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Jung AM, Furlong MA, Goodrich JM, Cardenas A, Beitel SC, Littau SR, Caban-Martinez AJ, Gulotta JJ, Wallentine DD, Urwin D, Gabriel J, Hughes J, Graber JM, Grant C, Burgess JL. Associations Between Epigenetic Age Acceleration and microRNA Expression Among U.S. Firefighters. Epigenet Insights 2023; 16:25168657231206301. [PMID: 37953967 PMCID: PMC10634256 DOI: 10.1177/25168657231206301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/20/2023] [Indexed: 11/14/2023] Open
Abstract
Epigenetic changes may be biomarkers of health. Epigenetic age acceleration (EAA), the discrepancy between epigenetic age measured via epigenetic clocks and chronological age, is associated with morbidity and mortality. However, the intersection of epigenetic clocks with microRNAs (miRNAs) and corresponding miRNA-based health implications have not been evaluated. We analyzed DNA methylation and miRNA profiles from blood sampled among 332 individuals enrolled across 2 U.S.-based firefighter occupational studies (2015-2018 and 2018-2020). We considered 7 measures of EAA in leukocytes (PhenoAge, GrimAge, Horvath, skin-blood, and Hannum epigenetic clocks, and extrinsic and intrinsic epigenetic age acceleration). We identified miRNAs associated with EAA using individual linear regression models, adjusted for sex, race/ethnicity, chronological age, and cell type estimates, and investigated downstream effects of associated miRNAs with miRNA enrichment analyses and genomic annotations. On average, participants were 38 years old, 88% male, and 75% non-Hispanic white. We identified 183 of 798 miRNAs associated with EAA (FDR q < 0.05); 126 with PhenoAge, 59 with GrimAge, 1 with Horvath, and 1 with the skin-blood clock. Among miRNAs associated with Horvath and GrimAge, there were 61 significantly enriched disease annotations including age-related metabolic and cardiovascular conditions and several cancers. Enriched pathways included those related to proteins and protein modification. We identified miRNAs associated with EAA of multiple epigenetic clocks. PhenoAge had more associations with individual miRNAs, but GrimAge and Horvath had greater implications for miRNA-associated pathways. Understanding the relationship between these epigenetic markers could contribute to our understanding of the molecular underpinnings of aging and aging-related diseases.
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Affiliation(s)
- Alesia M Jung
- Department of Community, Environment & Policy, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Department of Pharmacology & Toxicology, R. Ken Coit College of Pharmacy, College of Public Health, Tucson, AZ, USA
| | - Melissa A Furlong
- Department of Community, Environment & Policy, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Jaclyn M Goodrich
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Andres Cardenas
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Shawn C Beitel
- Department of Community, Environment & Policy, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Sally R Littau
- Department of Community, Environment & Policy, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | | | - Derek Urwin
- Los Angeles County Fire Department, Los Angeles, CA, USA
- Department of Chemistry & Biochemistry, University of California Los Angeles, Los Angeles, CA, USA
- Division of Health Safety and Medicine, International Association of Fire Fighters, Washington, DC, USA
| | - Jamie Gabriel
- Los Angeles County Fire Department, Los Angeles, CA, USA
| | | | - Judith M Graber
- Department of Biostatistics & Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Casey Grant
- Fire Protection Research Foundation, Quincy, MA, USA
| | - Jefferey L Burgess
- Department of Community, Environment & Policy, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Jung AM, Beitel SC, Gutenkunst SL, Billheimer D, Jahnke SA, Littau SR, White M, Hoppe-Jones C, Cherrington NJ, Burgess JL. Excretion of polybrominated diphenyl ethers and AhR activation in breastmilk among firefighters. Toxicol Sci 2023; 192:kfad017. [PMID: 36856729 PMCID: PMC10109531 DOI: 10.1093/toxsci/kfad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Excretion of toxicants accumulated from firefighter exposures through breastmilk represents a potential hazard. We investigated if firefighting exposures could increase the concentration of polybrominated diphenyl ethers (PBDEs) and aryl hydrocarbon receptor (AhR) activation in excreted breastmilk. Firefighters and non-firefighters collected breastmilk samples prior to any firefighting responses (baseline) and at 2, 8, 24, 48, and 72 hours after a structural fire (firefighters only). Five PBDE analytes (BDEs 15, 28, 47, 99, and 153) detected in at least 90% of samples were summed for analyses. The AhR in vitro DR CALUX® bioassay assessed the mixture of dioxin-like compounds and toxicity from breastmilk extracts. Baseline PBDEs and AhR response were compared between firefighters and non-firefighters. Separate linear mixed models assessed changes in sum of PBDEs and AhR response among firefighters over time and effect modification by interior or exterior response was assessed. Baseline PBDE concentrations and AhR responses did not differ between the 21 firefighters and 10 non-firefighters. There were no significant changes in sum of PBDEs or AhR response among firefighters over time post-fire, and no variation by interior or exterior response. Plots of sum of PBDEs and AhR response over time demonstrated individual variation but no consistent pattern. Currently, our novel study results do not support forgoing breastfeeding after a fire exposure. However, given study limitations and the potential hazard of accumulated toxicants from firefighter exposures excreted via breastfeeding, future studies should consider additional contaminants and measures of toxicity by which firefighting may impact maternal and child health.
