Characterization of fire investigators' polyaromatic hydrocarbon exposures using silicone wristbands.

BACKGROUND: Exposures to polyaromatic hydrocarbons (PAHs) contribute to cancer in the fire service. Fire investigators are involved in evaluations of post-fire scenes. In the US, it is estimated that there are up to 9000 fire investigators, compared to approximately 1.1 million total firefighting personnel. This exploratory study contributes initial evidence of PAH exposures sustained by this understudied group using worn silicone passive samplers. OBJECTIVES: Evaluate PAH exposures sustained by fire investigators at post-fire scenes using worn silicone passive samplers. Assess explanatory factors and health risks of PAH exposure at post-fire scenes. METHODS: As part of a cross-sectional study design, silicone wristbands were distributed to 16 North Carolina fire investigators, including eight public, seven private, and one public and private. Wristbands were worn during 46 post-fire scene investigations. Fire investigators completed pre- and post-surveys providing sociodemographic, occupational, and post-fire scene characteristics. Solvent extracts from wristbands were analyzed via gas chromatography-mass spectrometry (GC-MS). Results were used to estimate vapor-phase PAH concentration in the air at post-fire scenes. RESULTS: Fire investigations lasted an average of 148 minutes, standard deviation ± 93 minutes. A significant positive correlation (r=0.455, p<.001) was found between investigation duration and PAH concentrations on wristbands. Significantly greater time-normalized PAH exposures (p=0.039) were observed for investigations of newer post-fire scenes compared to older post-fire scenes. Regulatory airborne PAH exposure limits were exceeded in six investigations, based on exposure to estimated vapor-phase PAH concentrations in the air at post-fire scenes. DISCUSSION: Higher levels of off-gassing and suspended particulates at younger post-fire scenes may explain greater PAH exposure. Weaker correlations are found between wristband PAH concentration and investigation duration at older post-fire scenes, suggesting reduction of off-gassing PAHs over time. Exceedances of regulatory PAH limits indicate a need for protection against vapor-phase contaminants, especially at more recent post-fire scenes.

Self-reported and objectively measured occupational exposures, health, and safety concerns among fishermen: A cross-sectional Fishing Industry Safety and Health (FISH) pilot study.

BACKGROUND: Fishing industry workers are exposed to hazardous working conditions, engage in strenuous labor, and work long hours in variable weather conditions. Despite these known employment challenges, little is known of their perceived occupational health and safety concerns. In this pilot study, we: (1) describe fishermen's perceptions on worker- and organizational-level characteristics that impact occupational health and safety; and (2) estimate environmental exposure to polycyclic aromatic hydrocarbons (PAHs) encountered during fishing activities. METHODS: We collected both qualitative and quantitative data from Mississippi and Florida fishermen. Using an ethnographic approach, the study team conducted 1-h key informant interviews, administered a one-page demographic survey, and collected objective measurements to PAHs using silicone-based passive sampling wristbands. RESULTS: Study participants (n = 17) had a mean age of 50.9 years (SD = 11.7), 88.2% were male, 94.1% white, 100.0% non-Hispanic/Latino, and 52.9% were married. Approximately, 87.5% reported fishing as their primary job, with a mean of 26.4 years in the industry (SD = 15.3). Four broad themes describing the culture of the fishing industry, common workplace exposures that impact fishermen's safety and health, and facilitators and barriers to safety while working in the fishing industry were documented. Deckhands had the lowest mean exposure to PAHs (8.3 ppb), followed by crew members (11.0 ppb), captains (82.64 ppb), and net makers (208.1 ppb). CONCLUSIONS: Gulf coast fishermen expressed specific occupational health and safety concerns and were exposed to carcinogenic PAHs during regular work. Opportunities exist and strategies are needed for health protection and health promotion interventions among Gulf fishermen.

Characterising near misses and injuries in the temporary agency construction workforce: qualitative study approach.

