FDNY) firefighters with rates in similarly healthy, non-WTC-exposed/non-FDNY firefighters, and compare mortality in each firefighter cohort with the general population. METHODS 10 786 male WTC-exposed FDNY firefighters and 8813 male non-WTC-exposed firefighters from other urban fire departments who were employed on 11 September 2001 were included in the analyses. Only WTC-exposed firefighters received health monitoring via the WTC Health Programme (WTCHP). Follow-up began 11 September 2001 and ended at the earlier of death date or 31 December 2016. Death data were obtained from the National Death Index and demographics from the fire departments. We estimated standardised mortality ratios (SMRs) in each firefighter cohort versus US males using demographic-specific US mortality rates. Poisson regression models estimated relative rates (RRs) of all-cause and cause-specific mortality in WTC-exposed versus non-WTC-exposed firefighters, controlling for age and race. RESULTS Between 11 September 2001 and 31 December 2016, there were 261 deaths among WTC-exposed firefighters and 605 among non-WTC-exposed. Both cohorts had reduced all-cause mortality compared with US males (SMR (95% CI)=0.30 (0.26 to 0.34) and 0.60 (0.55 to 0.65) in WTC-exposed and non-WTC-exposed, respectively). WTC-exposed firefighters also had lower rates of all-cause mortality (RR=0.54, 95% CI=0.49 to 0.59) and cancer-specific, cardiovascular-specific and respiratory disease-specific mortality compared with non-WTC-exposed firefighters. CONCLUSION Both firefighter cohorts had lower than expected all-cause mortality. Fifteen years post 11 September 2001, mortality was lower in WTC-exposed versus non-WTC-exposed firefighters. Lower mortality in the WTC-exposed suggests not just a healthy worker effect, but additional factors such as greater access to free health monitoring and treatment that they receive via the WTCHP.
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Affiliation(s)
- Ankura Singh
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Madeline Cannon
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David G Goldfarb
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Robert D Daniels
- Division of Science integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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10
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Bessa MJ, Sarmento B, Oliveira M, Rodrigues F. In vitro data for fire pollutants: contribution of studies using human cell models towards firefighters' occupational. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2023; 26:238-255. [PMID: 36883725 DOI: 10.1080/10937404.2023.2187909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Firefighters are the principal line of defense against fires, being at elevated risk of exposure to health-relevant pollutants released during fires and burning processes. Although many biomonitoring studies exist, only a limited number of human in vitro investigations in fire risk assessment are currently available. In vitro studies stand out as valuable tools to assess the toxicity mechanisms involved following exposure to fire pollutants at a cellular level. The aim of the present review was to contextualize existing in vitro studies using human cell models exposed to chemicals emitted from fire emissions and wood smoke and discuss the implications of the observed toxic outcomes on adverse health effects detected in firefighters. Most of the reported in vitro investigations focused on monocultures respiratory models and exposure to particulate matter (PM) extracts collected from fire effluents. Overall, (1) a decrease in cellular viability, (2) enhanced oxidative stress, (3) increased pro-inflammatory cytokines levels and (4) elevated cell death frequencies were noted. However, limited information remains regarding the toxicity mechanisms initiated by firefighting activities. Hence, more studies employing advanced in vitro models and exposure systems using human cell lines are urgently needed taking into consideration different routes of exposure and health-related pollutants released from fires. Data are needed to establish and define firefighters' occupational exposure limits and to propose mitigation strategies to promote beneficial human health.
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Affiliation(s)
- Maria João Bessa
- UNIPRO - Unidade de Investigação em Patologia e Reabilitação Oral, Instituto Universitário de Ciências da Saúde (IUCS), CESPU, Gandra, Portugal
| | - Bruno Sarmento
- UNIPRO - Unidade de Investigação em Patologia e Reabilitação Oral, Instituto Universitário de Ciências da Saúde (IUCS), CESPU, Gandra, Portugal
- i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- INEB - Institute of Biomedical Engineering, University of Porto, Porto, Portugal
| | - Marta Oliveira
- REQUIMTE/LAQV, ISEP, Polytechnique of Porto, Porto, Portugal
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11
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Lee DJ, Ahn S, McClure LA, Caban-Martinez AJ, Kobetz EN, Ukani H, Boga DJ, Hernandez D, Pinheiro PS. Cancer risk and mortality among firefighters: a meta-analytic review. Front Oncol 2023; 13:1130754. [PMID: 37251928 PMCID: PMC10213433 DOI: 10.3389/fonc.2023.1130754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Firefighting is a hazardous occupation that is associated with an increased risk of select cancers. The number of studies has grown in recent years allowing for a synthesis of findings. Methods Following PRISMA guidelines, multiple electronic databases were searched to identify studies on firefighter cancer risk and mortality. We computed pooled standardized incidence risk (SIRE) and standardized mortality estimates (SMRE), tested for publication bias, and conducted moderator analyses. Results Thirty-eight studies published between 1978 and March 2022 were included for final meta-analysis. Overall, cancer incidence and mortality were significantly lower for firefighters (SIRE = 0.93; 95% CI: 0.91-0.95; SMRE = 0.93; 95% CI: 0.92 - 0.95) compared to the general population. Incident cancer risks were significantly higher for skin melanoma (SIRE = 1.14; 95% CI:1.08 - 1.21), other skin cancers (SIRE = 1.24; 95% CI:1.16-1.32), and prostate cancer (SIRE = 1.09; 95% CI: 1.04-1.14). Firefighters showed higher mortality for rectum (SMRE = 1.18; 95% CI: 1.02-1.36), testis (SMRE = 1.64; 95% CI: 1.00-2.67), and non-Hodgkin lymphoma (SMRE = 1.20; 95% CI: 1.02-1.40). There was evidence of publication bias for SIRE and SMRE estimates. Some moderators explained variations in study effects, including study quality scores. Conclusion Firefighters are at higher risk for several cancers; to the extent that some (e.g., melanoma and prostate) are screening amenable, more study into firefighter-specific recommendations for cancer surveillance is needed. Moreover, longitudinal studies with more detailed data on the specific length and types of exposures are necessary, as well as on unstudied subtypes of cancers (e.g., subtypes of brain cancer and leukemias) are needed.