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Affiliation(s)
- Alesia M Jung
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724, USA
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724, USA
| | - Shawn C Beitel
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724, USA
| | - Shannon L Gutenkunst
- Statistics Consulting Lab, BIO5 Institute, University of Arizona, Tucson, Arizona 85721, USA
- Southwest Environmental Health Sciences Center, University of Arizona, Tucson, Arizona 85721, USA
| | - Dean Billheimer
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724, USA
- Statistics Consulting Lab, BIO5 Institute, University of Arizona, Tucson, Arizona 85721, USA
- Southwest Environmental Health Sciences Center, University of Arizona, Tucson, Arizona 85721, USA
| | - Sara A Jahnke
- Center for Fire, Rescue, & EMS Health Research, NDRI-USA, Leawood, Kansas 66224, USA
| | - Sally R Littau
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724, USA
| | - Mandie White
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724, USA
| | | | - Nathan J Cherrington
- Southwest Environmental Health Sciences Center, University of Arizona, Tucson, Arizona 85721, USA
- Department of Pharmacology and Toxicology, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, Arizona 85721, USA
| | - Jefferey L Burgess
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724, USA
- Southwest Environmental Health Sciences Center, University of Arizona, Tucson, Arizona 85721, USA
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Jung AM, Jahnke SA, Dennis LK, Bell ML, Burgess JL, Farland LV. Firefighter occupational factors and the risk of preterm birth: results from a survey of women firefighters in the USA. Occup Environ Med 2023; 80:77-85. [PMID: 36564180 PMCID: PMC9887375 DOI: 10.1136/oemed-2022-108332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/17/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Previous research has suggested that women firefighters may have a greater risk of adverse reproductive outcomes compared with non-firefighting women. In this study, we investigated the association between firefighter occupational factors and risk of preterm birth. METHODS This cross-sectional analysis of US firefighters surveyed in 2017 compared preterm birth among firefighters to non-firefighters using age-at-pregnancy-standardised prevalence ratios. Generalised estimating equations estimated relative risks and 95% CIs between firefighter occupational factors (career or volunteer, wildland status, shift schedule, fire responses, work restriction) and preterm birth risk. We adjusted for age-at-pregnancy, education, gravidity, BMI, and smoking and considered effect modification by age-at-pregnancy and career versus volunteer status. RESULTS Among 934 women who reported 1356 live births, 12% were preterm (n=161). Preterm birth prevalence among firefighters was 1.41 times greater than non-firefighters (95% CI 1.18 to 1.68). Among wildland and combination wildland/structural firefighters, volunteers had 2.82 times the risk of preterm birth (95% CI 1.19 to 6.67) compared with career firefighters. Firefighters who started restricting their work in the 2nd trimester had a nonsignificant 0.67 times lower risk of preterm birth than those who started in the 3rd trimester or did not restrict work at all (95% CI 0.43 to 1.03). CONCLUSIONS Firefighters may have greater risk of preterm birth than non-firefighters, which could be influenced by roles in the fire service and work restrictions taken.
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Affiliation(s)
- Alesia M Jung
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA .,Department of Community, Environment and Policy, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Sara A Jahnke
- Center for Fire Rescue and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
| | - Leslie K Dennis
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Jefferey L Burgess
- Department of Community, Environment and Policy, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA,Department of Obstetrics and Gynecology, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
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Goodrich JM, Jung AM, Furlong MA, Beitel S, Littau S, Gulotta J, Wallentine D, Burgess JL. Repeat measures of DNA methylation in an inception cohort of firefighters. Occup Environ Med 2022; 79:656-663. [PMID: 35332072 PMCID: PMC9484361 DOI: 10.1136/oemed-2021-108153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Firefighters face exposures associated with adverse health outcomes including risk for multiple cancers. DNA methylation, one type of epigenetic regulation, provides a potential mechanism linking occupational hazards to adverse health outcomes. We hypothesised that DNA methylation profiles would change in firefighters after starting their service and that these patterns would be associated with occupational exposures (cumulative fire-hours and fire-runs). METHODS We profiled DNA methylation with the Infinium MethylationEPIC in blood leucocytes at two time points in non-smoking new recruits: prior to live fire training and 20-37 months later. Linear mixed effects models adjusted for potential confounders were used to identify differentially methylated CpG sites over time using data from 50 individuals passing all quality control. RESULTS We report 680 CpG sites with altered methylation (q value <0.05) including 60 with at least a 5% methylation difference at follow-up. Genes with differentially methylated CpG sites were enriched in biological pathways related to cancers, neurological function, cell signalling and transcription regulation. Next, linear mixed effects models were used to determine associations between occupational exposures with methylation at the 680 loci. Of these, more CpG sites were associated with fire-runs (108 for all and 78 for structure-fires only, q<0.05) than with fire-hours (27 for all fires and 1 for structure fires). These associations were independent of time since most recent fire, suggesting an impact of cumulative exposures. CONCLUSIONS Overall, this study provides evidence that DNA methylation may be altered by fireground exposures, and the impact of this change on disease development should be evaluated.
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Affiliation(s)
- Jaclyn M Goodrich
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alesia M Jung
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Melissa A Furlong
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Shawn Beitel
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Sally Littau
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | | | | | - Jefferey L Burgess
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
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Burgess JL, Fisher JM, Nematollahi A, Jung AM, Calkins MM, Graber JM, Grant CC, Beitel SC, Littau SR, Gulotta JJ, Wallentine DD, Hughes RJ, Popp C, Calafat AM, Botelho JC, Coleman AD, Schaefer-Solle N, Louzado-Feliciano P, Oduwole SO, Caban-Martinez AJ. Serum per- and polyfluoroalkyl substance concentrations in four municipal US fire departments. Am J Ind Med 2022; 66:411-423. [PMID: 35864570 PMCID: PMC9859935 DOI: 10.1002/ajim.23413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/05/2022] [Accepted: 07/08/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Firefighters have occupational and environmental exposures to per- and polyfluoroalkyl substances (PFAS). The goal of this study was to compare serum PFAS concentrations across multiple United States fire departments to National Health and Nutrition Examination Survey (NHANES) participants. METHODS Nine serum PFAS were compared in 290 firefighters from four municipal fire departments (coded A-D) and three NHANES participants matched to each firefighter on sex, ethnicity, age, and PFAS collection year. Only Departments A and C had sufficient women study participants (25 and six, respectively) to compare with NHANES. RESULTS In male firefighters compared with NHANES, geometric mean perfluorohexane sulfonate (PFHxS) was elevated in Departments A-C, sum of branched perfluoromethylheptane sulfonate isomers (Sm-PFOS) was elevated in all four departments, linear perfluorooctane sulfonate (n-PFOS) was elevated in Departments B and C, linear perfluorooctanoate (n-PFOA) was elevated in Departments B-D, and perfluorononanoate (PFNA) was elevated in Departments B-D, but lower in A. In male firefighters compared with NHANES, perfluoroundecanoate (PFUnDA) was more frequently detected in Departments B and D, and 2-(N-methyl-perfluorooctane sulfonamido) acetate (MeFOSAA) was less frequently detected in Departments B-D. In female firefighters compared with NHANES, PFHxS and Sm-PFOS concentrations were elevated in Departments A and C. Other PFAS concentrations were elevated and/or reduced in only one department or not significantly different from NHANES in any department. CONCLUSIONS Serum PFHxS, Sm-PFOS, n-PFOS, n-PFOA, and PFNA concentrations were increased in at least two of four fire departments in comparison to NHANES.
