Exposures to environmental phenols in Southern California firefighters and findings of elevated urinary benzophenone-3 levels.

Firefighters are at increased risk for exposure to toxic chemicals compared to the general population, but few studies of this occupational group have included biomonitoring. We measured selected phenolic chemicals in urine collected from 101 Southern California firefighters. The analytes included bisphenol A (BPA), triclosan, benzophenone-3 (BP-3), and parabens, which are common ingredients in a range of consumer products. BP-3, BPA, triclosan, and methyl paraben were detected in almost all study subjects (94-100%). The BP-3 geometric mean for firefighters was approximately five times higher than for a comparable National Health and Nutrition Examination Survey (NHANES) subgroup. Demographic and exposure data were collected from medical records and via a questionnaire, and covariates were examined to assess associations with BP-3 levels. BP-3 levels were elevated across all firefighter age groups, with the highest levels observed in the 35 to 39year old group. Body fat percentage had a significant inverse association with BP-3 concentrations. Our results indicate pervasive exposure to BP-3, BPA, triclosan, and methyl paraben in this population of firefighters, consistent with studies of other populations. Further research is needed to investigate possible explanations for the higher observed BP-3 levels, such as occupational or California-specific exposures.

High levels of polybrominated diphenyl ethers in vacuum cleaner dust from California fire stations.

Firefighters are exposed to chemicals during fire events and may also experience chemical exposure in their fire stations. Dust samples from used vacuum cleaner bags were collected from 20 fire stations in California and analyzed for polybrominated diphenyl ethers (PBDEs), polycyclic aromatic hydrocarbons (PAHs), and polychlorinated biphenyls (PCBs) using gas chromatography-mass spectrometry. Median dust concentrations were higher for PBDEs (e.g., 47 000 ng/g for BDE-209) than for PAHs (e.g., 220 ng/g for benzo[a]pyrene) or PCBs (e.g., 9.3 ng/g for PCB-180). BDE-209 concentrations in dust from California fire stations were among the highest of any previously documented homes or occupational settings in the world. We examined factors such as the frequency of emergency responses, the number of fire vehicles on site, and building age, but we could not account for the high levels of BDE-209 observed in fire station dust. Based on the findings of our pilot study, we hypothesize that possible sources of BDE-209 in fire stations include contaminated ash tracked back from fire events via boots, clothing, and other equipment as well as specialized equipment treated with BDE-209, including turnout gear and fire vehicles. We suggest possible follow-up studies to confirm these hypotheses.

High exposure of California firefighters to polybrominated diphenyl ethers.

Concern about persistent organic pollutants (POPs) in Californians prompted the state's biomonitoring program to conduct a study in firefighters, who are occupationally exposed to high levels of POPs. In this work we present serum concentrations of several classes of POPs (polybrominated diphenyl ethers [PBDEs], polychlorinated biphenyls [PCBs], and organochlorine pesticides [OCPs]) in 101 Southern California firefighters. Despite recently reported declining trends of PBDEs in Californians, high levels were measured in firefighters' serum (Σ5PBDEs: median = 59.1 ng/(g of lipid); range = 18.8-714 ng/(g of lipid)) in comparison to other populations in California during the same period. In addition, nearly one-third of subjects had particularly high serum levels of decabromodiphenyl ether (BDE-209), consistent with other recent results in firefighters; this pattern may be a marker of recent firefighting activity. In contrast, serum levels of PCBs and OCPs measured in firefighters' sera were not elevated compared to U.S. levels. Multivariable analysis indicated that lower levels of serum PBDEs were associated with turnout gear cleaning and storage practices after fires. Our study supports the hypothesis that firefighting activities are likely to increase exposure to PBDEs and that good housekeeping and personal hygiene practices may reduce exposure to these compounds.

Biomonitoring in California firefighters: metals and perfluorinated chemicals.

OBJECTIVE: To assess California firefighters' blood concentrations of selected chemicals and compare with a representative US population. METHODS: We report laboratory methods and analytic results for cadmium, lead, mercury, and manganese in whole blood and 12 serum perfluorinated chemicals in a sample of 101 Southern California firefighters. RESULTS: Firefighters' blood metal concentrations were all similar to or lower than the National Health and Nutrition Examination Survey (NHANES) values, except for six participants whose mercury concentrations (range: 9.79 to 13.42 µg/L) were close to or higher than the NHANES reporting threshold of 10 µg/L. Perfluorodecanoic acid concentrations were elevated compared with NHANES and other firefighter studies. CONCLUSIONS: Perfluorodecanoic acid concentrations were three times higher in this firefighter group than in NHANES adult males. Firefighters may have unidentified sources of occupational exposure to perfluorinated chemicals.

