Florida Firefighters Research Articles

Weight Status and Binge Drinking Among Male and Female Florida Firefighters.

The aim of the study is to examine the association between weight status and binge drinking among Florida firefighters. Health survey data collected between 2015 and 2019 among Florida firefighters participating in the Annual Cancer Survey were analyzed for weight class (healthy, overweight, obese) and binge-drinking behaviors. Binary logistic regression models were fit and stratified by sex while controlling for sociodemographic and health characteristics. Among 4002 firefighter participants, 45.1% binge drink, 50.9% are overweight, and 31.3% are obese. Among male firefighters, being overweight (adjusted odds ratio = 1.34; 95% confidence interval = 1.10-1.64) or obese (1.29; 1.04-1.61) was significantly associated with binge drinking compared with healthy weight counterparts. In female firefighters, being obese (2.25; 1.21-4.22) was significantly associated with binge drinking but being overweight was not. Being overweight or obese is selectively associated with binge drinking among male and female firefighters.

Prevalence of Hearing Loss and Perceptions of Hearing Health and Protection among Florida Firefighters.

Firefighters are exposed to extensive hazardous noise while on the job, both during routine tasks at the station and when responding to calls. However, little is known about firefighters' occupational noise hazards. This study employed mixed methods, including focus groups, a survey, and audiometric testing, to identify sources of noise in the firefighters' work environment, determine hearing protective strategies, discern firefighters' perceptions of occupational noise exposure and impacts to their health, and quantify the prevalence of hearing loss among South Florida firefighters. A total of 6 senior officers served in an expert panel, 12 participated in focus groups, 300 completed the survey, and 214 received audiometric tests. Most firefighters were unaware of the risk and their departments' policies, and did not participate in hearing protection practices and avoided using hearing protection devices, which they believed impede team communication and situational awareness. Nearly 30% of participating firefighters showed mild to profound hearing loss, a prevalence that is considerably worse than expected by normal aging alone. Educating firefighters about noise-induced hearing loss early in their careers may have significant health implications for their future. These findings provide insights for developing technologies and programs to mitigate the effects of noise exposure in the firefighting population.

Sleep Latency and Post-Traumatic Stress Disorder Among Retired Career Florida Firefighters: Evidence From the Advancing Epidemiology of Retired Firefighters Aging Longitudinally Cohort.

Our objective was to estimate the association of post-traumatic stress disorder (PTSD) and sleep latency among retired firefighters. Baseline health survey data collected from retried career Florida firefighters participating in an ongoing prospective cohort study from 2017 to 2021 were analyzed. Risk for PTSD was assessed using a four-item primary care PTSD screening construct, and sleep onset latency was assessed by self-reported length of time to fall asleep. Among the 500 participants, 8.0% screened positive for PTSD risk and 37.6% had prolonged sleep onset latency (≥20 minutes to fall asleep). Retired firefighters with PTSD risk were 2.7 times more likely (adjusted odds ratio, 2.70; 95% confidence interval, 1.27-5.75) to have prolonged sleep latency compared with those without PTSD risk while controlling for covariates. Retired firefighters who screen positive for PTSD risk are three times more likely to report delayed sleep onset latency.

Rapid bioanalytical screening for the assessment of internalized exposure to Polycyclic Aromatic Hydrocarbons in clinical samples of Florida Firefighters

BACKGROUND AND AIM: Polycyclic aromatic hydrocarbons (PAHs) are toxic byproducts of combustion and ubiquitous environmental pollutants which can cause carcinogenesis. Firefighters are routinely exposed to these contaminants and numerous studies have described a high incidence of various cancer types in firefighters compared to the general population. Our aim was to develop a streamlined process that allows accurate quantitative evaluation of PAH exposure in clinical samples collected from Florida Firefighters. METHODS: Urine samples were collected from twenty-five (25) active firefighters stationed in Florida at the beginning and end of a 24-hour shift, and twenty-one (21) new recruits after the completion of different fire trainings. We developed a rapid, non-invasive method to assess their internalized exposure to PAHs as part of the Firefighter Cancer Initiative (FCI). The use of automated extraction systems and Gas Chromatography – Mass Spectrometry enabled the accurate, qualitative, and quantitative detection of PAHs identified as priority pollutants by the United States Environmental Protection Agency. RESULTS: Total PAH exposure levels of the 25 active firefighters were significantly higher after the completion of the 24-hour shift, with those that answered fire-related calls, rather than EMS calls, exhibiting the highest concentrations of individual and gross PAHs. Similarly, total internalized exposure was increased in firefighter trainees compared to controls. We observed that participation in a Class B fire training, which involves flammable liquid materials, is associated with higher exposure to PAHs compared to participation in Class A exercises that employ ordinary combustible materials. CONCLUSIONS: Our findings showcase the unsafe levels of carcinogen exposure faced routinely by firefighters, highlighting the need for further investigation of the link between occupational exposure and health-related effects. The novel biomonitoring tool we developed facilitates large-scale screening of clinical samples and can be used for real-time assessment of carcinogen exposure. KEYWORDS: PAHs, exposure assessment, firefighters, biomonitoring, occupational exposure