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Affiliation(s)
- Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Julia M. Fisher
- Statistics Consulting Laboratory, BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Amy Nematollahi
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Alesia M. Jung
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Miriam M. Calkins
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Judith M. Graber
- Rutgers the State University of New Jersey, Piscataway, New Jersey, USA
| | - Casey C. Grant
- D&S Research Associates & Engineers, LLC, Belmont, Massachusetts, USA
| | - Shawn C. Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Sally R. Littau
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | | | | | - Charles Popp
- Boston Fire Department, Boston, Massachusetts, USA
| | - Antonia M. Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julianne C. Botelho
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alissa D. Coleman
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | | | - Simi O. Oduwole
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
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Davidson S, Jahnke S, Jung AM, Burgess JL, Jacobs ET, Billheimer D, Farland LV. Anti-Müllerian Hormone Levels among Female Firefighters. Int J Environ Res Public Health 2022; 19:5981. [PMID: 35627519 PMCID: PMC9141260 DOI: 10.3390/ijerph19105981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023]
Abstract
Female firefighters have occupational exposures which may negatively impact their reproductive health. Anti-müllerian hormone (AMH) is a clinical marker of ovarian reserve. We investigated whether AMH levels differed in female firefighters compared to non-firefighters and whether there was a dose-dependent relationship between years of firefighting and AMH levels. Female firefighters from a pre-existing cohort completed a cross-sectional survey regarding their occupational and health history and were asked to recruit a non-firefighter friend or relative. All participants provided a dried blood spot (DBS) for AMH analysis. Linear regression was used to assess the relationship between firefighting status and AMH levels. Among firefighters, the influence of firefighting-related exposures was evaluated. Firefighters (n = 106) and non-firefighters (n = 58) had similar age and BMI. Firefighters had a lower mean AMH compared to non-firefighters (2.93 ng/mL vs. 4.37 ng/mL). In multivariable adjusted models, firefighters had a 33% lower AMH value than non-firefighters (-33.38%∆ (95% CI: -54.97, -1.43)). Years of firefighting was not associated with a decrease in AMH. Firefighters in this study had lower AMH levels than non-firefighters. More research is needed to understand the mechanisms by which firefighting could reduce AMH and affect fertility.
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Affiliation(s)
- Samantha Davidson
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA;
| | - Alesia M. Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Jefferey L. Burgess
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Dean Billheimer
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
- Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85724, USA
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Jung AM, Jahnke SA, Dennis LK, Bell ML, Burgess JL, Jitnarin N, Kaipust CM, Farland LV. Occupational factors and miscarriages in the US fire service: a cross-sectional analysis of women firefighters. Environ Health 2021; 20:116. [PMID: 34749749 PMCID: PMC8573857 DOI: 10.1186/s12940-021-00800-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence from previous studies suggests that women firefighters have greater risk of some adverse reproductive outcomes. The purpose of this study was to investigate whether women firefighters had greater risk of miscarriage compared to non-firefighters and whether there were occupational factors associated with risk of miscarriage among firefighters. METHODS We studied pregnancies in the United States fire service using data from the Health and Wellness of Women Firefighters Study (n = 3181). We compared the prevalence of miscarriage among firefighters to published rates among non-firefighters using age-standardized prevalence ratios. We used generalized estimating equations to estimate relative risks (RRs) and 95% confidence intervals (CIs) between occupational factors (employment (career/volunteer), wildland firefighter status (wildland or wildland-urban-interface/structural), shift schedule, fire/rescue calls at pregnancy start) and risk of miscarriage, adjusted for age at pregnancy, education, gravidity, BMI, and smoking. We evaluated if associations varied by age at pregnancy or employment. RESULTS Among 1074 firefighters and 1864 total pregnancies, 404 pregnancies resulted in miscarriages (22%). Among most recent pregnancies, 138 resulted in miscarriage (13%). Compared to a study of US nurses, firefighters had 2.33 times greater age-standardized prevalence of miscarriage (95% CI 1.96-2.75). Overall, we observed that volunteer firefighters had an increased risk of miscarriage which varied by wildland status (interaction p-value< 0.01). Among structural firefighters, volunteer firefighters had 1.42 times the risk of miscarriage (95% CI 1.11-1.80) compared to career firefighters. Among wildland/wildland-urban-interface firefighters, volunteer firefighters had 2.53 times the risk of miscarriage (95% CI 1.35-4.78) compared to career firefighters. CONCLUSIONS Age-standardized miscarriage prevalence among firefighters may be greater than non-firefighters and there may be variation in risk of miscarriage by fire service role. Further research is needed to clarify these associations to inform policy and decision-making.
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Affiliation(s)
- Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
| | - Sara A Jahnke
- Center for Fire, Rescue, & EMS Health Research, NDRI-USA, Leawood, KS, USA
| | - Leslie K Dennis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Jefferey L Burgess
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Nattinee Jitnarin
- Center for Fire, Rescue, & EMS Health Research, NDRI-USA, Leawood, KS, USA
| | | | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
- Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, AZ, USA
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Goodrich JM, Calkins MM, Caban-Martinez AJ, Stueckle T, Grant C, Calafat AM, Nematollahi A, Jung AM, Graber JM, Jenkins T, Slitt AL, Dewald A, Botelho JC, Beitel S, Littau S, Gulotta J, Wallentine D, Hughes J, Popp C, Burgess JL. Per- and polyfluoroalkyl substances, epigenetic age and DNA methylation: a cross-sectional study of firefighters. Epigenomics 2021; 13:1619-1636. [PMID: 34670402 PMCID: PMC8549684 DOI: 10.2217/epi-2021-0225] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/27/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Per- and polyfluoroalkyl substances (PFASs) are persistent chemicals that firefighters encounter. Epigenetic modifications, including DNA methylation, could serve as PFASs toxicity biomarkers. Methods: With a sample size of 197 firefighters, we quantified the serum concentrations of nine PFASs, blood leukocyte DNA methylation and epigenetic age indicators via the EPIC array. We examined the associations between PFASs with epigenetic age, site- and region-specific DNA methylation, adjusting for confounders. Results: Perfluorohexane sulfonate, perfluorooctanoate (PFOA) and the sum of branched isomers of perfluorooctane sulfonate (Sm-PFOS) were associated with accelerated epigenetic age. Branched PFOA, linear PFOS, perfluorononanoate, perfluorodecanoate and perfluoroundecanoate were associated with differentially methylated loci and regions. Conclusion: PFASs concentrations are associated with accelerated epigenetic age and locus-specific DNA methylation. The implications for PFASs toxicity merit further investigation.