OBJECTIVES: To understand and characterise the construct of 'near misses' from the perspective of temporary construction workers and to describe the safety and health risks associated with and contributing to near misses and injuries in temporary workers in the construction industry. METHODS: Six semistructured language-sensitive (ie, English and Spanish) focus group discussions were conducted with workers (n=43) employed with temporary staffing agencies in South Florida. This convenience sample completed a demographic questionnaire prior to the focus group discussion. A general inductive approach was used to examine near misses in the construction industry and the unique safety and health concerns of temporary workers. RESULTS: Four broad themes describing near misses, reporting practices and workplace safety hazards in the construction industry were derived from the group discussions: (1) non-standard workers in the construction industry draw a clear distinction between near misses and injury and believe their best protections from both occur at the worker level; (2) social network structure on construction worksites is an effective way to protect workers against injury and near misses; (3) safety and health priorities and policies at the organisational level differ from those at the worker level, which contributes to workplace injury; and (4) reporting of safety concerns and near misses is influenced by injury severity. CONCLUSIONS: Temporary workers in the construction industry are familiar with near misses but have limited resources to protect themselves against potential health and safety hazards. These non-standard workers addressed unique barriers to staying safe at work and identified potential improvements.

Epidemiology of SARS-CoV-2 antibodies among firefighters/paramedics of a US fire department: a cross-sectional study.

OBJECTIVES: We estimate the point seroprevalence of SARS-CoV-2 antibodies in the frontline firefighter/paramedic workforce of a South Florida fire department located in the epicentre of a State outbreak. METHODS: A cross-sectional study design was used to estimate the point seroprevalence of SARS-CoV-2 antibodies using a rapid immunoglobulin (Ig)M-IgG combined point-of-care lateral flow immunoassay among frontline firefighters/paramedics collected over a 2-day period, 16-17 April 2020. Fire department personnel were emailed a survey link assessing COVID-19 symptoms and work exposures the day prior to the scheduled drive-through antibody testing at a designated fire station. Off-duty and on-duty firefighter/paramedic personnel drove through the fire station/training facility in their personal vehicles or on-duty engine/rescue trucks for SARS-CoV-2 antibody testing. RESULTS: Among the 203 firefighters/paramedics that make up the fire department workforce, 18 firefighters/paramedics (8.9%) tested positive for SARS-CoV-2 antibodies, of which 8 firefighters/paramedics (3.9%) were IgG positive only, 8 (3.9%) were IgM positive only and 2 (0.1%) were IgG/IgM positive. The positive predictive value (PPV) of the serological test is estimated to be 33.2% and the negative predictive value is 99.3%. The average number of COVID-19 case contacts (ie, within 6 feet of an infected person (laboratory-confirmed or probable COVID-19 patient) for ≥15 min) experienced by firefighters/paramedics was higher for those with positive serology compared with those with negative (13.3 cases vs 7.31 cases; p=0.022). None of the antibody positive firefighters/paramedics reported receipt of the annual influenza vaccine compared with firefighters/paramedics who tested negative for SARS-CoV-2 antibodies (0.0% vs 21.0%; p=0.027). CONCLUSION: Rapid SARS-CoV-2 IgM-IgG antibody testing documented early-stage and late-stage infection in a firefighter workforce providing insight to a broader medical surveillance project on return to work for firefighters/paramedics. Given the relatively low PPV of the serological test used in this study back in April 2020, caution should be used in interpreting test results.

Evaluation of silicone-based wristbands as passive sampling systems using PAHs as an exposure proxy for carcinogen monitoring in firefighters: Evidence from the firefighter cancer initiative.

Compared to the general population, firefighters are known to sustain greater levels of exposure to hazardous compounds, despite their personal protective equipment, also known as turnout gear. Among the most significant toxins that firefighters are chronically exposed to are polycyclic aromatic hydrocarbons (PAHs). Additionally, firefighters have also been noted to exhibit an increased incidence of certain types of cancer. Considering a probable link between exposure to PAHs and increased rates of cancer in the fire service, we aim to document ambient chemical concentrations in the firefighter work environment. Our strategy involves the use of silicone-based wristbands that have the capacity to passively sorb PAHs. To determine if wristbands can serve as an effective chemical monitoring device for the fire service, silicone wristbands were pilot-tested as personal sampling devices for work environment risk monitoring in active-duty firefighters. Recovered wristbands underwent multiple extraction steps, followed by GC-MS analysis to demonstrate their efficacy in monitoring PAHs in the firefighter environment. Initial findings from all wristband samples taken from firefighters showed multiple exposures to various PAHs of concern for the health of the firefighters when in a fire environment. In addition to PAH monitoring, we examined known and potential sources of PAH contamination in their work environment. To that end, profiles of elevated PAH concentrations were documented at various fire stations throughout South Florida, for individual firefighters both during station duties and active fire response.

