Background: In a study by Ma et. al 2006, it was documented that Florida female firefighters have higher risk of cervical, lymphocytic, thyroid and overall cancer when compared to the general Florida population. Despite known and available female-related cancer screening guidelines, little is known about the cancer screening behaviors of female firefighters. This study characterizes self-reported cancer diagnosis, cancer type and cancer screening practices in Florida female firefighters.

Methods: This cross-sectional study examined female firefighter baseline health survey data from the 2015-2018 Annual Cancer Survey, a cohort of Florida firefighters. Descriptive statistics of demographics and corresponding statistical tests of associations were estimated. Univariate and multivariable logistic regression models were used to identify factors that contributed to cancer screening behaviors in this population.

Results: Among the 343 female firefighter respondents, average age was 41.4±8.8 years with 27.4% self-identifying as Hispanic, with an average firefighter tenure of 13.9±7.9 years and 98.3% reported having health insurance. The most frequently reported cancer type and cancer screening behaviors were skin cancer (5.8%); and Pap-smear (83.1%), HPV testing (74.9%), mammogram (97.3%), colonoscopy (73.4%) and full body skin exam (62.5%). HPV screening rates were significantly lower among female firefighters of Black ethnicity (38.9%, p<0.001) and those with a household income <$35,000 (45.5%, p=0.0314). Black female firefighters were significantly less likely to have a Pap test (aOR= 0.16; 95%CI: 0.05-0.49) and have full body skin cancer screening (aOR= 0.02; 95%CI: 0.00-0.12) compared to Caucasian female firefighters. Hispanic female firefighters (aOR=0.40; 95%CI: 0.23-0.68) were less likely to have skin cancer screening compared to Caucasian female firefighters.

Conclusion: Female firefighters in this sample did not screen for HPV (25.1%), Pap-smear (16.9%), mammogram (2.7%) and colonoscopy (26.6%) despite near universal health insurance coverage. Female firefighters of ethnic/racial minority groups appear to engage in cancer screening behaviors less than their Caucasian counterparts.

Background and Objective(s): Epidemiologic studies have reported an increased risk of developing melanoma in incumbent Florida firefighters when compared to the general Florida population. The median age for melanoma diagnosis among this workforce is 42 years, significantly younger than the median age of 62 years among the general population. Despite this disproportionate risk, there is limited research on skin cancer screening behaviors for firefighters that are retired or in the Deferred Retirement Option Plan (DROP). In the present study, we examine characteristics associated with skin cancer screening among retired Florida firefighters.

Methods: Retired Florida firefighters and those in the DROP (1-5 years prior to retirement) were recruited through various firefighter networks and outreach activities throughout Florida to complete an online comprehensive cancer survey using the REDCap survey administration system. The survey consisted of 427 items which assess medical and cancer history, cancer risk and screening behaviors, and occupational history. Statistical analysis was performed with SAS v9.4.

Results: Retired/DROP firefighters (n=425) completed the survey between April 2017-January 2019. Approximately half of the study participants, 47.0%, reported a cancer diagnosis. Those who reported having a full-body skin exam (n=356, 83.8%) by a healthcare provider were mostly aged 50-59 years old (34.0%), male (89.3%), White (97.5%), non-Hispanic (92.7%), attended some college (63.2%), married or part of an unmarried couple (83.4%), and had an annual income equal to or more than $75,000 (78.7%). Among retired firefighters with a family history of skin cancer, 9.3% never had a full-body skin exam by a healthcare provider. Retired Black firefighters (adjusted odds ratio=0.04; 95% confidence interval [0.01-0.21]) and Hispanic firefighters (aOR=0.32; 95% CI [0.15-0.70]) were significantly less likely to report skin cancer screening compared to their White and non-Hispanic counterparts, respectively.

Conclusion: Racial and ethnic disparities in full-body skin cancer screening are observed among Florida retired/DROP firefighters.

Background and Objective(s): Firefighters exhibit an increased risk of specific cancers compared to the general population. In addition to being exposed to carcinogenic materials, firefighters develop stress-induced inflammation (a contributor to the genesis of cancer) from stressors such as sleep disturbance, work pace, and traumatic calls. Frequent exercise and maintaining a healthy weight reduces inflammation and potentially, cancer risk. We examine pilot data for objectively measured PA levels (i.e., sedentary, light, moderate) across normal weight and overweight/obese firefighters.