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Affiliation(s)
- Jaclyn M Goodrich
- Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Miriam M Calkins
- National Institute for Occupational Safety & Health, Centers for Disease Control & Prevention, Cincinnati, OH 45226, USA
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Todd Stueckle
- National Institute for Occupational Safety & Health, Centers for Disease Control & Prevention, Morgantown, WV 26505, USA
| | - Casey Grant
- Fire Protection Research Foundation, Quincy, MA 02169, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control & Prevention, Atlanta, GA 30341, USA
| | - Amy Nematollahi
- Department of Community, Environment & Policy, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ 85724, USA
| | - Alesia M Jung
- Department of Epidemiology & Biostatistics, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ 85724, USA
| | - Judith M Graber
- Department of Biostatistics & Epidemiology, Rutgers the State University of New Jersey, Piscataway, NJ 08854, USA
| | - Timothy Jenkins
- Department of Cell Biology & Physiology, Brigham Young University, Provo, UT 84602, USA
| | - Angela L Slitt
- Department of Biomedical Sciences, University of Rhode Island College of Pharmacy, Kingston, RI 02881, USA
| | - Alisa Dewald
- Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Julianne Cook Botelho
- National Center for Environmental Health, Centers for Disease Control & Prevention, Atlanta, GA 30341, USA
| | - Shawn Beitel
- Department of Community, Environment & Policy, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ 85724, USA
| | - Sally Littau
- Department of Community, Environment & Policy, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ 85724, USA
| | | | | | - Jeff Hughes
- Orange County Fire Authority, Irvine, CA 92602, USA
| | | | - Jefferey L Burgess
- Department of Community, Environment & Policy, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ 85724, USA
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Hoppe-Jones C, Griffin SC, Gulotta JJ, Wallentine DD, Moore PK, Beitel SC, Flahr LM, Zhai J, Zhou JJ, Littau SR, Dearmon-Moore D, Jung AM, Garavito F, Snyder SA, Burgess JL. Evaluation of fireground exposures using urinary PAH metabolites. J Expo Sci Environ Epidemiol 2021; 31:913-922. [PMID: 33654270 PMCID: PMC8445814 DOI: 10.1038/s41370-021-00311-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Firefighters have increased cancer incidence and mortality rates compared to the general population, and are exposed to multiple products of combustion including known and suspected carcinogens. OBJECTIVE The study objective was to quantify fire response exposures by role and self-reported exposure risks. METHODS Urinary hydroxylated metabolites of polycyclic aromatic hydrocarbons (PAH-OHs) were measured at baseline and 2-4 h after structural fires and post-fire surveys were collected. RESULTS Baseline urine samples were collected from 242 firefighters. Of these, 141 responded to at least one of 15 structural fires and provided a post-fire urine. Compared with baseline measurements, the mean fold change of post-fire urinary PAH-OHs increased similarly across roles, including captains (2.05 (95% CI 1.59-2.65)), engineers (2.10 (95% CI 1.47-3.05)), firefighters (2.83 (95% CI 2.14-3.71)), and paramedics (1.84 (95% CI 1.33-2.60)). Interior responses, smoke odor on skin, and lack of recent laundering or changing of hoods were significantly associated with increased post-fire urinary PAH-OHs. SIGNIFICANCE Ambient smoke from the fire represents an exposure hazard for all individuals on the fireground; engineers and paramedics in particular may not be aware of the extent of their exposure. Post-fire surveys identified specific risks associated with increased exposure.
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Affiliation(s)
- Christiane Hoppe-Jones
- Department of Chemical and Environmental Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA
| | - Stephanie C Griffin
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | | | | | - Shawn C Beitel
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Leanne M Flahr
- Department of Chemical and Environmental Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA
| | - Jing Zhai
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Jin J Zhou
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Sally R Littau
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Devi Dearmon-Moore
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Fernanda Garavito
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Shane A Snyder
- Department of Chemical and Environmental Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA
| | - Jefferey L Burgess
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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Jung AM, Zhou J, Beitel SC, Littau SR, Gulotta JJ, Wallentine DD, Moore PK, Burgess JL. Longitudinal evaluation of whole blood miRNA expression in firefighters. J Expo Sci Environ Epidemiol 2021; 31:900-912. [PMID: 33603099 PMCID: PMC8445815 DOI: 10.1038/s41370-021-00306-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dysregulated microRNA (miRNA) expression could provide a mechanism linking firefighter exposure to increased cancer risk. OBJECTIVE To determine if changes in longitudinal miRNA expression in firefighters are associated with occupational exposures. METHODS Whole blood MiRNA was evaluated in 52 new recruits prior to live-fire training and 20-37 months later. Linear mixed effects models adjusted for age, ethnicity, BMI, and batch effects were used to determine associations separately for all fires and structure fires only between employment duration, cumulative fire-hours and fire-runs, and time since most recent fire with (1) nine a priori and (2) the full array of 799 miRNAs. RESULTS For multivariable models including all fires, two a priori miRNAs were associated with employment duration and four with time since most recent fire. For multivariable models restricted to structure fires, three a priori miRNAs were associated with employment duration and one with fire-runs. Additional miRNAs from the full array were associated with employment duration for all fires and/or structure fires. In general, tumor suppressive miRNAs decreased and oncogenic miRNAs increased with exposure. SIGNIFICANCE Changes in miRNAs may serve as biomarkers of exposure effects and a mechanism for increased cancer risk in firefighters.