Per- and polyfluoroalkyl substances (PFAS) and thyroid hormone measurements in dried blood spots and neonatal characteristics: a pilot study.

BACKGROUND: Pediatric thyroid diseases have been increasing in recent years. Environmental risk factors such as exposures to chemical contaminants may play a role but are largely unexplored. Archived neonatal dried blood spots (DBS) offer an innovative approach to investigate environmental exposures and effects. OBJECTIVE: In this pilot study, we applied a new method for quantifying per- and polyfluoroalkyl substances (PFAS) to 18 archived DBS from babies born in California from 1985-2018 and acquired thyroid hormone measurements from newborn screening tests. Leveraging these novel data, we evaluated (1) changes in the concentrations of eight PFAS over time and (2) the relationship between PFAS concentrations, thyroid hormone concentrations, and neonatal characteristics to inform future research. METHODS: PFAS concentrations in DBS were measured using ultra-high-performance liquid chromatography-mass spectrometry. Summary statistics and non-parametric Wilcoxon rank-sum and Kruskal-Wallis tests were used to evaluate temporal changes in PFAS concentrations and relationships between PFAS concentrations, thyroid hormone concentrations, and neonatal characteristics. RESULTS: The concentration and detection frequencies of several PFAS (PFOA, PFOS, and PFOSA) declined over the assessment period. We observed that the timing of specimen collection in hours after birth was related to thyroid hormone but not PFAS concentrations, and that thyroid hormones were related to some PFAS concentrations (PFOA and PFOS). IMPACT STATEMENT: This pilot study examines the relationship between concentrations of eight per- and polyfluoroalkyl substances (PFAS), thyroid hormone levels, and neonatal characteristics in newborn dried blood spots (DBS) collected over a period of 33 years. To our knowledge, 6 of the 22 PFAS we attempted to measure have not been quantified previously in neonatal DBS, and this is the first study to examine both PFAS and thyroid hormone concentrations using DBS. This research demonstrates the feasibility of using newborn DBS for quantifying PFAS exposures in population-based studies, highlights methodological considerations in the use of thyroid hormone data for future studies using newborn DBS, and indicates potential relationships between PFAS concentrations and thyroid hormones for follow-up in future research.

Perceptions of Occupational Cancer Risk and Prevention Among Dominican Republic Firefighters: A Qualitative Study.

OBJECTIVES: Characterize occupational cancer risk perceptions and attitudes toward cancer prevention practices among firefighters in the Dominican Republic. METHODS: Focus group discussions and key informant interviews were conducted in June 2019 among firefighters from three fire departments. Themes were inductively created using a qualitative descriptive approach. RESULTS: Thirty-seven firefighters were interviewed with a group mean age of 36.2 ±â€Š10.3 years, of which 97.3% were male, and 37.1% worked at least 10 years. Six themes emerged: 1) availability of personal protective equipment (PPE); 2) toxic exposure during fire suppression; 3) work-related stress; 4) lack of workplace health promotion activities; 5) Dominican culture impacts medical checkups; and 6) expensive medical copays limits healthcare access. CONCLUSION: Dominican firefighters are willing to adopt cancer prevention practices, however organizational barriers (ie, PPE availability, cultural barriers, and health promotion practices) limit engagement.

Characterizing the Health and Safety Concerns of U.S. Rideshare Drivers: A Qualitative Pilot Study.