Abstract 25: Per- and polyfluoroalkyl substances and obesity in Florida firefighters

Abstract Background/Objective: Per- and polyfluoroalkyl substances (PFASs) are hazardous synthetic chemicals that have been linked to adverse human health effects such as cancer and endocrine disruption. Firefighters have been shown to be occupationally exposed to PFAS through aqueous film-forming foam (AFFF) used during difficult-to-suppress fires, and in the textile liners of their safety turnout gear. PFASs have both hydrophobic and hydrophilic chemical structures, giving them strong thermal stability and making them resistant to environmental and physiological degradation. Studies of human exposures to PFAS have observed associations between some PFAS and increased risk of obesity or elevated body mass index (BMI). Given the unique occupational exposures of firefighters to PFAS, we examine the association between obesity and PFAS in a sample of Florida firefighters. Methods: A cross-sectional study design was used to collect a health survey and a blood sample from a non-probabilistic sample of career Florida fighters between June and October 2021. The health surveys, administered on REDCap using tablet devices, assessed information on firefighter socio-demographic and work characteristics. We quantified 7 distinct PFASs using a solid-phase extraction-high-performance liquid chromatography-isotope dilution-tandem mass spectrometry approach; the limit of detection was between 0.5 and 0.05 ng/mL, depending on the analyte. All 7 PFASs, including Perfluorobutanesulfonic Acid (PFBS), Perfluoroheptanoic Acid (PFHpA), Perfluorohexanesulfonic Acid (PFHxS), Perfluorooctanoic Acid (PFNA), Perfluorononanoic Acid (PFNA), Perfluorooctanesulfonic Acid (PFOS), and Perfluoroctanesulfonamide (PFOSA), were detected in the blood samples; concentrations below the limit of detection were replaced by the limit of detection/√2.35. Results: Among the 208 firefighters who completed the survey and provided a blood sample, 92.8% were male, 16.2% Hispanic/Latinx, 81.7% White, 89.8% used AFFF at their fire department, with a group mean age 40.2±10.3 standard deviation. Approximately 15.8% of firefighters were of healthy weight, 51.5% overweight, and 32.7% obese. Firefighter body mass index was positively correlated with serum concentrations of PFHxS (rs=.17;p=.020) and PFBS (rs=.60;p=.26). Group geometric mean of each PFAS congener (in ng/mL): PFBS (0.09), PFHpA (0.08), PFHxS (2.17), PFOA (1.38), PFNA (0.42), PFOS (2.69), and PFOSA (0.10). Total serum PFAS concentrations was highest among obese firefighters (7.62 ng/mL) and lowest in healthy weight firefighters (6.55 ng/mL). Conclusions: Firefighters who were overweight and obese, based on body mass index, had higher total serum PFAS concentrations than those firefighters of healthy weight. Both long- and short-chain PFASs, PFHxS and PFBS respectively, were positively correlated with firefighter body mass index. Citation Format: Alberto J. Caban-Martinez, Paola Louzado Feliciano, Simi Oduwole, Natasha Schaefer Solle, Catalina Gonzalez-Umana, Thomas Stone, Erin N. Kobetz. Per- and polyfluoroalkyl substances and obesity in Florida firefighters [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 25.

Integrating User-Centered Design Into the Sylvester Firefighter Cancer Initiative’s Personal Exposure Reporter

Firefighters are potentially exposed to many carcinogens in their work. Collection of occupational hazard exposure data offers firefighters greater awareness of their health and wellness and analysis of the data provides researchers opportunities to identify firefighters’ specific health risks. The University of Miami’s Firefighters’ Cancer Initiative conducted user-centered design research with 450 Florida firefighters to develop and implement the Personal Exposure Reporter system for firefighters. Responses after product launch suggest that the system is well received and allows firefighters to successfully submit incident exposure information. The Personal Exposure Reporter will help both firefighters and cancer researchers better understand and address cancer risks.