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Affiliation(s)
- Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Jin Zhou
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Shawn C Beitel
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Sally R Littau
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | | | | | - Jefferey L Burgess
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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Goodrich JM, Furlong MA, Caban-Martinez AJ, Jung AM, Batai K, Jenkins T, Beitel S, Littau S, Gulotta J, Wallentine D, Hughes J, Popp C, Calkins MM, Burgess JL. Differential DNA Methylation by Hispanic Ethnicity Among Firefighters in the United States. Epigenet Insights 2021; 14:25168657211006159. [PMID: 35036834 PMCID: PMC8756104 DOI: 10.1177/25168657211006159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/02/2021] [Indexed: 01/04/2023] Open
Abstract
Firefighters are exposed to a variety of environmental hazards and are at increased risk for multiple cancers. There is evidence that risks differ by ethnicity, yet the biological or environmental differences underlying these differences are not known. DNA methylation is one type of epigenetic regulation that is altered in cancers. In this pilot study, we profiled DNA methylation with the Infinium MethylationEPIC in blood leukocytes from 31 Hispanic white and 163 non-Hispanic white firefighters. We compared DNA methylation (1) at 12 xenobiotic metabolizing genes and (2) at all loci on the array (>740 000), adjusting for confounders. Five of the xenobiotic metabolizing genes were differentially methylated at a raw P-value <.05 when comparing the 2 ethnic groups, yet were not statistically significant at a 5% false discovery rate (q-value <.05). In the epigenome-wide analysis, 76 loci exhibited DNA methylation differences at q < .05. Among these, 3 CpG sites in the promoter region of the biotransformation gene SULT1C2 had lower methylation in Hispanic compared to non-Hispanic firefighters. Other differentially methylated loci included genes that have been implicated in carcinogenesis in published studies (FOXK2, GYLTL1B, ZBTB16, ARHGEF10, and more). In this pilot study, we report differential DNA methylation between Hispanic and non-Hispanic firefighters in xenobiotic metabolism genes and other genes with functions related to cancer. Epigenetic susceptibility by ethnicity merits further study as this may alter risk for cancers linked to toxic exposures.
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Affiliation(s)
- Jaclyn M Goodrich
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA,Jaclyn M Goodrich, Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Melissa A Furlong
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alesia M Jung
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Ken Batai
- Department of Urology, University of Arizona, Tucson, AZ, USA
| | - Timothy Jenkins
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, USA
| | - Shawn Beitel
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Sally Littau
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | | | | | - Jeff Hughes
- Orange County Fire Authority, Irvine, CA, USA
| | | | - Miriam M Calkins
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Jefferey L Burgess
- Department of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Jung AM, Missmer SA, Cramer DW, Ginsburg ES, Terry KL, Vitonis AF, Farland LV. Self-reported infertility diagnoses and treatment history approximately 20 years after fertility treatment initiation. Fertil Res Pract 2021; 7:7. [PMID: 33712085 PMCID: PMC7953690 DOI: 10.1186/s40738-021-00099-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/01/2021] [Indexed: 11/17/2022]
Abstract
Background Infertility history may have important implications for clinical practice and scientific discovery. Previous research on the validity of self-reported infertility measurements has been limited in scope and duration (< 5 years). In this study, we validated self-reported infertility history measures 15–23 years after fertility treatment initiation among women who utilized assisted reproductive technology (ART). Methods Women who received ART treatments from three Boston infertility clinics and who enrolled in a prior study (1994–2003) were re-contacted in 2018 for the AfteR Treatment Follow-up Study (ART-FS). Infertility history was collected from clinical records and two self-report questionnaires (at ART initiation and at ART-FS enrollment). Treatment history included specific details (fresh or frozen embryo transfers, number of cycles) and treatment recall prior to ART initiation. Self-reported infertility diagnoses included polycystic ovary syndrome (PCOS), endometriosis, uterine factor infertility, tubal factor infertility, diminished ovarian reserve/advanced maternal age, male factor infertility, and other/unknown. We compared self-reported measures from 2018 to self-reported and clinical data from prior study initiation, using Cohen’s kappa, sensitivity, specificity, and 95% confidence intervals. Results Of 2644 women we attempted to recontact, 808 completed the ART-FS, with an average follow-up of 19.6 years (standard deviation: 2.7). Recall of fertility treatment usage had moderate sensitivity (IVF = 0.85, Clomiphene/Gonadotropin = 0.81) but low specificity across different infertility treatment modalities (IVF = 0.63, Clomiphene/Gonadotropin = 0.55). Specific IVF details had low to moderate validity and reliability with clinical records. Reliability of recalled infertility diagnosis was higher when compared to self-report at ART initiation (PCOS K = 0.66, Endometriosis K = 0.76, Tubal K = 0.73) than when compared to clinical records (PCOS K = 0.31, Endometriosis K = 0.48, Tubal K = 0.62) and varied by diagnosis. Conclusions The ability of women to recall specific IVF treatment details was moderately accurate and recall of self-reported infertility diagnosis varied by diagnosis and measurement method. Supplementary Information The online version contains supplementary material available at 10.1186/s40738-021-00099-2.
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Affiliation(s)
- Alesia M Jung
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ, 85724, USA.
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel W Cramer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elizabeth S Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kathryn L Terry
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Allison F Vitonis
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Leslie V Farland
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ, 85724, USA
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Allen AM, Jung AM, Alexander AC, Allen SS, Ward KD, al’Absi M. Cannabis use and stressful life events during the perinatal period: cross-sectional results from Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2016. Addiction 2020; 115:1707-1716. [PMID: 32032979 PMCID: PMC9219169 DOI: 10.1111/add.15003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/11/2019] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
AIMS We aimed to determine the association between stressful life events (SLEs) in the year prior to childbirth with (1) pre-pregnancy cannabis use, (2) cessation of cannabis use during pregnancy and (3) postpartum relapse to cannabis use. DESIGN We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016, a cross-sectional, population-based surveillance system. SETTING Mailed and telephone surveys conducted in five states-Alaska, Colorado, Maine, Michigan and Washington-in the United States. PARTICIPANTS Women (n = 6061) who delivered a live infant within the last 6 months and had data on cannabis use. MEASUREMENTS Self-reported data included SLEs (yes/no response for 14 individual events in the 12 months prior to childbirth) and cannabis use [yes/no prior to pregnancy, during pregnancy, and at the time of the survey (approximately 2-6 months postpartum)]. The associations between SLEs and cannabis use (primary outcomes) were examined in logistic regression models adjusted for maternal demographics (e.g. age, race, education), geography (i.e. state of residence) and cigarette smoking. FINDINGS Pre-pregnancy, 16.4% (997/6061) of respondents endorsed using cannabis, with 36.4% (363/997) continuing cannabis use during pregnancy. Among the 63.6% (634/997) who did not report use during pregnancy, 23.2% (147/634) relapsed to cannabis use during the postpartum. Nine of the 14 possible SLEs were associated with increased odds of pre-pregnancy cannabis use [e.g. husband/partner or mother went to jail, adjusted odds ratio (aOR) = 2.16, 95% confidence interval (CI) = 1.30-3.62] and four were associated with increased odds of continued cannabis use during pregnancy (e.g. husband/partner lost job, aOR = 2.19, 95% CI = 1.21-3.96). The odds of postpartum relapse to cannabis were significantly associated with two SLEs (husband/partner said they did not want pregnancy, aOR = 2.86, CI = 1.10-7.72; husband/partner or mother went to jail, aOR = 0.37, 95% CI = 0.13-1.00). CONCLUSIONS Stressful life events during the year prior to childbirth appear to be linked to greater odds of women's cannabis use during the perinatal period, especially during pre-pregnancy.