BACKGROUND: Despite the growth and popularity of gig work, limited information exists about the occupational health and safety concerns faced by individuals who are employed through ridesharing online applications. In this qualitative study, we characterized the perceived health and safety concerns of drivers employed by rideshare companies. METHODS: During September-October 2019, we requested car rides, using digital rideshare platforms. During the ride, drivers responded verbally to a brief closed-end sociodemographic and work characteristics survey. A semi-structured interview script was used to collect rideshare driver perceptions on health and safety risks. FINDINGS: A total of 35 rideshare drivers of group mean age of 43.1 ± 11.2 years were interviewed, of whom 77.1% were male and 82.9% identified as Latino. Sixty percent of participants reported rideshare as their primary job, working an average of 47.9 ± 19.6 hours weekly (minimum = 6 hours, maximum = 84 hours). Drivers enjoyed job autonomy yet faced stressors such as passenger risky behavior, car accidents, and lack of policies that protect the driver. Rideshare drivers also raised concerns about their current health status, economic pressures, and worker safety. CONCLUSION/APPLICATION TO PRACTICE: Drivers are forced to extend work hours to support themselves financially, exacerbating their current health concerns and safety risks as it means more time spent working in their sedentary job, compromising their mental and physical health as well as their safety. Occupational health and safety programs geared toward workers in the gig economy are needed.

Perceptions of Work-Related Health and Cancer Risks Among Women Firefighters: A Qualitative Study.

OBJECTIVES: We use a qualitative method to gain further insight into women firefighters' experiences, perceptions of cancer, health, and safety risks in the fire service. METHODS: We conducted six focus groups with U.S. women firefighters. Participants engaged in a 60 to 75-minute, semi-structured discussion and completed a sociodemographic questionnaire. A qualitative descriptive approach was used to inductively create themes. Data collection concluded when saturation was met. RESULTS: Forty-nine women firefighters participated. Qualitative results indicated the main health concerns include: occupational cancer risks including, risks related to hazardous exposures, sleep disruption and stress; and women's health concerns including, cancer, pregnancy and breastfeeding, and lack of resources. CONCLUSIONS: Women firefighters are concerned about their risk for cancer due to their occupation and identify a lack of resources specific to health and safety needs of women firefighters.

COVID-19 Vaccine Acceptability Among US Firefighters and Emergency Medical Services Workers: A Cross-Sectional Study.

OBJECTIVES: Estimate the point prevalence of COVID-19 vaccine acceptability among US firefighters and Emergency Medical Services (EMS) workers. METHODS: A cross-sectional study design was used to administer an anonymous online survey to a national non-probabilistic sample of firefighter and EMS workers. RESULTS: Among the 3169 respondents, 48.2% expressed high acceptability of the COVID-19 vaccine when it becomes available, while 24.2% were unsure and 27.6% reported low acceptability. Using the "high COVID-19 vaccine acceptability" group as the reference category, the groups with greater odds of reporting low acceptability included those: 30 to 39 years of age (odds ratio = 3.62 [95% confidence interval = 2.00 to 6.55]), Black race (3.60 [1.12 to 11.53]), Hispanic/Latinx ethnicity (2.39 [1.45 to 3.92]), with some college education (2.06 [1.29 to 3.27]), married (1.65 [1.03 to 2.65]), of current rank firefighter/EMS (2.21 [1.60 to 3.08]). CONCLUSIONS: Over half of US firefighters and EMS workers were uncertain or reported low acceptability of the COVID-19 vaccine when it becomes available.

Impact of Visual Thinking Strategies (VTS) on the Analysis of Clinical Images: A Pre-Post Study of VTS in First-Year Medical Students.

To assess the effectiveness of Visual Thinking Strategies (VTS) in medical education curricula, a pretest-posttest experimental study design was used to evaluate the impact of participating in VTS workshops on first-year medical students. A total of forty-one intervention and sixty comparative students completed the study which included the analysis of clinical images followed by a measurement of word count, length of time analyzing images, and quality of written observations of clinical images. VTS training increased the total number of words used to describe clinical images, the time spent analyzing the images, and the number of clinically relevant observations.

Characterizing Objective and Self-Reported Levels of Physical Activity Among Florida Firefighters Across Weight Status Category: A Cross-Sectional Pilot Study.