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Affiliation(s)
- David J. Lee
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Soyeon Ahn
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, Miami, FL, United States
| | - Laura A. McClure
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Alberto J. Caban-Martinez
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
- Department of Physical Medicine and Rehabilitation, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Erin N. Kobetz
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
- Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Henna Ukani
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Devina J. Boga
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Diana Hernandez
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Paulo S. Pinheiro
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
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12
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Hwang J, Chong NS, Zhang M, Agnew RJ, Xu C, Li Z, Xu X. Face-to-face with scorching wildfire: potential toxicant exposure and the health risks of smoke for wildland firefighters at the wildland-urban interface. LANCET REGIONAL HEALTH. AMERICAS 2023; 21:100482. [PMID: 37008196 PMCID: PMC10060103 DOI: 10.1016/j.lana.2023.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
As wildfire risks have elevated due to climate change, the health risks that toxicants from fire smoke pose to wildland firefighters have been exacerbated. Recently, the International Agency for Research on Cancer (IARC) has reclassified wildland firefighters' occupational exposure as carcinogenic to humans (Group 1). Wildfire smoke contributes to an increased risk of cancer and cardiovascular disease, yet wildland firefighters have inadequate respiratory protection. The economic cost of wildland fires has risen concurrently, as illustrated by the appropriation of $45 billion for wildfire management over FYs 2011-2020 by the U.S. Congress. Occupational epidemiological studies of wildland firefighters are crucial for minimizing health risks; however, they must account for the mixture of exposures in wildfire smoke. This review focuses on four aspects of wildland firefighters' health risks at the wildland-urban interface: 1) economic costs and health impact, 2) respiratory protection, 3) multipollutant mixtures, and 4) proactive management of wildfires.
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Affiliation(s)
- Jooyeon Hwang
- Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA
| | - Ngee-Sing Chong
- Department of Chemistry, Middle Tennessee State University, Murfreesboro, TN 37132, USA
| | - Mengliang Zhang
- Department of Chemistry, Middle Tennessee State University, Murfreesboro, TN 37132, USA
| | - Robert J. Agnew
- Fire Protection & Safety Engineering Technology Program, College of Engineering, Architecture and Technology, Oklahoma State University, Stillwater, OK 74078, USA
| | - Chao Xu
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Zhuangjie Li
- Department of Chemistry and Biochemistry, California State University at Fullerton, Fullerton, CA 92831, USA
| | - Xin Xu
- Shanghai Anti-doping Laboratory, Shanghai University of Sport, Shanghai 200438, China
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13
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Sidossis A, Lan FY, Hershey MS, Hadkhale K, Kales SN. Cancer and Potential Prevention with Lifestyle among Career Firefighters: A Narrative Review. Cancers (Basel) 2023; 15:cancers15092442. [PMID: 37173909 PMCID: PMC10177420 DOI: 10.3390/cancers15092442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Career firefighters are at considerable risk for chronic diseases, including an increased risk of various cancers, compared to the general population. Over the last two decades, several systematic reviews and large cohort studies have demonstrated that firefighters have statistically significant increases in overall and site-specific cancer incidence and site-specific cancer mortality compared to the general population. Exposure assessment and other studies have documented exposures to a variety of carcinogens in fire smoke and within the fire station. Other occupational factors such as shift work, sedentary behavior, and the fire service food culture may also contribute to this working population's increased cancer risk. Furthermore, obesity and other lifestyle behaviors such as tobacco use, excessive alcohol consumption, poor diet, inadequate physical activity, and short sleep duration have also been associated with an increased risk of certain firefighting-associated cancers. Putative prevention strategies are proposed based on suspected occupational and lifestyle risk factors.
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Affiliation(s)
- Amalia Sidossis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Occupational Medicine, Department of Family Medicine, National Yang Ming Chiao Tung University Hospital, Yilan 260, Taiwan
| | - Maria S Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
| | - Kishor Hadkhale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
- Faculty of Social Sciences Health Sciences (Epidemiology), Tampere University, 33100 Tampere, Finland
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
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14
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Goldfarb DG, Prezant DJ, Zeig-Owens R, Schwartz T, Liu Y, Kavouras IG. Development of a job-exposure matrix (JEM) for exposure to smoke particle mass among firefighters of the Fire Department of the City of New York (FDNY). Occup Environ Med 2023; 80:104-110. [PMID: 36635097 DOI: 10.1136/oemed-2022-108549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES A refined job exposure matrix (JEM) based on incident types and severities and response characteristics was developed for firefighters to estimate quantities of smoke particles emitted during structural and non-structural fire incidents from 2010 to 2021. METHODS The cohort included a subset of 3237 Fire Department of the City of New York firefighters who responded to at least one incident between 2010 and 2021, prior to retirement. Fire incident data included dates, type, severity (alarm level) and location. Response data included dates worked, firehouse, position titles and shift lengths for each firefighter. The quantity of smoke particle mass generated during structural and non-structural fires adjusted by individual firefighter engagement was computed using the United States Environmental Protection Agency AP-42 emissions framework. Correlations between years of employment, fire responses and career total particle mass concentration by firefighter were examined. Linear regression models were fit and corresponding R2 values were calculated. RESULTS Firefighters responded to a median of 424.7 (IQR=202.3-620.0) annual incidents/person; 17.6% were fire incidents (median=77.1; IQR=40.4-114.0). Structural fires were the most common type of fire incident (72.5% of annual incidents/person; median=55.9; IQR=29.6-85.5). Incident severity (alarm level) and firefighter engagement (position title) appeared to differentiate between high and low exposure regimes (R2=0.43). Incident severity explained most of the variability of particle exposures (R2=0.90). CONCLUSIONS Using the JEM, job-related smoke particle concentrations were estimated to vary by incident type, incident severity and firefighter engagement, highlighting the importance of using refined measures, so that future studies can more accurately evaluate associations between firefighting and health outcomes.
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Affiliation(s)
- David G Goldfarb
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA .,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA.,Department of Medicine, Montefiore Medical Center, Brooklyn, New York, USA
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA.,Department of Medicine, Montefiore Medical Center, Brooklyn, New York, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Theresa Schwartz
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA.,Department of Medicine, Montefiore Medical Center, Brooklyn, New York, USA
| | - Yang Liu
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Ilias G Kavouras
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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15
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Kunz KR, Turcotte K, Pawer S, Zheng A, Purewal A, Wellar A, Karmali S, Garis L, Thomas LS, Pike I. Cancer in female firefighters: The clinicobiological, psychological, and social perspectives. Front Public Health 2023; 11:1126066. [PMID: 37124817 PMCID: PMC10130581 DOI: 10.3389/fpubh.2023.1126066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives This study explored how demographic characteristics, life experiences, and firefighting exposures have an impact on cancer among female firefighters, and described the types and biologic characteristics of cancers as reported by women in the fire service. Methods The online survey was available from June 2019 to July 2020. Questions related to demographic characteristics, lifestyle factors, firefighting exposures, and cancer diagnoses. Descriptive analyses characterized variables by the presence or absence of cancer. Qualitative data provided insight into both firefighting and cancer experiences among women. Results There were 1,344 female firefighter respondents from 12 different countries, 256 of whom provided information on their cancer diagnosis. North American respondents made up 92% of the total. Those with cancer were older, had been in the fire service longer, had more career fires and toxic exposures, and were less likely to still be in active service. They also reported more tobacco use, and more full-term pregnancies. There were no differences in family history of cancer between the two groups. The average age at diagnosis was 39.0 years. The major types of cancer reported included breast (25.4%), cervical (21.1%), melanoma (20.7%), base cell/skin (16.4%), and uterine (14.8%). The cancer was detected when seeking medical attention for symptoms (42.1%), during routine health screening (29.8%), and during specific cancer screening (28.1%). The stage of cancer was reported by 44.5%, and 30.9% included the histopathological grade. Treatments included surgery (72.7%), chemotherapy (14.8%), radiotherapy (13.7%), and observation (13.7%). Challenges associated with cancer included psychosocial (33.2%), financial (18.8%), physical (6.6%), and spiritual (6.3%). Concerns about reporting a cancer experience to their employer included the desire to keep health information private (11.3%), a feeling of vulnerability (7.4%), and being perceived as weak (7.0%). Lack of support from their employer or insurer was also noted. Conclusion Female firefighters experienced a wide variety of different types of cancers which may come earlier than similar cancers in the public. These findings can help inform resource allocation, the development of new policies, and the need for broader presumptive coverage to support female firefighters diagnosed with cancer.