Methods: A repeated measures study design (conducted June-July 2018 and ongoing) was used to collect self-reported and objectively measured (ActiGraph wGT3X-BT devices) PA levels in a convenience sample of Florida firefighters (n=18) over 7 consecutive days. Participants initially completed a baseline questionnaire assessing PA (using the International Physical Activity Questionnaire [IPAQ]), body pain location and demographics. At the end of observation, ActiGraph’s were collected and a follow-up questionnaire assessed the same measures as baseline.

Results: Of the mostly male (94.4%) sample, 27.8% were normal weight and 72.2% were overweight or obese. Accelerometer data documented that obese firefighters spent more time in sedentary PA (1,476 more min/week; P=0.069) than normal weight firefighters. Normal weight firefighters spend more time in light (872 more min/week; P= 0.119) and moderate (630 more min/week; P= 0.045) PA than overweight/obese firefighters. Overweight/obese firefighters took more sedentary breaks than normal weight firefighters (83, 65 respectively; P= 0.412) but normal weight firefighters took longer sedentary breaks (126 min.) than the overweight/obese firefighters (61 min.)(P=0.063). Normal weight firefighters had a higher total step count than overweight/obese firefighters (95870, 65392 respectively; P=0.061).

Conclusions: Preliminary findings suggest that normal weight firefighters spend significantly more time engaged in moderate PA than overweight/obese firefighters. Workplace health promotion activities should aim to increase work-related physical activity to support firefighters in achieving healthy weight.

background and objective(s):

Previous studies of firefighters indicate high rates of exposure to toxic and potentially carcinogenic chemicals, including volatile organic compounds (VOCs) and semi-VOCs (sVOCs). While improvements have been made in the characterization of exposure sustained by firefighters, no readily available methods exist for determining real-time presence of high-risk compounds in the field. Modalities that do exist are specific to the detection of acute toxins, such as carbon monoxide or hydrogen cyanide. We evaluate the effectiveness of a portable solid-state sensor array in detecting carcinogens during a controlled burn training exercise.

methods:

In October 2018, sensor arrays were deployed during a Class A controlled burn at a fire department training facility. Burning materials were well-documented, allowing for reproducible output of environmentally released volatilized compounds. Sensor arrays were designed to allow for multiple sensor compound detection in parallel. Sensor response effectiveness was operationalized as the difference in sVOCs and VOCs in the ambient air levels before and during the controlled burn.

results:

Sensor array responses measured outside of the hot zone during a controlled burn displayed significant differences in sensor activity consistent with expected exposure. The following are responses to released compounds detected during the burn, e.g. while breaching a door during training events: 48% (benzene and cyclic organics such as PAHs), 76% (PAHs and hydroxylated cyclic compounds), and 74% (halogenated organics i.e. methylene chloride and flame retardants). Exposures resulted in an average deviation of 31%, 55%, and 67% from the baseline sensor response, respectively.

conclusions:

This pilot study found that solid-state sensor arrays are effective in detecting sVOCs and VOCs during controlled burn simulations, presenting an opportunity to provide real-time hazardous compound detection to firefighters. This proof-of-concept can be advanced to a fully-realized sVOC and VOC detection system to help inform policy and regulations to improve firefighter safety.

Background and Objective(s):Polycyclic Aromatic Hydrocarbons (PAHs) are toxic organic compounds, formed by incomplete combustion of organic matter, such as wood or coal. These carcinogenic compounds can be metabolized by firefighters through inhalation, ingestion, or dermal exposures in the work environment. In the present study, we 1) characterize the number and type of PAHs encountered by incumbent firefighters during a typical 24-hours work shift using urine and novel silicone-based wristband passive samplers; and 2) examine the association of wristband and urinary PAH levels in the same firefighters.

Methods:Florida firefighters were invited and consented to complete a brief anonymous health survey along with providing a 4-oz. urine sample at both the beginning and end of their 24-hour work shift. They were also instructed to wear a silicone-based wristband during their shift as a passive sampling device collecting work environment PAHs. The presence of PAHs, was evaluated using a competitive immunoassay. Solid Phase Extraction was performed to extract the PAHs from urine samples, and the extracts were then analysed via Gas Chromatography-Mass Spectrometry (GC-MS).