Background: Firefighters suffer from a disproportionally high burden of chronic diseases that could be prevented from regular bouts of physical activity (PA). The goal(s) of this pilot study were to (a) describe typical PA levels in professional paid firefighters, and (b) assess their ability to estimate their own levels of PA. Methods: A repeated measures study design was used to assess self-reported and objectively measured levels of PA from a non-probabilistic sample of firefighters (n = 18) over 1 week. Objective measures of PA, measured by accelerometry were defined as the number of minutes spent in sedentary, light, moderate, and vigorous PA. Firefighters completed a follow-up questionnaire recording their self-reported levels of PA. Results: Obese (body mass index [BMI] > 30 kg/m2) firefighters spent 8,033 ± 2,543 minutes/week in sedentary activity, overweight (BMI = 25-29 kg/m2) firefighters 6,533 ± 1,587 minutes/week, and healthy weight (BMI = 18.5-24.9 kg/m2) firefighters 5,846 ± 1,160 minutes/week. The difference in self-reported weekly minutes spent in light, moderate, and vigorous activity and objectively measured minutes in activity was calculated. Healthy weight firefighters reported the least difference (1,924 minutes/week), followed by the overweight (3,884 minutes/week) and obese (5,749 minutes/week). Conclusion/Application to Practice: Firefighters poorly estimated their true level of PA compared with their objectively measured PA and obese firefighters reported the greatest inconsistency. Occupational health nurses should aim to support firefighters in achieving PA levels that assist firefighters to achieve a healthy weight and educate them about what it means to be engaged in each level of PA.

Cell Phone Ownership and Cellular Text/Email Capabilities Among Temporary and Payroll Construction Workers.

Background: With high rates of temporary workers and a transient worker population, the U.S. construction workforce presents a challenge for long-term research and outreach activities. Increasing availability of affordable cell phone technologies may provide an opportunity for research follow-up among construction workers once they leave the worksite. Using pilot study survey data we characterize and examine the association of cell phone technology ownership and cellular text/email services among a non-probabilistic sample of payroll and temporary construction workers. Methods: A cross-sectional study design was used to administer a one-time paper-based anonymous survey to construction workers working at construction sites in Florida, USA. The survey featured questions on sociodemographic characteristics, occupational history, cell phone technology ownership, and cellular text/email services capabilities. Results: Among the 223 construction worker survey respondents, 31.4% identified as temporary workers and 68.6% were on payroll and 87.4% owned a cell phone. Construction workers who own a cell phone had greater than a high school education (28.9% vs. 25.0%; p = 0.019), made >$30,000/year (27.1% vs. 14.8%; p = 0.011), had same cell phone number for >1 year (74.4% vs. 40.7%; p = 0.001), and were employed as a payroll worker (71.0% vs. 50.0%; p = 0.037). Temporary construction workers compared to their payroll counterparts were significantly less likely to have email services on their cell phone [unadjusted-odds ratio 0.41 (95% CI: 0.17-0.97)]. Conclusion: Cell phone ownership and smartphone-enabled technologies such as email/texting capabilities are higher among payroll than temporary construction workers. Further research on frequency of cell phone use and types of email/texting services used by construction workers are needed.

Objective Measurement of Carcinogens Among Dominican Republic Firefighters Using Silicone-Based Wristbands.

OBJECTIVE: Characterize objective measurements of carcinogenic exposure using passive sampling silicone-based wristbands among Dominican firefighters. METHODS: Firefighters from a metropolitan fire service in the Dominican Republic were asked to wear a silicone-based wristband during one typical 24-hour shift. A pre- and post-shift survey collected work shift characteristics. Wristbands were processed for the type and quantity of polycyclic aromatic hydrocarbons (PAHs), a family of known carcinogenic compounds. RESULTS: Fifteen firefighters wore a wristband, of which 73.3% responded to a fire with an average of 3.7 calls during the shift. Total PAH exposure was significantly higher among firefighters who responded to a fire versus firefighters with no fire during their shift (261 parts per billion [ppb] vs 117 ppb, P = 0.003). CONCLUSIONS: Silicone-based wristbands as objective passive samplers documented exposure to carcinogenic compounds during a typical 24-hour firefighter shift.

Fire Service Organizational-Level Characteristics Are Associated With Adherence to Contamination Control Practices in Florida Fire Departments: Evidence From the Firefighter Cancer Initiative.