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Affiliation(s)
| | - Kate Turcotte
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- *Correspondence: Kate Turcotte,
| | - Samantha Pawer
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Alex Zheng
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Amanat Purewal
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Alyssa Wellar
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Shazya Karmali
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Len Garis
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- School of Culture, Media, and Society, University of the Fraser Valley, Abbotsford, BC, Canada
| | | | - Ian Pike
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
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16
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Horn GP, Stakes K, Neumann DL, Madrzykowski D, Fent KW. Exposure Risks and Potential Control Measures for a Fire Behavior Lab Training Structure: Part B. Chemical Gas Concentrations. FIRE TECHNOLOGY 2023; 59:3255-3282. [PMID: 38650825 PMCID: PMC11034741 DOI: 10.1007/s10694-023-01447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/09/2023] [Indexed: 04/25/2024]
Abstract
Firefighters' or instructors' exposure to airborne chemicals during live-fire training may depend on fuels being burned, fuel orientation and participants' location within the structure. This study was designed to evaluate the impact of different control measures on exposure risk to combustion byproducts during fire dynamics training where fuel packages are mounted at or near the ceiling. These measures included substitution of training fuels (low density wood fiberboard, oriented strand board (OSB), pallets, particle board, plywood) and adoption of engineering controls such as changing the location of the instructor and students using the structure. Experiments were conducted for two different training durations: the typical six ventilation cycle (6-cycle) and a shorter three ventilation cycle (3-cycle) with a subset of training fuels. In Part A of this series, we characterized the fire dynamics within the structure, including the ability of each fuel to provide an environment that achieves the training objectives. Here, in Part B, airborne chemical concentrations are reported at the location where fire instructors would typically be operating. We hypothesized that utilizing a training fuel package with solid wood pallets would result in lower concentrations of airborne contaminants at the rear instructor location than wood-based sheet products containing additional resins and/or waxes. In the 6-cycle experiments (at the rear instructor location), OSB-fueled fires produced the highest median concentrations of benzene and 1,3 butadiene, plywood-fueled fires produced the highest total polycyclic aromatic hydrocarbon (PAH) concentrations, particle board-fueled fires produced the highest methyl isocyanate concentrations, and pallet-fueled fires produced the highest hydrogen chloride concentrations. All fuels other than particle board produced similarly high levels of formaldehyde at the rear instructor location. The OSB fuel package created the most consistent fire dynamics over 6-cycles, while fiberboard resulted in consistent fire dynamics only for the first three cycles. In the follow-on 3-cycle experiment, PAH, benzene, and aldehyde concentrations were similar for the OSB and fiberboard-fueled fires. Air sampling did not identify any clear differences between training fires from burning solid wood pallets and those that incorporate wood-based sheet products for this commonly employed fuel arrangement with fuels mounted high in the compartment. However, it was found that exposure can be reduced by moving firefighters and instructors lower in the compartment and/or by moving the instructor in charge of ventilation from the rear of the structure (where highest concentrations were consistently measured) to an outside position.
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Affiliation(s)
- Gavin P Horn
- Fire Safety Research Institute, UL Research Institutes, 6200 Old Dobbin Lane, Suite 150, Columbia, MD, 21045, USA
| | - Keith Stakes
- Fire Safety Research Institute, UL Research Institutes, 6200 Old Dobbin Lane, Suite 150, Columbia, MD, 21045, USA
| | - Danielle L Neumann
- Asset and Sustainability Performance, UL Solutions, Lake Forest, CA, USA
| | - Daniel Madrzykowski
- Fire Safety Research Institute, UL Research Institutes, 6200 Old Dobbin Lane, Suite 150, Columbia, MD, 21045, USA
| | - Kenneth W Fent
- National Institute for Occupational Safety & Health, Cincinnati, OH, USA
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17
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Schaefer Solle N, Legros A, Jackson R, Rangan A, Beaver CC, Kling H, Khan F, Koru-Sengul T, Penedo FJ, Caban-Martinez AJ, Kobetz EN. Understanding Cancer Survivorship among Firefighters: A Mixed-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:257. [PMID: 36612579 PMCID: PMC9819887 DOI: 10.3390/ijerph20010257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Firefighters are exposed to a unique set of carcinogens through their work environment that predispose them to several cancers, yet there is limited research related to cancer survivorship amongst this occupational group. METHODS A mixed-method approach was used to assess cancer survivorship amongst firefighters. Four focus groups and one in-depth interview were conducted with 29 active and retired firefighters who have been diagnosed with cancer to understand the experiences and challenges associated with cancer survivorship in the fire service and desired resources. Qualitative data were analyzed using Nvivo software. All participants completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey to assess their quality of life. RESULTS The primary themes that emerged from the focus groups included managing health and well-being changes, navigating support systems in place, and accessing new resources. FACT-G scores (mean ± standard deviation) of the firefighter cancer survivor sample demonstrate relatively lower levels of emotional well-being (19.26 ± 4.67) and higher quality of life in the physical well-being (23.67 ± 5.08), social well-being (23.38 ± 4.16), and functional well-being (22.6 ± 4.966) domains. CONCLUSIONS Firefighters requested curated resources, such as support groups and department training resources, supporting the need for more cancer survivorship resources specific to firefighters.