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Affiliation(s)
- Alicia M. Allen
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Alesia M. Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Adam C. Alexander
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sharon S. Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Mustafa al’Absi
- Department of Family Medicine and Biobehavioral Health, Medical School, University of Minnesota, Duluth, MN, USA
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Bui DP, Griffin SC, French DD, Hu C, Pollack Porter K, Jung AM, Crothers S, Burgess JL. The use of proactive risk management to reduce emergency service vehicle crashes among firefighters. J Safety Res 2019; 71:103-109. [PMID: 31862021 DOI: 10.1016/j.jsr.2019.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Emergency service vehicle crashes (ESVCs), including rollovers and collisions with other vehicles and fixed objects, are a leading cause of death among U.S. firefighters. Risk management (RM) is a proactive intervention to identifying and mitigating occupational risks and hazards. The goal of this study was to assess the effect of RM in reducing ESVCs. METHODS Three fire departments (A, B and C), representing urban and suburban geographies, and serving medium to large populations, participated in facilitated RM programs to reduce their ESVCs. Interventions were chosen by each department to address their department-specific circumstances and highest risks. Monthly crash rates per 10,000 calls were calculated for each department an average of 28 months before and 23 months after the start of the RM programs. Interrupted time series analysis was used to assess the effect of the RM programs on monthly crash rates. Poisson regression was used to estimate the number of crashes avoided. Economic data from Department A were analyzed to estimate cost savings. RESULTS Department A had a 15.4% (P = 0.30) reduction in the overall monthly crash rate immediately post-RM and a 1% (P = 0.18) decline per month thereafter. The estimated two-year average cost savings due to 167 crashes avoided was $253,100 (95%CI= $192,355 - $313,885). Department B had a 9.7% (P = 0.70) increase in the overall monthly crash rate immediately post-RM and showed no significant changes in their monthly crash rate. Department C had a 28.4% (P = 0.001) reduction in overall monthly crash rate immediately post-RM and a 1.2% (P = 0.09) increase per month thereafter, with an estimated 122 crashes avoided. CONCLUSIONS RM programs have the potential to reduce ESVCs in the fire service and their associated costs; results may vary based on the interventions chosen and how they are implemented. Practical applications: Risk management may be an effective and broadly implemented intervention to reduce ESVCs in the US fire service.
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Affiliation(s)
- David P Bui
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.
| | - Stephanie C Griffin
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.
| | - Dustin D French
- Center for Healthcare Studies, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA.
| | - Chengcheng Hu
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.
| | - Keshia Pollack Porter
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA.
| | - Alesia M Jung
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.
| | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.
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Zhou J, Jenkins TG, Jung AM, Jeong KS, Zhai J, Jacobs ET, Griffin SC, Dearmon-Moore D, Littau SR, Peate WF, Ellis NA, Lance P, Chen Y, Burgess JL. DNA methylation among firefighters. PLoS One 2019; 14:e0214282. [PMID: 30913233 PMCID: PMC6435149 DOI: 10.1371/journal.pone.0214282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/11/2019] [Indexed: 01/09/2023] Open
Abstract
Firefighters are exposed to carcinogens and have elevated cancer rates. We hypothesized that occupational exposures in firefighters would lead to DNA methylation changes associated with activation of cancer pathways and increased cancer risk. To address this hypothesis, we collected peripheral blood samples from 45 incumbent and 41 new recruit non-smoking male firefighters and analyzed the samples for DNA methylation using an Illumina Methylation EPIC 850k chip. Adjusting for age and ethnicity, we performed: 1) genome-wide differential methylation analysis; 2) genome-wide prediction for firefighter status (incumbent or new recruit) and years of service; and 3) Ingenuity Pathway Analysis (IPA). Four CpGs, including three in the YIPF6, MPST, and PCED1B genes, demonstrated above 1.5-fold statistically significant differential methylation after Bonferroni correction. Genome-wide methylation predicted with high accuracy incumbent and new recruit status as well as years of service among incumbent firefighters. Using IPA, the top pathways with more than 5 gene members annotated from differentially methylated probes included Sirtuin signaling pathway, p53 signaling, and 5' AMP-activated protein kinase (AMPK) signaling. These DNA methylation findings suggest potential cellular mechanisms associated with increased cancer risk in firefighters.
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Affiliation(s)
- Jin Zhou
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Timothy G. Jenkins
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Alesia M. Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Kyoung Sook Jeong
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jing Zhai
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Stephanie C. Griffin
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Devi Dearmon-Moore
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Sally R. Littau
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | | | - Nathan A. Ellis
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Peter Lance
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Yin Chen
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson, Arizona, United States of America
| | - Jefferey L. Burgess
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
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16
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Bui DP, Hu C, Jung AM, Pollack Porter KM, Griffin SC, French DD, Crothers S, Burgess JL. Driving behaviors associated with emergency service vehicle crashes in the U.S. fire service. Traffic Inj Prev 2019; 19:849-855. [PMID: 30605007 DOI: 10.1080/15389588.2018.1508837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Emergency service vehicle incidents are a leading cause of firefighter fatalities and are also hazardous to civilian road users. Modifiable driving behaviors may be associated with emergency service vehicle incidents. The goal of this study was to use telematics to identify driving behaviors associated with crashes in the fire service. METHODS Forty-three emergency service vehicles in 2 fire departments were equipped with telematics devices (12 in Department A and 31 in Department B). The devices collected vehicle coordinates, speed, and g forces, which were monitored for exceptions to driving rules established by the fire departments regarding speeding, harsh braking, and hard cornering. Fire department administrative reports were used to identify vehicles involved in crashes and merged with daily telematics data. Penalized logistic regression was used to identify driving rules associated with crashes. Least absolute shrinkage and selection operator (LASSO) regression was used to generate a telematics-based risk index for emergency service vehicle incidents. RESULTS Nearly 1.1 million km of driving data and 44 crashes were recorded among the 2 departments during the study. Harsh braking was associated with increased odds of crash in Department A (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.09-4.51) and Department B (OR = 1.55; 95% CI, 1.12-2.15). For every kilometer of nonemergency speeding, the odds of crash increased by 35% in Department A (OR = 1.35; 95% CI, 1.03-1.77) and by over 2-fold in Department B (OR = 2.09; 95% CI, 1.19-3.66). In Department B, hard cornering (OR = 1.14; 95% CI, 1.03-1.26) and emergency speeding (OR = 1.65; 95% CI, 1.06-2.57) were also associated with increased odds of crash. The final LASSO risk index model had a sensitivity of 73% and specificity of 57%. CONCLUSIONS Harsh braking and excessive speeding were driving behaviors most associated with crash in the fire service. Telematics may be a useful tool for monitoring driver safety in the fire service.