Short-term test-retest reliability of the Job Content Questionnaire and Effort-Reward Imbalance Questionnaire items and scales among professional firefighters.

Relatively little is known about the short-term test-retest reliability of the Job Content Questionnaire (JCQ) and Effort-Reward Imbalance Questionnaire (ERIQ). Seventeen JCQ and six ERIQ items were qualitatively reviewed by 19 firefighters in focus groups. The items were then administered twice to 81 firefighters with a time interval of 1-8 weeks. The short-term reliability of the JCQ and ERIQ items and scales with the four-point Likert item responses was at least fair or moderate with several complementary statistical methods. It improved substantially when the four-point responses were simplified into the two ('agree' or 'disagree') responses. The JCQ psychological demands and the ERIQ effort scales were among the least reliable scales and their items were most frequently indicated by the firefighters to be clarified. The responses of professional firefighters to the JCQ and ERIQ items and scales were stable during an 8-week period, particularly when dichotomous item responses were used.

Very Long (> 48 hours) Shifts and Cardiovascular Strain in Firefighters: a Theoretical Framework.

Shift work and overtime have been implicated as important work-related risk factors for cardiovascular disease (CVD). Many firefighters who contractually work on a 24-hr work schedule, often do overtime (additional 24-hr shifts) which can result in working multiple, consecutive 24-hr shifts. Very little research has been conducted on firefighters at work that examines the impact of performing consecutive 24-hr shifts on cardiovascular physiology. Also, there have been no standard field methods for assessing in firefighters the cardiovascular changes that result from 24-hr shifts, what we call "cardiovascular strain". The objective of this study, as the first step toward elucidating the role of very long (> 48 hrs) shifts in the development of CVD in firefighters, is to develop and describe a theoretical framework for studying cardiovascular strain in firefighters on very long shifts (i.e., > 2 consecutive 24-hr shifts). The developed theoretical framework was built on an extensive literature review, our recently completed studies with firefighters in Southern California, e-mail and discussions with several firefighters on their experiences of consecutive shifts, and our recently conducted feasibility study in a small group of firefighters of several ambulatory cardiovascular strain biomarkers (heart rate, heart rate variability, blood pressure, salivary cortisol, and salivary C-reactive protein). The theoretical framework developed in this study will facilitate future field studies on consecutive 24-hr shifts and cardiovascular health in firefighters. Also it will increase our understanding of the mechanisms by which shift work or long work hours can affect CVD, particularly through CVD biological risk factors, and thereby inform policy about sustainable work and rest schedules for firefighters.

Exploring occupational and health behavioral causes of firefighter obesity: a qualitative study.

BACKGROUND: Firefighters, as an occupational group, have one of the highest prevalence rates of obesity. A qualitative study investigated occupational and health behavioral determinants of obesity among firefighters. METHODS: Four focus groups were conducted with firefighters of every rank as Phase I of the FORWARD study which was designed to assess health behavioral and occupational characteristics related to obesity in firefighters. RESULTS: Analysis revealed five main themes of central importance to firefighters: (1) fire station eating culture; (2) night calls and sleep interruption; (3) supervisor leadership and physical fitness; (4) sedentary work; and (5) age and generational influences. CONCLUSION: The results showed a strong interrelationship between occupational and health behavioral causes of obesity in firefighters. The relevance of these qualitative findings are discussed along with the implications for future obesity interventions with firefighters.

Exploring occupational and behavioral risk factors for obesity in firefighters: a theoretical framework and study design.

Firefighters and police officers have the third highest prevalence of obesity among 41 male occupational groups in the United States (US). However, few studies have examined the relationship of firefighter working conditions and health behaviors with obesity. This paper presents a theoretical framework describing the relationship between working conditions, health behaviors, and obesity in firefighters. In addition, the paper describes a detailed study plan for exploring the role of occupational and behavioral risk factors in the development of obesity in firefighters enrolled in the Orange County Fire Authority Wellness Fitness Program. The study plan will be described with emphasis on its methodological merits: adopting a participatory action research approach, developing a firefighter-specific work and health questionnaire, conducting both a cross-sectional epidemiological study using the questionnaire and a sub-study to assess the validity of the questionnaire with dietary intake and physical activity measures, and evaluating the strengths and weaknesses of the body mass index as an obesity measure in comparison to skinfold-based percent body fat. The study plan based on a theoretical framework can be an essential first step for establishing effective intervention programs for obesity among professional and voluntary firefighters.