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Affiliation(s)
- Natasha Schaefer Solle
- Departments of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Amy Legros
- Departments of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Rachael Jackson
- Departments of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Apoorva Rangan
- Departments of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Cynthia Campos Beaver
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Hannah Kling
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Fatima Khan
- Departments of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Tulay Koru-Sengul
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Frank J. Penedo
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Psychology, University of Miami, Coral Gables, FL 33146, USA
| | - Alberto J. Caban-Martinez
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Erin N. Kobetz
- Departments of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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18
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Pinkerton LE, Bertke S, Dahm MM, Kubale TL, Siegel MR, Hales TR, Yiin JH, Purdue MP, Beaumont JJ, Daniels RD. End-stage renal disease incidence in a cohort of US firefighters from San Francisco, Chicago, and Philadelphia. Am J Ind Med 2022; 65:975-984. [PMID: 36268894 PMCID: PMC9828160 DOI: 10.1002/ajim.23435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Firefighters perform strenuous work in hot environments, which may increase their risk of chronic kidney disease. The purpose of this study was to evaluate the risk of end-stage renal disease (ESRD) and types of ESRD among a cohort of US firefighters compared to the US general population, and to examine exposure-response relationships. METHODS ESRD from 1977 through 2014 was identified through linkage with Medicare data. ESRD incidence in the cohort compared to the US population was evaluated using life table analyses. Associations of all ESRD, systemic ESRD, hypertensive ESRD, and diabetic ESRD with exposure surrogates (exposed days, fire runs, and fire hours) were examined in Cox proportional hazards models adjusted for attained age (the time scale), race, birth date, fire department, and employment duration. RESULTS The incidence of all ESRD was less than expected (standardized incidence ratio (SIR) = 0.79; 95% confidence interval = 0.69-0.89, observed = 247). SIRs for ESRD types were not significantly increased. Positive associations of all ESRD, systemic ESRD, and hypertensive ESRD with exposed days were observed: however, 95% confidence intervals included one. CONCLUSIONS We found little evidence of increased risk of ESRD among this cohort of firefighters. Limitations included the inability to evaluate exposure-response relationships for some ESRD types due to small observed numbers, the limitations of the surrogates of exposure, and the lack of information on more sensitive outcome measures for potential kidney effects.
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Affiliation(s)
- Lynne E. Pinkerton
- MaximusMcLeanVirginiaUSA,Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Stephen Bertke
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Matthew M. Dahm
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Travis L. Kubale
- World Trade Center Health ProgramNational Institute for Occupational Safety and HealthWashingtonDistrict of ColumbiaUSA
| | - Miriam R. Siegel
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Thomas R. Hales
- Division of Safety ResearchNational Institute for Occupational Safety and HealthDenverColoradoUSA
| | - James H. Yiin
- Office of Extramural ProgramsNational Institute for Occupational Safety and HealthAtlantaGeorgiaUSA
| | - Mark P. Purdue
- Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - James J. Beaumont
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
| | - Robert D. Daniels
- World Trade Center Health ProgramNational Institute for Occupational Safety and HealthWashingtonDistrict of ColumbiaUSA
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19
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Kim JA, Song SY, Jeong W, Jun JK. Non-cancer health risks in firefighters: a systematic review. Epidemiol Health 2022; 44:e2022109. [PMID: 36397239 PMCID: PMC10396521 DOI: 10.4178/epih.e2022109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/16/2022] [Indexed: 08/04/2023] Open
Abstract
osFirefighters are occupationally exposed to hazardous factors that may increase their risk of disease. However, non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed to identify non-cancer disease risk in firefighters and determine whether the risk differs according to job characteristics. We searched the Cochrane Library, Embase, PubMed, and KoreaMed databases using relevant keywords from their inception to April 30, 2021. The Risk of Bias Assessment Tool for Non-randomized Studies version 2.0 was used to assess the quality of evidence. Due to study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2,491 studies, of which 66 met the selection and quality criteria. We confirmed that the healthy worker effect is strong in firefighters as compared to the general population. We also identified a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder (PTSD) in firefighters compared to other occupational groups. Contradictory results for the risk of PTSD and anxiety disorders related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and PTSD was available. The risk of non-cancer diseases varied depending on job type, years of service, and rank. However, caution should be exercised when interpreting the results because the classification criteria for firefighters' jobs and ranks differ by country.
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Affiliation(s)
- Jeong Ah Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Wonjeong Jeong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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Joe MJ, Hatsu IE, Tefft A, Mok S, Adetona O. Dietary Behavior and Diet Interventions among Structural Firefighters: A Narrative Review. Nutrients 2022; 14:nu14214662. [PMID: 36364927 PMCID: PMC9653630 DOI: 10.3390/nu14214662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Structural firefighters (SFFs) are exposed to multiple occupational hazards that affect dietary behavior and can contribute to increased risks of cancer and cardiovascular disease compared to the United States’ general population. Dietary behavior is a feasible modification for positive health outcomes. The objectives of this narrative review are to summarize the diet behavior of SFFs, review findings of diet interventions that positively modify diet behavior, identify research gaps, and suggest recommendations for addressing those gaps. PubMed, MEDLINE, Scopus, and CABI Web of Science were searched between February 2020 and June 2022 for peer-reviewed articles. The inclusion criteria were as follows: (1) study population must include SFFs; (2) investigate diet or diet intervention among SFFs; (3) report results specific to SFFs; and (4) be published in the English language. Thirty-four studies were included. Results indicate that SFFs recognize the importance of a healthy dietary pattern, but do not follow one, and that food choices are often influenced by colleagues. Diet interventions, such as the Mediterranean diet, were observed to have positive health improvements, such as improved lipid levels and lower CVD risk. Team counseling was found to be more effective for adopting healthier diets compared to one-on-one counseling; and general counseling was more effective than no counseling. A gap identified by this review is the lack of information concerning differences in dietary intake, diet quality, and dietary behaviors while on- and off-shift, and throughout the career. Diet is an important risk factor for occupational disease development; therefore, effective, consistent dietary interventions are necessary.
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Affiliation(s)
- Margaux J. Joe
- Department of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Irene E. Hatsu
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
- OSU Extension, The Ohio State University, Columbus, OH 43210, USA
| | - Ally Tefft
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Sarah Mok
- Department of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Olorunfemi Adetona
- Department of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
- Correspondence:
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Orysiak J, Młynarczyk M, Piec R, Jakubiak A. Lifestyle and environmental factors may induce airway and systemic inflammation in firefighters. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:73741-73768. [PMID: 36094704 PMCID: PMC9465149 DOI: 10.1007/s11356-022-22479-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
Health status depends on multiple genetic and non-genetic factors. Nonheritable factors (such as lifestyle and environmental factors) have stronger impact on immune responses than genetic factors. Firefighters work is associated with exposure to air pollution and heat stress, as well as: extreme physical effort, mental stress, or a changed circadian rhythm, among others. All these factors can contribute to both, short-term and long-term impairment of the physical and mental health of firefighters. Increased levels of some inflammatory markers, such as pro-inflammatory cytokines or C-reactive protein (CRP) have been observed in firefighters, which can lead to local, acute inflammation that promotes a systemic inflammatory response. It is worth emphasizing that inflammation is one of the main hallmarks of cancer and also plays a key role in the development of cardiovascular and respiratory diseases. This article presents possible causes of the development of an inflammatory reaction in firefighters, with particular emphasis on airway inflammation caused by smoke exposure.