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Affiliation(s)
- D P Bui
- a The Mel and Enid Zuckerman College of Public Health, Department of Epidemiology and Biostatistics , The University of Arizona , Tucson , Arizona
| | - C Hu
- a The Mel and Enid Zuckerman College of Public Health, Department of Epidemiology and Biostatistics , The University of Arizona , Tucson , Arizona
| | - A M Jung
- a The Mel and Enid Zuckerman College of Public Health, Department of Epidemiology and Biostatistics , The University of Arizona , Tucson , Arizona
| | - K M Pollack Porter
- b Johns Hopkins Bloomberg School of Public Health , Johns Hopkins Center for Injury Research and Policy , Baltimore , Maryland
| | - S C Griffin
- c The Mel and Enid Zuckerman College of Public Health, Department of Community Environment and Policy , The University of Arizona , Tucson , Arizona
| | - D D French
- d Department of Ophthalmology, Feinberg School of Medicine , Northwestern University , Chicago , Illinois
- e Feinberg School of Medicine, Center for Healthcare Studies, Northwestern University , Chicago , Illinois
- f Veterans Affairs Health Services Research and Development Service , Chicago , Illinois
| | - S Crothers
- g Seattle Fire Department , Seattle , Washington
| | - J L Burgess
- c The Mel and Enid Zuckerman College of Public Health, Department of Community Environment and Policy , The University of Arizona , Tucson , Arizona
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17
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Allen AM, Jung AM, Lemieux AM, Alexander AC, Allen SS, Ward KD, al'Absi M. Stressful life events are associated with perinatal cigarette smoking. Prev Med 2019; 118:264-271. [PMID: 30468790 PMCID: PMC6322958 DOI: 10.1016/j.ypmed.2018.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 12/01/2022]
Abstract
Perinatal smoking, including smoking during pregnancy and postpartum smoking relapse, is a persistent public health problem. While childhood trauma has been linked to perinatal smoking, less is known about the association with more proximal stressful life events (SLEs). The objective of this study was to examine the association between SLEs that occurred during the year prior to childbirth with perinatal smoking. Using the Pregnancy Risk Assessment Monitoring System 2009-2011, perinatal smoking was assessed at three time points: (1) three months prior to pregnancy, (2) the last three months of pregnancy, and (3) two to six months postpartum. Survey respondents endorsed up to 13 SLEs (i.e., death of someone close). SLEs were analyzed individually, as well as using a cumulative score (range 0-13). Weighted analyses included unadjusted and adjusted logistic regression. Among those who smoked prior to pregnancy (n = 15,316), 48% (n = 7308) reported quitting smoking during pregnancy. Of those, 44% (n = 3126) reported postpartum smoking relapse. A total of 11 SLEs were associated with smoking during pregnancy and 2 SLEs were associated with postpartum smoking relapse. The odds of continued smoking during pregnancy was 12% higher for each SLE endorsed (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI]: 1.09, 1.15) and this association was attenuated in relation to the odds of postpartum smoking relapse (aOR = 1.03, 95% CI: 0.99, 1.08). SLEs are associated with perinatal smoking. Additional research is needed to elucidate the mechanisms of action and to develop interventions specific to the needs of women who experience SLEs.
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Affiliation(s)
- Alicia M Allen
- Department of Family & Community Medicine, College of Medicine, University of Arizona, 3950 South Country Club Road, Suite 330, Tucson, AZ 85714-2238, United States of America.
| | - Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, PO Box 245211, Tucson, AZ 85724-5211, United States of America
| | - Andrine M Lemieux
- Department of Family Medicine & Biobehavioral Health, Medical School, University of Minnesota, Duluth, 1035 University Drive, 291 SMed, Duluth, MN 55812-3031, United States of America
| | - Adam C Alexander
- Department of Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 DeSoto Avenue, Room 207, Memphis, TN 38152, United States of America
| | - Sharon S Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, 420 Delaware Street SE, Room A682, Minneapolis, MN 55455-0341, United States of America
| | - Kenneth D Ward
- School of Public Health, University of Memphis, 201 Robison Hall, Memphis, TN 38152-3420, United States of America
| | - Mustafa al'Absi
- Department of Family Medicine & Biobehavioral Health, Medical School, University of Minnesota, Duluth, 1035 University Drive, Duluth, MN, 55812-3031, United States of America
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18
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Jung AM, Dennis LK, Jacobs ET, Wondrak GT. Sun sensitivity and sun protective behaviors during sun exposure among indoor office workers in the American Midwest. Photodermatol Photoimmunol Photomed 2018; 34:393-399. [PMID: 29888418 DOI: 10.1111/phpp.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND/PURPOSE Sun sensitivity, a confounder between sun exposure and sun protection, is often overlooked. We examined how sun exposure and sun protection behaviors among indoor workers varied by sun sensitivity. METHODS Sun exposure and sun protection diaries over a 45-day period from Midwestern United States indoor workers were examined. We categorized sun sensitivity (fair and non-fair complexion) using tanning inability and sunburn tendency. Total exposure (sunrise to sunset) and peak exposure (10 am and 4 pm) lasting at least 60 minutes were examined. Percentages of time using sun protection were reported. We determined associations between fair complexion, mean sun exposure, and mean sun protection times with logistic regression. RESULTS Fair individuals spent less time in the sun than non-fair individuals, but a greater proportion of time using sun protection behaviors, including sunscreen with SPF 30+ (odds ratio (OR) = 1.36; 95% confidence interval (95% CI) = 0.98, 1.87)), or wearing long-sleeved shirts (OR = 2.89; 95% CI = 1.24, 6.73). CONCLUSION Fair individuals spent less time in the sun and practiced more sun protective behaviors than non-fair individuals. This complex association between sun sensitivity, sun protection and sun exposure has not consistently been addressed in studies of skin cancer.
