Introduction and objective
In summer, wearing personal protective equipment (PPE) increases the physiological and psychological strain on firefighters. This study aimed to examine the strain caused by Full-PPE compared to station uniform (SU) with the effect of repeated work in a hot and humid environment through human wear trials.

Methods
Twenty-eight male firefighters (age: 39±9 years, BMI: 25.1±3.0 kg·m^-2) participated in two clothing conditions at an air temperature of 30^oC with 61%RH: (1)SU (undershorts, station uniform [short sleeve shirts and long pants], socks, sneakers; 1.4±0.1 kg); (2)Full-PPE (turnout jacket and pants, fire hood, helmet, firefighting gloves, boots, and self-contained breathing apparatus [SCBA] wearing SU inside; 17.2±0.2 kg). Each trial consisted of 10-min rest, 30-min exercise (treadmill walk at 5.0 km·h^-1; EXE1), 20-min recovery (RCV1), another 30-min exercise (EXE2), and 20-min recovery (RCV2) (total 110-min).

Results
There were significant differences in the immune-inflammatory, cardiovascular, and thermoregulatory responses according to the clothing condition and time phases (all P<0.05). Immune-inflammatory responses were activated higher in Full-PPE during RCV2: Leukocyte (Full-PPE: 7.4±2.5 vs. SU: 6.1±1.7 103·mL^-1); Lymphocyte (2.6±0.8 vs. 2.1±0.7 103·mL^-1); Platelet (297.3±42.6 vs. 263.5±38.1 103·mL^-1); Interleukin-6 (4.2±3.5 vs. 1.6±1.6 pg·mL^-1). Heart rate was higher in Full-PPE at EXE1 (135±18 vs. 102±15 bpm), and EXE2 (155±20 vs. 109±17 bpm). Heart rate variability was lower in Full-PPE: SDNN (RCV1: 34.0±18.9 vs. 53.9±23.2; RCV2: 20.3±12.9 vs. 52.3±21.9 ms), RMSSD (RCV1: 34.0±18.9 vs. 44.5±35.3; RCV2: 10.0±16.8 vs. 42.6±30.1 ms). Rectal temperature increased by approximately 1.7^oC with Full-PPE, compared to 0.6^oC with SU. Firefighters felt warmer and more exerted with Full-PPE compared to SU.

Conclusion
The heavy and semi-impermeable Full-PPE aggravated not only cardiovascular and thermoregulatory responses but also immune-inflammatory responses on firefighters gradually as the work repeated. The findings of this study can be used to improve turnout gear to reduce the strains on firefighters in summer.

New York City (NYC) was the epicenter of the COVID-19 pandemic in the US, with dramatic numbers of infections, hospitalizations, and deaths in the early months. These factors compounded existing structural disparities by race, nativity, age, and household composition. In NYC, all non-essential businesses closed for 11-weeks. The essential workforce of 1 million New Yorkers worked across multiple sectors to support the 8.5 million NYC residents during this time. A substantial share of these essential workers are in low-wage jobs that result in them being more susceptible to the pandemic, further exacerbating longstanding disparities.

A COVID-19 module was added to the 2021 NYC Housing and Vacancy Survey (NYCHVS), a citywide representative survey of NYC’s population and housing stock fielded about every three years by the US Census on behalf of the City of New York. The 2021 NYCHVS was fielded from March to July of 2021. Data were collected about every individual in the household, including essential worker status during lockdown, demographics, income and employment, and self-reported health outcomes related to COVID-19 (n~7,000 households). Our analysis examines the health outcomes of essential workers and their families compared to other New Yorkers.

70% of essential works were people of color, 30% were low-income, and 45% were born outside of the United States. In this paper, we will examine differential risk of being diagnosed with COVID-19 for essential workers and their families. This analysis is critical for understanding the intersection of factors that produced differential risk for this population to inform more equitable and just working conditions in the future as the downstream consequences of the pandemic continue to unfold.

Child care facilities in the United States enroll over 11 million children ages five and under. The COVID-19 pandemic emphasized child care's importance to our economy and workforce. Many child care facilities permanently closed leaving numerous providers unemployed. Child care facilities that remained open did their best to provide safe care with limited resources. Children and providers spend the majority of their time in these child care settings, making them one of the most important environments that may affect their health.