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Affiliation(s)
- Joanna Orysiak
- Central Institute for Labour Protection - National Research Institute, Czerniakowska St. 16, 00-701, Warsaw, Poland.
| | - Magdalena Młynarczyk
- Central Institute for Labour Protection - National Research Institute, Czerniakowska St. 16, 00-701, Warsaw, Poland
| | - Robert Piec
- Institute of Internal Security, The Main School of Fire Service, Słowackiego St. 52/54, 01-629, Warsaw, Poland
| | - Agnieszka Jakubiak
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Żwirki and Wigury St. 61, 02-091, Warsaw, Poland
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22
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Horn GP, Fent KW, Kerber S, Smith DL. Hierarchy of contamination control in the fire service: Review of exposure control options to reduce cancer risk. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:538-557. [PMID: 35853136 PMCID: PMC9928012 DOI: 10.1080/15459624.2022.2100406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The international fire service community is actively engaged in a wide range of activities focused on development, testing, and implementation of effective approaches to reduce exposure to contaminants and the related cancer risk. However, these activities are often viewed independent of each other and in the absence of the larger overall effort of occupational health risk mitigation. This narrative review synthesizes the current research on fire service contamination control in the context of the National Institute for Occupational Safety and Health (NIOSH) Hierarchy of Controls, a framework that supports decision making around implementing feasible and effective control solutions in occupational settings. Using this approach, we identify evidence-based measures that have been investigated and that can be implemented to protect firefighters during an emergency response, in the fire apparatus and at the fire station, and identify several knowledge gaps that remain. While a great deal of research and development has been focused on improving personal protective equipment for the various risks faced by the fire service, these measures are considered less effective. Administrative and engineering controls that can be used during and after the firefight have also received increased research interest in recent years. However, less research and development have been focused on higher level control measures such as engineering, substitution, and elimination, which may be the most effective, but are challenging to implement. A comprehensive approach that considers each level of control and how it can be implemented, and that is mindful of the need to balance contamination risk reduction against the fire service mission to save lives and protect property, is likely to be the most effective.
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Affiliation(s)
- Gavin P Horn
- Fire Safety Research Institute, UL Research Institutes, Columbia, Maryland
- Illinois Fire Service Institute, Champaign, Illinois
| | - Kenneth W Fent
- National Institute for Occupational Safety & Health, Cincinnati, Ohio
| | - Steve Kerber
- Fire Safety Research Institute, UL Research Institutes, Columbia, Maryland
| | - Denise L Smith
- Illinois Fire Service Institute, Champaign, Illinois
- Skidmore College, Saratoga Springs, New York
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Characteristics of Hazardous Substances Extracted from Laundry Water for Fire Protection Suit Exposed to Fire. WATER 2022. [DOI: 10.3390/w14152383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
(1) Background: It is well known that various toxic substances, including carcinogens, are generated at the fire scenes, so it is very important for firefighters to wear comprehensive personal protective equipment. The extent of the type and amount of harmful substances contained in the washing water of fire protection suits (FPS) exposed to fire scenes have not yet been confirmed. The purpose of this study is to evaluate the characteristics of harmful substances contained in wash water extracted from FPSs exposed to fire. (2) Methods: The study design was a simulation-based experimental study. To evaluate the degree of contamination exposure of FPSs, 10 sets of fire suits were classified into four groups as follows: newly supplied, field use, one fire exposure, and two consecutive fire exposures. In the experimental environment, after exposing three to four groups of FPSs to residential fire conditions. they were sealed in a plastic bag in the experimental space. The washing water for FPSs was extracted through manual washing in the order of Groups 1 to 4, and 24 items were analyzed according to the water pollution process test standards. (3) Results: According to the results of the FPS laundry analysis, the concentration of acrylonitrile in laundry was higher when exposed to fire twice than when exposed to fire once. Moreover, there was a dose–response relationship, and the risk of cumulative toxicity was shown. Naphthalene and diethylhexyl phthalate (DEHP) were detected to be high in the washing water of Group 3 FPSs exposed to incomplete combustion fire. Of the 24 items that were analyzed for in the water, four item exceeded the standard for sewage discharge facilities in accordance with the Water Environment Conservation Act. Copper and its compounds exceeded the standards by 3.4 times, antimony 4.8 times, acrylonitrile 26.0 times, and DEHP 4.1 times, respectively. (4) Conclusions: Therefore, when removing FPSs after firefighting activities, care should be taken to avoid contaminating the skin. In addition, facilities that wash FPS that have been exposed to a fire scene must have a sewage treatment and purification facility. However, if emergency decontamination of FPSs is conducted at the fire scene, the concentration of toxic substances contained in laundry can be reduced. In the case of large-scale fire, there is a risk of water pollution near the fire scene, so it is necessary to prepare a national countermeasure. The results of this study can be applied to the revision of regulations related to the building of the fire departments, reduction of water pollution, and water environment policy.
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Demers PA, DeMarini DM, Fent KW, Glass DC, Hansen J, Adetona O, Andersen MH, Freeman LEB, Caban-Martinez AJ, Daniels RD, Driscoll TR, Goodrich JM, Graber JM, Kirkham TL, Kjaerheim K, Kriebel D, Long AS, Main LC, Oliveira M, Peters S, Teras LR, Watkins ER, Burgess JL, Stec AA, White PA, DeBono NL, Benbrahim-Tallaa L, de Conti A, El Ghissassi F, Grosse Y, Stayner LT, Suonio E, Viegas S, Wedekind R, Boucheron P, Hosseini B, Kim J, Zahed H, Mattock H, Madia F, Schubauer-Berigan MK. Carcinogenicity of occupational exposure as a firefighter. Lancet Oncol 2022; 23:985-986. [PMID: 35780778 DOI: 10.1016/s1470-2045(22)00390-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Paul A Demers
- International Agency for Research on Cancer, Lyon, France
| | | | - Kenneth W Fent
- International Agency for Research on Cancer, Lyon, France
| | | | - Johnni Hansen
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | - David Kriebel
- International Agency for Research on Cancer, Lyon, France
| | | | - Luana C Main
- International Agency for Research on Cancer, Lyon, France
| | - Marta Oliveira
- International Agency for Research on Cancer, Lyon, France
| | - Susan Peters
- International Agency for Research on Cancer, Lyon, France
| | - Lauren R Teras
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Anna A Stec
- International Agency for Research on Cancer, Lyon, France
| | - Paul A White
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Aline de Conti
- International Agency for Research on Cancer, Lyon, France
| | | | - Yann Grosse
- International Agency for Research on Cancer, Lyon, France
| | | | - Eero Suonio
- International Agency for Research on Cancer, Lyon, France
| | - Susana Viegas
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Bayan Hosseini
- International Agency for Research on Cancer, Lyon, France
| | - Joanne Kim
- International Agency for Research on Cancer, Lyon, France
| | - Hana Zahed
- International Agency for Research on Cancer, Lyon, France
| | - Heidi Mattock
- International Agency for Research on Cancer, Lyon, France
| | - Federica Madia
- International Agency for Research on Cancer, Lyon, France
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Fent KW, Mayer AC, Toennis C, Sammons D, Robertson S, Chen IC, Bhandari D, Blount BC, Kerber S, Smith DL, Horn GP. Firefighters' urinary concentrations of VOC metabolites after controlled-residential and training fire responses. Int J Hyg Environ Health 2022; 242:113969. [PMID: 35421664 PMCID: PMC9969558 DOI: 10.1016/j.ijheh.2022.113969] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Firefighters are exposed to volatile organic compounds (VOCs) during structural fire responses and training fires, several of which (e.g., benzene, acrolein, styrene) are known or probable carcinogens. Exposure studies have found that firefighters can absorb chemicals like benzene even when self-contained breathing apparatus (SCBA) are worn, suggesting that dermal absorption contributes to potentially harmful exposures. However, few studies have characterized VOC metabolites in urine from firefighters. OBJECTIVES We quantified VOC metabolites in firefighters' urine following live firefighting activity across two field studies. METHODS In two separate controlled field studies, spot urine was collected before and 3 h after firefighters and firefighter students responded to simulated residential and training fires. Urine was also collected from instructors from the training fire study before the first and 3 h after the last training scenario for each day (instructors led three training scenarios per day). Samples were analyzed for metabolites of VOCs to which firefighters may be exposed. RESULTS In the residential fire study, urinary metabolites of xylenes (2MHA), toluene (BzMA), and styrene (MADA) increased significantly (at 0.05 level) from pre- to post-fire. In the training fire study, MADA concentrations increased significantly from pre- to post-fire for both firefighter students and instructors. Urinary concentrations of benzene metabolites (MUCA and PhMA) increased significantly from pre- to post-fire for instructors, while metabolites of xylenes (3MHA+4MHA) and acrolein (3HPMA) increased significantly for firefighter students. The two highest MUCA concentrations measured post-shift from instructors exceeded the BEI of 500 μg/g creatinine. CONCLUSIONS Some of the metabolites that were significantly elevated post-fire are known or probable human carcinogens (benzene, styrene, acrolein); thus, exposure to these compounds should be eliminated or reduced as much as possible through the hierarchy of controls. Given stringent use of SCBA, it appears that dermal exposure contributes in part to the levels measured here.