Results:A total of 25 firefighters completed the survey, urine, and wristband protocol. Participants were 96.0% male, 45.8% Hispanic, 21.7% Black with a mean age of 41.6 ±9.3 years and 15.1 ±7.4 years’ as a firefighter. Wristband analysis by GC-MS revealed the presence of 16 PAHs, with naphthalene most frequently detected at a mean sample concentration of 41.3 ppb after 24 hours. The total urinary PAHs was moderately correlated with the total of number of PAHs in the wristbands (r=0.403, n=18, p=0.136). The total number of PAHs detected in the pre-shift urine sample was significantly and moderately correlated with the post urinary PAH total (r=0.407, n=24, p=0.048).

Conclusions:Passive sampling wristband devices can be linked with urinary PAH levels in firefighters as an exposure surveillance system.

Background: Among the top three cancers diagnosed in all U.S. men and women from 1970 to 2016, colorectal cancer remains in the top 3. Occupational epidemiologic studies suggest that U.S. firefighters are at an increased risk for colorectal cancer compared to the general U.S. population. In the present study, we examine predictors of colorectal cancer screening in Florida firefighters.

Methods: Using baseline health survey data collected from the 2015-2018 Annual Cancer Survey, a longitudinal cohort of Florida firefighters, we estimated, using a logistics regression model, the probability of firefighters reporting colonoscopy screening based on occupational and non-occupational risk factors. Variables considered in the model include, age as a categorical variable, race/ethnicity, gender, and tenure as a firefighter. Unadjusted as well as adjusted odd ratios were calculated and included in the logistical regression, including a 95% confidence interval.

Results: Among the 5,816 participating Florida firefighters, 12.0% were eligible for CRC screening and of those 67.1% reported ever undergoing a colonoscopy. Florida firefighters who reported CRC screening were mostly aged 50-55 years old (53.7%), male (87.6%), and Caucasian non-Hispanic (80.0%). Among firefighters with a family history of colorectal cancer between the ages of 40-50 years old, 37.7% reported never having undergone CRC screening. Florida firefighters of Black race (adjusted Odds Ratio (aOR)=2.33; 95% confidence interval [1.02-5.30]) were significantly more likely to report colorectal cancer screening than their Caucasian non-Hispanic counterparts. Firefighters with a longer job tenure were also significantly more likely to engage in CRC screening (aOR=1.22; 95%CI[1.09-1.38]) compared to firefighters with a shorter job tenure.

Conclusion: Colorectal cancer screening rates in Florida firefighters with a family history of colorectal cancer were lower than the Florida general population. Moreover, firefighters who are Black and have a longer tenure are more likely to screen for colorectal cancer compared to their younger counterparts.

Background and Objectives: Firefighters face many carcinogenic exposures, yet cancer risk in females, which now comprise approximately 5% of the US workforce, has not been extensively documented.

Methods: Over 99% of Florida firefighter employment/certification records were linked with LexisNexis to obtain social security number (SSN) and other missing information. FastLink software was used to link 1981-2014 Florida Cancer Data System (FCDS) data by using SSN, address, date of birth, gender, and name, identifying 168 female firefighters with cancer. We used a previously reported case-control approach, (AJIM:2007;50:339-344), defining controls as females diagnosed with cancers other than the cancer of interest when the number of index cancers exceeded 10. Exposure was defined as career firefighter employment and non-exposure as female adults in the FCDS database with a documented work history (n=427,715). We calculated age- and year-of-cancer-diagnosis-adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI) calculated from multivariable logistic regression models.

Results: Among female firefighters with cancer, there were sufficient numbers of breast (n=49), thyroid (n=25), and melanoma (n=14) cases available for analysis. Females showed significantly elevated risk of melanoma (aOR=1.95; 95%CI: 1.13-3.38, p=0.0171) and thyroid cancer (2.39; 1.55-3.71, p<0.001) but a significantly decreased risk of breast cancer (0.67; 0.48-0.93, p=0.0182).