OBJECTIVES: To characterize the types of contamination control practices followed by Florida fire departments and examine the association between fire department organizational-level characteristics and adherence to contamination control practices. METHODS: Using a cross-sectional study design, a survey was administered to 142 Florida firefighters. Validated survey measures assessed organizational level characteristics and 32 recommended national contamination control practices. RESULTS: An average of 18.9 contamination control practices (standard deviation = 5.54; min = 3; max = 30) were reported by fire departments of which, wearing personal protective equipment (PPE) according to manufacturer instructions (98.9%) and access to special machine for cleaning (91%) were most cited. Fire departments with one or more health and safety officers had significantly higher implementation of contamination control practices (P = 0.032). CONCLUSION: Health and safety officers may have a positive impact on the number of contamination control practices followed in Florida fire departments.

Impact of Organizational-level Factors on Cancer Screening Activities in Fire Departments: A Cross-sectional Study from the Sylvester Firefighter Cancer Initiative.

Despite known individual-level facilitators of cancer screening, the impact of work-related organizational-level characteristics on cancer screening is unknown particularly in the firefighter workforce who is experiencing a disproportionate burden of cancer. We examine the association between fire service organizational-level factors and implementation of cancer screening activities within Florida fire departments. We used a cross-sectional observational study design to survey fire department leaders attending the Florida Fire Chiefs' Association Health and Safety conference about cancer screening activities implemented by their fire departments. Measures assessing organizational-level characteristics include: fire department workforce size, total health and safety officers, fire department geographic location, employment type, leadership support and capacity. Among the 126 fire departments participating (response rate = 47.7%), approximately 44% reported some type of cancer screening activity in the 12 months prior to survey administration. The proportion of fire departments with two or more health and safety officers was significantly greater among those with cancer screening activities as compared with departments without cancer screening activities (46.3% vs. 24.2%; P = 0.016). There were no statistical differences noted for cancer screening activities among all other organizational-level characteristics including workforce size, fire department geographic location, employment type, leadership support, and individual capacity measures. Most organizational-level characteristics of a fire department evaluated in this study were not associated with cancer screening activities; however, having two or more dedicated health and safety officers supports the delivery of cancer screening activities. These officers may be a key to improving availability of cancer screening activities at work.

Developing a Worksite-based Culturally Adapted Smoking Cessation Intervention for Male Hispanic/Latino Construction Workers.

INTRODUCTION: Over 2.6 million Hispanic/Latino construction workers (CWs) live in the US; 91% of South Florida CWs are Hispanic/Latino. CWs have higher smoking and lower cessation rates than other workers. Limited access to cessation services, worksite turnover, and lack of interventions tailored to culture/occupation hinder cessation. Partnering with worksite food trucks to deliver unique cessation interventions may improve these efforts. AIMS: To explore a novel cessation approach, assess worker/worksite acceptability, and seek input into intervention development. METHODS: In 2016, we conducted five semi-structured focus groups with 37 daily smoking Hispanic/Latino CWs. Constant comparative analysis was used to examine a priori themes regarding smoking behaviors, cessation treatments, intervention delivery, cultural adaptation, and quit interest. RESULTS: CWs reported tremendous job stress. Most smoking occurred during the workday and most CWs did not use Nicotine Replacement Therapy with past quit attempts. Most CWs were open to a worksite face-to-face group cessation intervention before work (many underutilize breaks and feel pressure to keep working). CWs felt it unnecessary to tailor the intervention to Hispanics/Latinos indicating smokers are the same regardless of race/ethnicity. CONCLUSIONS: Findings demonstrate the need to consider work environments, job demands/stress, and worker preferences when developing accessible and acceptable cessation interventions.

Physical Exposures, Work Tasks, and OSHA-10 Training Among Temporary and Payroll Construction Workers.

OBJECTIVE: We characterize and compare the self-reported physical exposures, work tasks, and OSHA-10 training in a non-probabilistic sample of temporary and payroll construction workers. METHODS: In June 2016, a total of 250 payroll and temporary general laborers employed at Florida construction sites completed a survey at the job site as part of the falls reported among minority employees (FRAME) study. RESULTS: Workers employed through temp agencies (57.1%) were significantly more likely to report moving or lifting materials more than 100 pounds than payroll workers (38.5%; P < 0.01). Temporary construction workers with 10-hour OSHA training (22.2%) spent significantly less time with intense hand use/awkward hand posture than temporary workers without 10-hour OSHA training (46.9%; P = 0.048). CONCLUSIONS: Temp construction workers with OSHA 10-hour training reported less hazardous physical postures than workers without the same training.