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Affiliation(s)
- Kenneth W. Fent
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - Alexander C. Mayer
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | | | - Deborah Sammons
- Health Effects Laboratory Division, NIOSH, CDC, Cincinnati, OH, USA
| | | | - I-Chen Chen
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - Deepak Bhandari
- Division of Laboratory Sciences, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Benjamin C. Blount
- Division of Laboratory Sciences, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Steve Kerber
- Fire Safety Research Institute, Underwriters Laboratories Inc, Columbia, MD, USA
| | - Denise L. Smith
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA, Illinois Fire Service Institute, University of Illinois at Urbana-Champaign, IL, USA
| | - Gavin P. Horn
- Fire Safety Research Institute, Underwriters Laboratories Inc, Columbia, MD, USA, Illinois Fire Service Institute, University of Illinois at Urbana-Champaign, IL, USA
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Impact of Firefighting Aqueous Film-Forming Foams on Human Cell Proliferation and Cellular Mortality. J Occup Environ Med 2022; 64:e340-e344. [DOI: 10.1097/jom.0000000000002527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Pohl H, Mumtaz M. Evaluation of interactions in chemical mixtures containing cyanides. Regul Toxicol Pharmacol 2022; 132:105187. [DOI: 10.1016/j.yrtph.2022.105187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/26/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
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Using Collaborative Partnerships to Engage Firefighters in Rural Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042009. [PMID: 35206197 PMCID: PMC8871703 DOI: 10.3390/ijerph19042009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to utilize community-based participatory research (CBPR) methods to identify behaviors that may increase the exposure rates of firefighters to carcinogens and other occupational hazards. Key informant interviews and focus groups were conducted as part of a larger study that included exposure assessments at fire stations, in fire engines, and in personal vehicles. A purposive sample of five fire chiefs and leaders of the firefighter association was chosen, and these individuals were selected to participate in interviews. Unstructured interviews explored issues related to firefighter exposures and occupational hazards. Three focus groups were conducted over a three-month period. Following the focus groups, survey questions emphasizing the following three aspects of firefighting were developed: exposure to airborne smoke contaminants during fire suppression, accumulated exposure on turnout gear after fire suppression, and exposure to airborne contaminants at the fire departments. The use of community-based participatory research can be very beneficial, especially when conducting research with a group that may be hard to reach or have misgivings regarding researchers. By utilizing this approach in the current study, researchers were able to partner with a community that may be hard to reach and gain buy-in from community leadership.
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Rajnoveanu AG, Rajnoveanu RM, Motoc NS, Postolache P, Gusetu G, Man MA. COPD in Firefighters: A Specific Event-Related Condition Rather than a Common Occupational Respiratory Disorder. Medicina (B Aires) 2022; 58:medicina58020239. [PMID: 35208563 PMCID: PMC8878660 DOI: 10.3390/medicina58020239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Smoking remains the most important risk factor, but occupational exposures may play an essential role as well. Firefighters are among occupations regularly exposed to a variety of irritative inhalational products, and they may be expected to develop respiratory health problems because of such an occupational exposure. To better understand and characterize this relationship, we performed an extensive search of the scientific literature, and we identified two major research areas: firefighters exposed to wildland fire smoke and firefighters involved in the World Trade Centre disaster-related operations. Most of the studies did not report a significant increase in COPD diagnosis in firefighters. An accelerated rate of decline in lung function was seen, a short time after major exposure events. This is the reason for an increased rate of exacerbations observed in individuals already diagnosed with obstructive respiratory disorders. A limited number of studies not covering these specific circumstances of exposure were found. They reported long-term morbidity and mortality data, and the results are controversial. Major confounding factors for most of the studies were the “healthy worker effect” and the lack of useful data regarding smoking habits. Efforts should be made in the future to better characterize specific biomarkers for the progression of COPD; to establish exposure limits; and to implement preventive strategies like rotation of workers, smoking cessation programs, and long-term monitoring programs for respiratory disorders.
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Affiliation(s)
- Armand-Gabriel Rajnoveanu
- Occupational Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Ruxandra-Mioara Rajnoveanu
- Palliative Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-742-029662
| | - Nicoleta Stefania Motoc
- Pneumology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (N.S.M.); (M.A.M.)
| | - Paraschiva Postolache
- Medical Department, Gr T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Gabriel Gusetu
- Cardiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Milena Adina Man
- Pneumology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (N.S.M.); (M.A.M.)
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30
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Solle NS, Santiago KM, Feliciano PL, Calkins MM, Fent K, Jahnke S, Parks N, Buren H, Grant C, Burgess JL, Caban-Martinez AJ. Perceptions of Work-Related Health and Cancer Risks Among Women Firefighters: A Qualitative Study. J Occup Environ Med 2021; 63:e846-e852. [PMID: 34538836 PMCID: PMC8814999 DOI: 10.1097/jom.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We use a qualitative method to gain further insight into women firefighters' experiences, perceptions of cancer, health, and safety risks in the fire service. METHODS We conducted six focus groups with U.S. women firefighters. Participants engaged in a 60 to 75-minute, semi-structured discussion and completed a sociodemographic questionnaire. A qualitative descriptive approach was used to inductively create themes. Data collection concluded when saturation was met. RESULTS Forty-nine women firefighters participated. Qualitative results indicated the main health concerns include: occupational cancer risks including, risks related to hazardous exposures, sleep disruption and stress; and women's health concerns including, cancer, pregnancy and breastfeeding, and lack of resources. CONCLUSIONS Women firefighters are concerned about their risk for cancer due to their occupation and identify a lack of resources specific to health and safety needs of women firefighters.