Conclusions: The increased risk of thyroid cancer and melanoma is consistent with studies of male firefighters, although findings in females are considerably stronger than newly reported pooled effect size estimates for these cancers (summary incidence ratios 1.22 [1.01-1.48] and 1.21 [1.02-1.45], respectively; Int J Cancer, 2019. doi:10.1002/ijc.32199). There is an urgent need for greater surveillance of cancer outcomes among female firefighters in order to adequately assess risk in less commonly occurring cancers. Linkage of cancer registry data with firefighter employment records on a national scale would provide a vital resource for evaluating risk in this group of public servants.

Background/Objective(s): The U.S. National Fire Protection Association reported 58,835 firefighter injuries in 2017 of which 53% were the result of sprains, strains, and muscular pain. Despite national surveillance of musculoskeletal injuries in U.S. firefighters, little information is available regarding specific anatomic injury sites reported by firefighters. In the present study, we use Florida firefighter cohort data to characterize and estimate the association between specific anatomic acute joint pain location and socio-demographic and occupational factors.

Methods: Data from the 2016-2018 Florida Firefighter Annual Cancer Survey was used to examine Florida firefighters self-reported acute joint pain, clinical pain diagnosis, and predictors of reporting. Acute joint pain was defined as pain or discomfort lasting less than 3 months in the 12-months prior to survey administration.

Results: Among respondents, 43.3% reported having acute joint pain in the 3-months prior to survey administration, of which 53.6% indicate it was associated with work. Self-reported acute joint pain was highest among firefighters who are non-Hispanic (73.3%), in the age bracket of 40-49 (38.2%), in males (91.8%), and white (88.9%). Across all anatomic sites both sides of the lower back (16.64%), both knees (10.32%) and both sides of the neck (8.67%) had the highest report of acute joint pain. Firefighters with degenerative disk pain (adjusted Odds Ratio (AOR)=0.39; 95% Confidence Interval (CI)=[0.17-0.88]) and vertebral disk disease (AOR=0.44;95%CI=[0.22-0.89]) were significantly less likely to be Hispanic as compared to non-Hispanic firefighters.

Conclusion(s): Florida firefighters most frequently report acute joint pain of both sides of the lower back, both knees, and both sides of the neck. Hispanic firefighters were less likely to report degenerative disk pain and vertebral disk disease than their non-Hispanic firefighter counterparts. These findings could be used to develop targeted ergonomic interventions in susceptible firefighter sub-groups to reduce rates of acute joint pain.

Background: Aircraft Rescue and Firefighting (ARFF) is a specialized category of fire service involving hazard mitigation, and evacuation and rescue of passengers and crew of aircrafts involved in airport emergencies. Despite the known carcinogenic hazards encountered by ARFF firefighters on the job, little is known about what reportable components should be documented from ARFF incidents. We describe perceptions of occupational exposure risks among ARFF Firefighters in Florida and characterize the type of variables needed for ARFF exposure reporting.

Methods: Interview and focus group scripts were designed to understand ARFF firefighters’ knowledge of and behaviors related to occupational exposures. Using a moderator led semi-structured guide, the interviews and groups conducted from August 2017 to December 2017 were recorded, transcribed, and analyzed using a content analysis approach.

Results: Participant interviews and focus group (n = 52) data was collected from three airport fire stations in South Florida. Firefighters had at least 1 year of ARFF experience, with a minimum of 3 years in the fire service. Ranks included firefighters, drivers, lieutenants, and captains, with a mean age of 46.8 ± 9.57 years. Three major themes emerged from qualitative analysis: First, ARFF firefighter perceptions of cancer risk are associated with performing essential incident based tasks, however greater concern was raised about indirect factors related to being a airport-based firefighter and chronic aircraft engine exhaust exposure. Second, firefighters expressed rarely engaging in gear decontamination, even when aware of the effectiveness of gear cleaning strategies. Third, specific ARFF reporting components were identified: exposures, rehabilitation procedures, personal protective equipment use, decontamination practices, and health symptoms.

Conclusions: ARFF firefighters are often overlooked in cancer research, even though it is critical to their field due to elevated occupational exposure risk during their operations and from being on airport grounds. ARFF exposure reporting is a necessary step for intervention.