Unfortunately, child care has always been underfunded, despite it being essential for our economy and children’s development. As a result, child care providers lack access to the resources, training, and professional development they need to build high-quality, sustainable programs. Many child care providers are not trained in children’s environmental health; comprehensive environmental health best practices are most often not included in their professional development, licensing regulations nor their states’ quality rating improvement systems.

The science linking poor health to exposure to environmental hazards is strong and continues to grow. Studies have found environmental hazards like mold, harmful chemicals, and dust in child care facilities putting children and staff at risk.

The Children’s Environmental Health Network’s Eco-Healthy Child Care® program has been working for over 12 years to deliver technical assistance, training, and professional development to child care professionals on identifying and reducing environmental health hazards within child care settings. The child care workforce predominantly consists of Black and Brown women of child-bearing age who are low-income placing them at greater risk of exposure to environmental hazards and poor health outcomes. Therefore creating high-quality, accessible child care programs that protect the health of child care providers and the children they care for is crucial. Doing so will lead to a more resilient workforce, and healthier child care environments.

Background: Vaccination is among the primary interventions available to mitigate COVID-19 infections. However, more than 25% of the general population, including essential workers (first responders, healthcare, and frontline workers) remain not fully vaccinated due to concerns about vaccine side effects. This study aimed to identify risk factors for COVID-19 vaccine side effects among a cohort of essential workers.

Methods: COVID-19 infection rates, socio-demographics, and self-reported vaccine side effects were collected between January 2020 to February 2023 from participants of an ongoing occupational cohort who had received at least one COVID vaccine dose of Pfizer-BioNTech or Moderna (n=469). Frequencies of the most common vaccine side effects and differences in cumulative side effects by occupational group and risk factors for side effects were analyzed.

Results: Among all participants, 83%, 78%, and 18% reported at least one side effect after the first, second, and booster COVID-19 vaccine, respectively. First responders reported twice as many side effects (median=5, p<0.01) than frontline and healthcare workers. Fever (50%), headache (46%), and discomfort at the injection site (14%) were the most common side effects. Workers who reported one COVID-19 side effect were more likely to be first responders (adjusted Odds ratio=4.99; 95%CI[2.42-11.24]), with COVID-19 positive results (aOR:4.06;[2.34,7.50]), male (aOR:2.55;[1.34-4.93]), and non-Hispanics (aOR:1.78;[1.05-3.04]) compared to workers without vaccine side effects. Workers with two or more vaccine side effects were more likely first responders (aOR:3.79;[1.79-8.09]), with COVID-19 positive results (aOR:3.40;[1.85-6.56]), males (aOR:2.38;[1.30-4.03]), and non-Hispanics (aOR:1.77;[1.08-2.91]).

Conclusion: Our findings suggest that the risk of side effects from the Pfizer-BioNTech/Moderna COVID-19 vaccine among essential workers were associated with type of occupational group, worker socio-demographics, and COVID-19 positive results, but only towards less adverse side effects. Future vaccination campaigns among essential workers should consider communicating risk estimates to modify behaviors toward vaccination.

Background/Objectives

Female firefighters have an increased risk of developing cancer, including a five-fold increase in cervical cancer and a six-fold increase in breast cancer. With female firefighters comprising 9% of the U.S. firefighter workforce, this underrepresented occupational subgroup lacks existing research on cancer prevention measures specific to female reproductive cancers. In the present analysis, we used data from the Florida Firefighter Women’s Cohort Study to describe the prevalence of female firefighter cancer prevention practices.

Methods:

Baseline health and safety survey data was collected at enrollment for an ongoing longitudinal cohort study of active female firefighters in Florida. Participants used a smart tablet with REDCap to self-administer the 298-item survey instrument. Survey measures included standardized questions on cancer screening among female firefighters, as well as socio-demographic and health characteristics.

Results:

Annual enrollment survey was completed by 56 female firefighters with a median age of 34.504±8.8 years, of which 48.2% reported their current rank as Firefighter/Paramedic/EMT. Health insurance coverage was reported by 92.9% of participants. Among participants at or above the age regular breast cancer screenings is recommended (n=19), 100% reported having both a mammogram and clinical breast exam in their lifetime. Of women at or above the age at which regular cervical cancer screening is recommended (n=55), 92.7% reported having a pap smear in their lifetime, with 92.2% of those having had one in the 3 years.