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Affiliation(s)
- Natasha Schaefer Solle
- Department of Medicine, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
| | - Katerina M. Santiago
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
| | - Paola Louzado Feliciano
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
| | - Miriam M. Calkins
- Division of Field Studies and Engineering (DFSE), National Institute for Occupational Safety and Health, Cincinnati OH 45226, USA
| | - Kenny Fent
- Division of Field Studies and Engineering (DFSE), National Institute for Occupational Safety and Health, Cincinnati OH 45226, USA
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, Leawood, KS, USA
| | | | | | - Casey Grant
- Fire Protection Research Foundation, Quincy, MA 02169, USA
| | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
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Dirand J, Rieunier F, Testa F, Temime L. Évaluation des bénéfices potentiels liés à l’utilisation d’un brouillard d’eau basse pression dans la lutte contre les incendies chez les sapeurs-pompiers de Paris, à partir d’une évaluation quantitative des risques. ARCH MAL PROF ENVIRO 2021. [DOI: 10.1016/j.admp.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Webber MP, Singh A, Zeig-Owens R, Salako J, Skerker M, Hall CB, Goldfarb DG, Jaber N, Daniels RD, Prezant DJ. Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the US adult male population: 2001-2016. Occup Environ Med 2021; 78:707-714. [PMID: 34507965 PMCID: PMC8458058 DOI: 10.1136/oemed-2021-107570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare cancer incidence in Fire Department of the City of New York (FDNY) firefighters who worked at the World Trade Center (WTC) site to incidence in a population of non-WTC-exposed firefighters, the Career Firefighter Health Study (CFHS) cohort, and to compare rates from each firefighter cohort to rates in demographically similar US males. METHODS FDNY (N=10 786) and CFHS (N=8813) cohorts included male firefighters who were active on 11 September 2001 (9/11) and were followed until death or 31 December 2016. Cases were identified from 15 state cancer registries. Poisson regression models assessed cancers in each group (FDNY and CFHS) versus US males, and associations between group and cancer rates; these models estimated standardised incidence ratios (SIRs) and adjusted relative rates (RRs), respectively. Secondary analyses assessed surveillance bias and smoking history. RESULTS We identified 915 cancer cases in 841 FDNY firefighters and 1002 cases in 909 CFHS firefighters. FDNY had: higher rates for all cancers (RR=1.13; 95% CI 1.02 to 1.25), prostate (RR=1.39; 95% CI 1.19 to 1.63) and thyroid cancer (RR=2.53; 95% CI 1.37 to 4.70); younger median ages at diagnosis (55.6 vs 59.4; p<0.001, all cancers); and more cases with localised disease when compared with CFHS. Compared with US males, both firefighter cohorts had elevated SIRs for prostate cancer and melanoma. Control for surveillance bias in FDNY reduced most differences. CONCLUSIONS Excess cancers occurred in WTC-exposed firefighters relative to each comparison group, which may partially be explained by heightened surveillance. Two decades post-9/11, clearer understanding of WTC-related risk requires extended follow-up and modelling studies (laboratory or animal based) to identify workplace exposures in all firefighters.
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Affiliation(s)
- Mayris P Webber
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Ankura Singh
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joke Salako
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Molly Skerker
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - David G Goldfarb
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Robert D Daniels
- World Trade Center Health Program, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - David J Prezant
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Mayer AC, Fent KW, Chen IC, Sammons D, Toennis C, Robertson S, Kerber S, Horn GP, Smith DL, Calafat AM, Ospina M, Sjodin A. Characterizing exposures to flame retardants, dioxins, and furans among firefighters responding to controlled residential fires. Int J Hyg Environ Health 2021; 236:113782. [PMID: 34119852 PMCID: PMC8325627 DOI: 10.1016/j.ijheh.2021.113782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 01/14/2023]
Abstract
Firefighters may encounter items containing flame retardants (FRs), including organophosphate flame retardants (OPFRs) and polybrominated diphenyl ethers (PBDEs), during structure fires. This study utilized biological monitoring to characterize FR exposures in 36 firefighters assigned to interior, exterior, and overhaul job assignments, before and after responding to controlled residential fire scenarios. Firefighters provided four urine samples (pre-fire and 3-h, 6-h, and 12-h post-fire) and two serum samples (pre-fire and approximately 23-h post-fire). Urine samples were analyzed for OPFR metabolites, while serum samples were analyzed for PBDEs, brominated and chlorinated furans, and chlorinated dioxins. Urinary concentrations of diphenyl phosphate (DPhP), a metabolite of triphenyl phosphate (TPhP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), a metabolite of tris(1,3-dichloro-2-propyl) phosphate (TDCPP), and bis(2-chloroethyl) phosphate (BCEtP), a metabolite of tris(2-chloroethyl) phosphate (TCEP), increased from pre-fire to 3-hr and 6-hr post-fire collection, but only the DPhP increase was statistically significant at a 0.05 level. The 3-hr and 6-hr post-fire concentrations of DPhP and BDCPP, as well as the pre-fire concentration of BDCPP, were statistically significantly higher than general population levels. BDCPP pre-fire concentrations were statistically significantly higher in firefighters who previously participated in a scenario (within the past 12 days) than those who were responding to their first scenario as part of the study. Similarly, firefighters previously assigned to interior job assignments had higher pre-fire concentrations of BDCPP than those previously assigned to exterior job assignments. Pre-fire serum concentrations of 2,3,4,7,8-pentachlorodibenzofuran (23478-PeCDF), a known human carcinogen, were also statistically significantly above the general population levels. Of the PBDEs quantified, only decabromodiphenyl ether (BDE-209) pre- and post-fire serum concentrations were statistically significantly higher than the general population. These results suggest firefighters absorbed certain FRs while responding to fire scenarios.