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Affiliation(s)
- Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Leslie K Dennis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, Tucson, AZ, USA
| | - Georg T Wondrak
- University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Pharmacology & Toxicology, College of Pharmacy, University of Arizona, Tucson, AZ, USA
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19
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Bui DP, Balland S, Giblin C, Jung AM, Kramer S, Peng A, Aquino MCP, Griffin S, French DD, Pollack Porter K, Crothers S, Burgess JL. Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review. Accid Anal Prev 2018; 115:189-201. [PMID: 29621721 DOI: 10.1016/j.aap.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/14/2017] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Emergency service vehicle incidents (ESVI), including crashes, rollovers, and roadside struck-by-incidents, are a leading cause of occupational fatality and injury among firefighters and other emergency responders. Though there are numerous strategies and interventions to prevent ESVIs, the evidence base for these strategies is limited and dispersed. The goal of this study was to gather and present a review of evidence-based ESVI interventions. METHODS We searched five academic databases for articles published within the last decade featuring interventions to reduce or prevent ESVIs. We interviewed key informants from fire departments serving major metropolitan areas for additional interventions. Interventions from both sources were summarized and data on intervention effectiveness were reported when available. RESULTS Sixty-five articles were included in the final review and 17 key informant interviews were completed. Most articles focused on vehicle engineering interventions (38%), followed by policy and administration interventions (26%), environmental engineering interventions (19%) and education or training (17%). Most key informants reported policy (49%) and training interventions (29%). Enhanced drivers' training and risk management programs were associated with 19-50% and 19-58% reductions in ESVIs, respectively. CONCLUSIONS Only a limited number of interventions to address ESVIs had adequate outcome data. Based on the available data, training and risk management approaches may be particularly effective approaches to reducing ESVIs.
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Affiliation(s)
- David P Bui
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA.
| | - Samantha Balland
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Casey Giblin
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Alesia M Jung
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Sandy Kramer
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Abigail Peng
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Marie Corazon Ponce Aquino
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Stephanie Griffin
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 440, Chicago, IL 60611, USA; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair, 20th Floor, Chicago, IL 60611, USA; Veterans Affairs Health Services Research and Development Service, Chicago, 5000 5th Ave, Hines, IL 60141, USA
| | - Keshia Pollack Porter
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, 615 N Wolfe St, Baltimore, MS 21205, USA
| | - Steve Crothers
- Seattle Fire Department, 301 2nd Ave S, Seattle, WA 98104, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
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20
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Bui DP, Pollack Porter K, Griffin S, French DD, Jung AM, Crothers S, Burgess JL. Correction to: Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations. BMC Public Health 2017; 17:923. [PMID: 29195498 PMCID: PMC5712151 DOI: 10.1186/s12889-017-4946-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- David P Bui
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ, 85724, USA.
| | - Keshia Pollack Porter
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA
| | - Stephanie Griffin
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ, 85724, USA
| | - Dustin D French
- Center for Healthcare Studies, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Alesia M Jung
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ, 85724, USA
| | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ, 85724, USA
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21
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Bui DP, Porter KP, Griffin S, French DD, Jung AM, Crothers S, Burgess JL. Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations. BMC Public Health 2017; 17:885. [PMID: 29149879 PMCID: PMC5693554 DOI: 10.1186/s12889-017-4894-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments. METHODS Three fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation. RESULTS Three to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver visibility while backing, and increased training frequency and enhanced training. The RM process was generally acceptable to department participants and considered useful. All departments reported that the focused and systematic analysis of crashes was particularly helpful. Implementation of controls was a commonly cited challenge. CONCLUSIONS Proactive RM of ESVCs in three US fire departments was positively received and supported the establishment of interventions tailored to each department's needs and priorities.
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Affiliation(s)
- David P. Bui
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ 85724 USA
| | - Keshia P. Porter
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, Baltimore, MD USA
| | - Stephanie Griffin
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ 85724 USA
| | - Dustin D. French
- Center for Healthcare Studies, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL USA
| | - Alesia M. Jung
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ 85724 USA
| | | | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ 85724 USA
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22
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Jung AM, Schweers N, Bell ML, Nair U, Yuan NP. Tobacco Use Cessation Among Quitline Callers Who Implemented Complete Home Smoking Bans During the Quitting Process. Prev Chronic Dis 2017; 14:E105. [PMID: 29072983 PMCID: PMC5662293 DOI: 10.5888/pcd14.170139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The implementation of a home smoking ban (HSB) is associated with tobacco use cessation. We identified which quitline callers were most likely to report 30-day cessation among those who implemented complete HSBs after enrollment. METHODS Our sample consisted of callers to the Arizona Smokers' Helpline who enrolled from January 1, 2011, through July 26, 2015, and who reported no HSB at enrollment and a complete HSB by 7-month follow-up. We used logistic regression to estimate associations between no use of tobacco in the previous 30 days (30-day quit) at 7-month follow-up and demographic characteristics, health conditions, tobacco use, and cessation strategies. RESULTS At 7-month follow-up, 65.4% of 399 callers who implemented a complete HSB reported 30-day quit. Lower odds of tobacco use cessation were associated with having a chronic health condition (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.18-0.56) and living with other smokers (OR, 0.46; 95% CI, 0.29-0.73). Higher odds of tobacco cessation were associated with completing 5 or more telephone coaching sessions (OR, 2.48; 95% CI, 1.54-3.98) and having confidence to quit (OR, 2.05; 95% CI, 1.05-3.99). However, confidence to quit was not significant in the sensitivity analysis. CONCLUSION Implementing an HSB after enrolling in quitline services increases the likelihood of cessation among some tobacco users. Individuals with complete HSBs were more likely to quit if they did not have a chronic health condition, did not live with another smoker, and were actively engaged in coaching services. These findings may be used by quitlines to develop HSB intervention protocols primarily targeting tobacco users most likely to benefit from them.
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Affiliation(s)
- Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, PO Box 245211, Tucson, AZ 85724.
| | - Nicholas Schweers
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.,School of Psychology, University of Sydney, Sydney, Australia
| | - Uma Nair
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Nicole P Yuan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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