Conclusion:

The data obtained from this analysis suggests that Florida female firefighters have met recommended breast and cervical cancer screening guidelines at high rates. Further research from this ongoing study targeting environmental and occupational exposures can offer greater insight into overall cancer prevention efforts in female firefighters as screening measures within this cohort were recognized.

Background and Objectives:

Cardiovascular diseases (CVD) and sudden cardiac arrest are the leading cause of death among active firefighter fatalities in US. Most of these events entail risk factors such as obesity and high blood pressure. This study aimed to determine changes in CVD risk factors within firefighters from a large municipal fire department over a 6-year period based on results from annual fitness-for-duty medical examinations.

Methods:

A fixed cohort of 613 male firefighters were included in these analyses. Fitness-for-duty medical examinations conducted from 2013 were considered baseline, with corresponding follow-ups from 2014 to 2018. Chi-square tests were performed to examine change over time in the proportion of employees in each health variable category (body mass index (BMI), systolic and diastolic blood pressure, blood glucose, triglycerides, and cholesterol). Linear mixed model for repeated measures was used to identify changes over time.

Results:

After the 6-year follow-up period, 35% of the firefighters with healthy BMI (<25) at the baseline moved into the overweight/obesity group while only 4.1% of those on the overweight/obesity group moved into the healthy weight group (p<.000). Similarly, 51% of those with normal blood pressure moved into the elevated/hypertension group after the 6-year period (p<.000). As to blood sugar, 45% of those with normal blood sugar index at the baseline were classified in the prediabetes/diabetes groups at the end of the study period (p<.000). CVD risk factors increased 0.18 units annually in firefighting personnel during the 6-year study.

Conclusions: Findings from this study showed declines in cardiovascular conditions among firefighters. It suggests that workplace wellness programs should combined clinically oriented prevention strategies focused on finding and treating cases or their early detection with strong policies and practices to tackle upstream work-related factors associated with the high rate of transfer from healthy to non-healthy cardiovascular risk groups.

Background and Objectives

The New Jersey Safe Schools Program (NJSS) provides the required trainings for work-based learning (WBL) supervision, allowing certified teachers to supervise students in school-sponsored work placements. As of March 18, 2020, NJ K-12 schools closed and teachers were required to transition to teach and conduct classroom lessons and school-sponsored activities online/virtually, due to the COVID-19 pandemic. To better understand potential mental health effects COVID-19 has had on NJ teachers, NJSS asked a subset of newer teachers in the 2021-2022 school year to share their experiences regarding safety and health while working in a school-based setting through a series of online surveys.

Methods

Two surveys were given to teachers who completed the WBL supervisor trainings provided by NJSS between October 2021 and June 2022, and a follow up assessment fall 2022. This study focuses on a group of questions regarding personal mental health of NJ teachers and mental health services offered in the schools they work in. Participants anonymously identified who should be responsible for supporting mental well-being in schools, satisfaction with school mental health services, and self-care practices implemented since the pandemic officially began in March 2020.

Results

To date, 163 teachers have successfully completed the surveys, with additional data being collected into summer 2023. Nearly 70% of teachers would recommend the available school mental health services to a colleague. Nearly 60% of teachers would also like to see an increase in the availability of mental health and counseling services at their school, as schools transition back to full time in-person learning.

Conclusions

This ongoing research recognizes the potential mental health effects the COVID-19 pandemic has had on NJ teachers and their needs expressed. Data will inform guidance to schools for how to better address identified needs, including employee wellness and positive social and emotional school environments.

BACKGROUND: The COVID-19 pandemic resulted in many changes in healthcare systems worldwide to cope with unprecedented circumstances. Delayed diagnosis and treatment may result in adverse effects on individual and public health outcomes. The World Trade Center Health Registry (WTCHR) surveyed its enrollees in 2021-22 regarding their health and well-being during the COVID-19 pandemic.

OBJECTIVE: To determine whether there was inequitable distribution of unmet healthcare needs among WTCHR enrollees by household income and occupational characteristics.

METHODS: The first WTCHR COVID-19 survey of 2021-22 asked questions about COVID-19, including whether they suffered from COVID-19, impacts of the disease, and whether they had unmet healthcare needs during the pandemic. We asked “Since the COVID-19 pandemic began (March 2020), did you need medical care not related to COVID-19?” If yes, we asked “Did you get the medical care that you needed?” We analyzed frequency of reporting unmet healthcare needs by household income and essential worker status. We calculated the concentration index to identify income-related inequalities in unmet healthcare needs.