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Affiliation(s)
- Alexander C Mayer
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA.
| | - Kenneth W Fent
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - I-Chen Chen
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - Deborah Sammons
- Health Effects Laboratory Division, NIOSH, CDC, Cincinnati, OH, USA
| | | | | | - Steve Kerber
- Firefighter Safety Research Institute, Underwriters Laboratories, Columbia, MD, USA
| | - Gavin P Horn
- Firefighter Safety Research Institute, Underwriters Laboratories, Columbia, MD, USA; Illinois Fire Service Institute, University of Illinois at Urbana-Champaign, IL, USA
| | - Denise L Smith
- Skidmore College, Saratoga Springs, NY, USA; Illinois Fire Service Institute, University of Illinois at Urbana-Champaign, IL, USA
| | - Antonia M Calafat
- Division of Laboratory Services, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Maria Ospina
- Division of Laboratory Services, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Andreas Sjodin
- Division of Laboratory Services, National Center for Environmental Health, CDC, Atlanta, GA, USA
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Firefighting-Associated Cancers: Can Increased Physical Activity and Improved Cardiorespiratory Fitness Be Potential Countermeasures? J Occup Environ Med 2021; 63:e392-e394. [PMID: 33840756 DOI: 10.1097/jom.0000000000002217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Kesler RM, Mayer A, Fent KW, Chen IC, Deaton AS, Ormond RB, Smith DL, Wilkinson A, Kerber S, Horn GP. Effects of firefighting hood design, laundering and doffing on smoke protection, heat stress and wearability. ERGONOMICS 2021; 64:755-767. [PMID: 33393449 PMCID: PMC9066276 DOI: 10.1080/00140139.2020.1867241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/15/2020] [Indexed: 06/02/2023]
Abstract
Firefighter hoods must provide protection from elevated temperatures and products of combustion (e.g. particulate) while simultaneously being wearable (comfortable and not interfering with firefighting activities). The purpose of this study was to quantify the impact of (1) hood design (traditional knit hood vs particulate-blocking hood), (2) repeated laundering, and (3) hood removal method (traditional vs overhead doffing) on (a) protection from soot contamination on the neck, (b) heat stress and (c) wearability measures. Using a fireground exposure simulator, 24 firefighters performed firefighting activities in realistic smoke and heat conditions using a new knit hood, new particulate-blocking hood and laundered particulate-blocking hood. Overall, soot contamination levels measured from neck skin were lower when wearing the laundered particulate-blocking hoods compared to new knit hoods, and when using the overhead hood removal process. No significant differences in skin temperature, core temperature, heart rate or wearability measures were found between the hood conditions. Practitioner Summary: The addition of a particulate-blocking layer to firefighters' traditional two-ply hood was found to reduce the PAH contamination reaching the neck but did not affect heat stress measurements or thermal perceptions. Modifying the process for hood removal resulted in a larger reduction in neck skin contamination than design modification. Abbreviations: ANOVA: analysis of variance; B: new particulate-blocking hood and PPE (PPE configuration); FES: fireground exposure simulator; GI: gastrointestinal; K: new knit hood and PPE (PPE configuration); L: laundered particulate-blocking hood and PPE (PPE configuration); LOD: limit of detection; MLE: maximum likelihood estimation; NFPA: National fire protection association; PAH: polycyclic aromatic hydrocarbon; PPE: personal protective equipment; SCBA: self-contained breathing apparatus; THL: total heat loss; TPP: thermal protective performance.
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Affiliation(s)
- Richard M. Kesler
- University of Illinois, Fire Service Institute; Urbana-Champaign, IL, USA
| | - Alex Mayer
- National Institute for Occupational Safety & Health; Cincinnati, OH, USA
| | - Kenneth W. Fent
- National Institute for Occupational Safety & Health; Cincinnati, OH, USA
| | - I-Chen Chen
- National Institute for Occupational Safety & Health; Cincinnati, OH, USA
| | | | | | - Denise L. Smith
- University of Illinois, Fire Service Institute; Urbana-Champaign, IL, USA
- Skidmore College; Saratoga Springs, NY, USA
| | - Andrea Wilkinson
- National Institute for Occupational Safety & Health; Cincinnati, OH, USA
- Skidmore College; Saratoga Springs, NY, USA
| | - Steve Kerber
- Underwriters Laboratories Firefighter Safety Research Institute; Columbia, MD, USA
| | - Gavin P. Horn
- University of Illinois, Fire Service Institute; Urbana-Champaign, IL, USA
- Underwriters Laboratories Firefighter Safety Research Institute; Columbia, MD, USA
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36
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Colbeth HL, Zeig-Owens R, Hall CB, Webber MP, Schwartz TM, Prezant DJ. Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6266. [PMID: 32872174 PMCID: PMC7504578 DOI: 10.3390/ijerph17176266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
The World Trade Center (WTC) attacks on 9/11/2001 have consistently been associated with elevated rates of physical and mental health morbidities, while evidence about mortality has been limited. We examined mortality between 9/12/2001 and 12/31/2017 among 15,431 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical service providers (EMS), specifically assessing associations between intensity of WTC-exposure and mortality risk. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) compared FDNY cohort mortality with the US general population using life table analysis. Deaths were identified via linkage to the National Death Index. Cox proportional hazards regression models were used to identify associations between intensity of WTC-exposure and mortality, accounting for age, sex, race/ethnicity, smoking history, and other relevant confounders. We identified 546 deaths and a lower than expected all-cause mortality rate (SMR = 0.34; 95% CI, 0.31–0.37). No cause-specific SMRs were meaningfully elevated. Mortality hazard ratios showed no association or linear trend with level of WTC-exposure. Our results provide evidence of the healthy worker effect, despite exposure to the World Trade Center. More follow-up time may be needed to assess the full impact of WTC-exposure on mortality in this occupational population.
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Affiliation(s)
- Hilary L. Colbeth
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Mayris P. Webber
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
- Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, New York, NY 10467, USA
| | - Theresa M. Schwartz
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, NY 10467, USA
| | - David J. Prezant
- Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA; (H.L.C.); (M.P.W.); (T.M.S.); (D.J.P.)
- Department of Medicine, Pulmonology Division, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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37
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Objective Measurement of Carcinogens Among Dominican Republic Firefighters Using Silicone-Based Wristbands. J Occup Environ Med 2020; 62:e611-e615. [DOI: 10.1097/jom.0000000000002006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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38
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Horn GP, Kerber S, Fent KW, Smith DL. Management of Firefighters' Chemical & Cardiovascular Exposure Risks on the Fireground. INTERNATIONAL FIRE SERVICE JOURNAL OF LEADERSHIP AND MANAGEMENT 2020; 14:7-16. [PMID: 35673618 PMCID: PMC9169513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The fire service research community around the world has focused substantial resources on reducing firefighter risk for sudden cardiac events and chemical exposures that may lead to cancer. Research presented here summarizes important lessons learned from a full-scale residential Fire Study that allowed quantification of the risks as well as the effectiveness of interventions to reduce those risks. To address fireground exposure concerns, personal protective equipment (PPE) and administrative controls exist. But, these controls are not always straightforward to apply. Leadership and management concerns with ongoing implementation of these controls are introduced and opportunities for change management are discussed. While research provides a solid basis upon which to institute policy and practice, fireground leadership and management is critical to ensure appropriate implementation.
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Affiliation(s)
- Gavin P Horn
- UL Firefighter Safety Research Institute, Columbia, MD and University of Illinois, Fire Service Institute, Urbana-Champaign, IL
| | - Steve Kerber
- UL Firefighter Safety Research Institute, Columbia, MD
| | - Kenneth W Fent
- National Institute for Occupational Safety & Health, Cincinnati, OH
| | - Denise L Smith
- University of Illinois, Fire Service Institute, Urbana-Champaign, IL and Skidmore College, First Responder Health and Safety Laboratory, Saratoga Springs, NY
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