Psychosocial working conditions and active leisure-time physical activity in middle-aged us workers.

OBJECTIVES: This study was to examine whether psychosocial work characteristics such as job control, psychological job demands, and their combinations are associated with leisure-time physical activity (LTPA) in US workers. MATERIALS AND METHODS: 2019 workers (age range: 32 to 69) from the National Survey of Midlife Development in the United States (MIDUS) II study (2004-2006) were chosen for this cross-sectional study. Job control and job demands were measured by standard questionnaire items. Active LTPA was defined as "moderate or vigorous" level of physical activity. RESULTS: After controlling for covariates (e.g., age, race, education, income, physical effort at work, obesity, and alcohol consumption), high job control was associated with active LTPA. Active jobs (high control and low demands) and low-strain jobs (high control and high demands), compared to passive jobs (low control and low demands), increased the odds for active LTPA. The associations varied by sex and education level. Job demands alone were not associated with active LTPA. CONCLUSIONS: Having on-the-job learning opportunities and decision authority on their tasks may be conducive to active LTPA in middle-aged US workers.

Sedentary work, low physical job demand, and obesity in US workers.

BACKGROUND: Little is known about the role of low physical activity at work (sedentary work or low physical job demand) in the increasing prevalence of obesity of US workers. METHODS: This cross-sectional and secondary data analysis included 1,001 male and 1,018 female workers (age range: 32-69) from the National Survey of Midlife Development in the United States (MIDUS) II study (2004-2006). Sedentary work and physical job demand were measured by questionnaire items. Total obesity (based on body mass index) and central obesity (based on waist circumference) were defined using WHO criteria. RESULTS: After controlling for covariates (socio-demographic, psychosocial working conditions, health status, and health behaviors), sedentary work, low physical job demand, or their combination increased the risk for total and central obesity in male workers, particularly when they worked longer than 40 hr per week. Sedentary work marginally increased the risk for total and central obesity in female workers. CONCLUSIONS: Low physical activity at work is a significant risk factor for total and central obesity in middle-aged US male workers.

Evidence for excess colorectal cancer incidence among asbestos-exposed men in the Beta-Carotene and Retinol Efficacy Trial.

The relation between asbestos exposure and colorectal cancer remains controversial. The authors of this 1984-2004 US study examined the association among 3,897 occupationally exposed participants in the Beta-Carotene and Retinol Efficacy Trial (CARET) for chemoprevention of lung cancer, followed prospectively for 10-18 years. When a Cox stratified proportional hazards model was used, risks of colorectal cancer were elevated among male heavy smokers exposed to asbestos. Their relative risk was 1.36 (95% confidence interval: 0.96, 1.93) when compared with that for CARET heavy smokers not exposed to asbestos, after adjusting for age, smoking history, and intervention arm. The presence of asbestos-induced pleural plaques at baseline was associated with a relative risk of 1.54 (95% confidence interval: 0.99, 2.40); colorectal cancer risk also increased with worsening pulmonary asbestosis (p = 0.03 for trend). A dose-response trend based on years of asbestos exposure was less evident. Nonetheless, these data suggest that colorectal cancer risk is elevated among men occupationally exposed to asbestos, especially those with evidence of nonmalignant asbestos-associated radiographic changes.

Garment workers in California: health outcomes of the Asian Immigrant Women Workers Clinic.

In this cross sectional descriptive study, the demographics, risk factors, and health outcomes of a volunteer, symptomatic sample of monolingual Cantonese garment workers in the Oakland, California Chinatown area are documented. Methods included a questionnaire and clinical examination and treatment at the Asian Immigrant Women Workers Clinic, a free clinic providing culturally focused occupational health consultation and treatment for painful musculoskeletal disorders. Because garment work involves highly repetitious, sustained awkward postures, focused education on stretching and ergonomics also was provided. Results from the first 100 clients revealed a highly symptomatic sample, with an average age of 48.7 years. Sixty-six percent rated their health status as fair or poor. Sixteen percent of the sample had nerve entrapments, and 99% had a diagnosed strain or sprain of the spine or upper extremities. This population did not file workers' compensation claims because of a lack of knowledge and a fear of reprisal. This study documented the barriers to seeking care for this low wage, immigrant population.