RESULTS: 22,268 out of 36,832enrollees participated in the WTCHR’s first COVID-19 survey (60,5%). Need for medical care unrelated to COVID-19 was reported by 11,877 (54.8%). Among those needing care, unmet healthcare needs were reported by 662(5.7%). Among those with annual household income <$25,000, 13.1% reported unmet healthcare needs, compared with 3.5% reporting income >$150,000. Essential workers had a similar frequency of unmet healthcare needs (5.7%) compared with non-essential workers (5.6%). The concentration index for reporting unmet healthcare needs by income was -.199 (Std. error 0.23) indicating unmet need was concentrated among participants with lowest household income.

CONCLUSION: Inequities were observed among WTCHR enrollees during the COVID-19 pandemic, with lower income enrollees reporting a higher frequency of unmet healthcare needs. Essential worker status was not associated with an increased frequency of reported unmet healthcare needs.

Background/Objective(s): The firefighting profession has been designated as a Group 1 known carcinogen to humans by the International Agency for Research on Cancer (IARC), due to substantial occupational exposures. Firefighters are frequently exposed to polycyclic aromatic hydrocarbons (PAHs), a family of carcinogens produced during incomplete combustion. This study aimed to determine differences in firefighters’ PAH exposures on-shift and off-shift using silicone passive sampling wristbands (SWBs). Exposures were quantified for lower molecular weight (LMW) PAHs with two or three aromatic rings, and higher molecular weight (HMW) PAHs with four or more aromatic rings.

Methods: SWBs were distributed to 50 Florida firefighters during a 12-month sampling period beginning between June and November of 2021. One SWB was worn while firefighters were on-shift and off-shift. A total of 54 pairs of wristbands were collected, extracted, and analyzed via gas chromatography-mass spectrometry for 16 EPA Priority PAHs. Concentrations were reported in nanograms of PAH per gram of silicone (ng/g).

Results: Average LMW PAH exposure was 59.1 ng/g (SD=25.8) for off-shift and 63.1 ng/g (SD=49.3) for on-shift. Average HMW PAH exposure was 15.4 ng/g (SD=16.1) for off-shift and 22.5 ng/g (SD=19.9) for on-shift. A matched-pairs t-test was conducted for comparisons of exposures to six LMW PAHs and ten HMW PAHs. HMW PAH exposure was significantly higher on-shift than off-shift (p=0.0268). No significant difference was found between LMW PAH exposures on-shift and off-shift.

Conclusions:

This study found that structural firefighters are exposed to a broad range of PAHs and sustain more exposure to HMW PAHs than LMW PAHs when on-shift at fire stations and/or during fire calls than when off-shift. Compared to LMW PAHs, HMW PAHs are more frequently particle-bound, which is indicative of higher levels of smoke and particulate matter exposure on-shift.

Recent disasters such as the derailment of a Norfolk Southern train in East Palestine, Ohio highlight the critical need for safety trainings to protect workers and community residents affected by these hazardous materials incidents. Since 2014, the International Association of Fire Fighters (IAFF) has provided Hazardous Materials Operations (HazMat) training to more than 24,000 volunteer and career firefighters and response partners (e.g., public health, law enforcement, emergency management, community stakeholders) to ensure health and safety of these workers and their communities in the event of a hazardous materials incident. With support from the National Institutes of Environmental Health, the IAFF provides HazMat training to first responders and potential partner responders free of charge across the United States and Canada. The IAFF provides the HazMat trainings and related resources to first responders from urban and rural areas and tribal lands, including those from economically challenged communities. As part of a comprehensive evaluation process, the IAFF recently developed a standard safety performance measure to assess the relationship between the IAFF HazMat training and improvements in safety-related performance outcomes. This presentation will highlight the design and developmental evaluation of the standard safety performance measure to assess critical behaviors associated with safely responding to hazardous materials incidents. Findings will be presented according to four safety performance dimensions: (1) using personal protective equipment; (2) engaging in work practices to reduce risk; (3) communicating safety and health information; and (4) exercising employee rights and responsibilities. Information on individual and contextual factors that contribute to improvement to training-related safety performance of firefighters and response partners also will be presented. Implications for strengthening related worker safety programs, thereby making better use of available resources and strategies, particularly for those in resource-constrained communities, will be discussed.