Skin cancer screening using total body photography and digital dermoscopy: A pilot study among Florida firefighters

To the Editor: Firefighters have an increased risk of developing melanomas than the general population, with these melanomas occurring at significantly younger ages.1 Early detection of skin cancer is associated with reduced morbidity, mortality, and financial costs.2 Currently, early detection is based on self-detection and opportunistic full-body skin exam (FBSE) by trained medical providers.3 However, performing FBSE becomes challenging in settings without on-site specialists or with social distancing policies.

Comparing cancer risk estimates using occupational record linkage approaches in male Florida firefighters.

Firefighters have an increased risk of cancer, but variations in reported results could be due to differences in occupational case ascertainment. This study compares cancer risk estimates generated by identifying firefighters from their occupational title available in the Florida Cancer Data System (FCDS) versus identification by a linkage method between the FCDS and the Florida State Fire Marshal's Office. Florida firefighter employment records (1972-2012; n = 109,009) were linked with FCDS data (1981-2014; ~3.3 million records), identifying 3760 primary cancers in male firefighters. Using the FCDS occupational data field we identified 1831 male cancer cases in those classified as firefighters, first-line supervisors of firefighting and prevention workers, fire inspectors, emergency medical technicians, or paramedics. Age and calendar year-adjusted odds ratios (aOR) and 95% confidence intervals for firefighters versus non-firefighters were calculated for both groups. For skin cancers the risk estimate for FCDS-indentified firefighters was substantially lower than in the employment-record-linked firefighters (aOR = 1.06; 0.87-1.29 vs. 1.54; 1.37-1.73), but for endocrine system cancers it was greater (aOR = 2.36; 1.77-3.14 vs. 2.08; 1.71-2.53). Remaining cancer risk estimates were in the same direction for the two samples except for lymphoma (aOR = 1.10; 0.90-1.34 vs. 0.86; 0.75-0.99). Reliance on occupational title in cancer registry records to characterize firefighter cancer risk may result in estimates that are over- or underestimated depending on cancer site. The authors recommend moving toward national linkages between cancer registries and certification or other administrative records, which are a vital resource for firefighter cancer research.

18466 Skin cancer screening using total body photography and digital dermoscopy: A pilot study among firefighters

Objective: The purpose of this study was to determine the feasibility and diagnostic accuracy of total body photography (TBP) and digital dermoscopy (DD) as a triage alternative to the initial face-to-face skin cancer screening (SCS) among Florida firefighters.

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

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. 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. 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). Health and safety officers may have a positive impact on the number of contamination control practices followed in Florida fire departments.

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.

SAT-439 Thyroid Ultrasound Reports and Thyroid Function Tests in Florida Firefighters: Data from the Firefighter Cancer Initiative

Background: Several epidemiological studies suggest firefighters are at risk for numerous site-specific malignancies, including thyroid cancer. However, it is not well known if chronic exposure to carcinogenic compounds or radio frequency radiation, increases the rate of thyroid nodules and/or affect the thyroid function in this high-risk occupational group. To gain a better understanding, we examine the rate of thyroid nodules and assess the presence of thyroid dysfunction in a sample of Florida firefighters. Methods: A cross sectional study design was conducted to evaluate 103 firefighters, with not known thyroid disease, who were assessed by a physician-performed, real time ultrasound protocol followed by a blood collection to evaluate TSH, Free T4, T4, T3, TPO and Tg antibodies. Additional data such as gender, age and race were also collected and analyzed. Results: Among the 103 firefighters who completed the study protocol, the sample mean age was 39.4+-7.6 years (range 26 to 60) 88.4% male, 87.6% Caucasian and 65% Hispanic. 8.7% of men and 33% of women were found to have thyroid nodules. Of the 20 participants with thyroid nodules only three nodules were above 1 cm, and only one was classified as high risk and met criteria for fine needle aspiration. 8.7 % of men and 33% of women were found to have +TPO antibodies. 18.6% of men and 25% of women were found to have isolated low T3. Conclusion: The prevalence of thyroid nodules, and of Hashimoto thyroiditis, among Florida firefighters, is comparable with the rate found in the general population based on previous epidemiological data. Surprisingly, we found that a significant number of subjects have isolated low T3. In this study, the level of Free T3 was not assessed, however since T4 was normal, we can conclude that the low T3 was not related to a low level of TBG. Low T3 is usually found in systemic illness and has been postulated as a prognostic factor in cardiovascular disease, chronic fatigue syndrome, survival after stroke, and Alzheimer’s disease. The clinical significance and the prevalence of Low T3 in a healthy population has not been well described. Further research is needed to fully understand the significance of this finding.

Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981-2014).

Firefighters are at increased risk for select cancers. However, many studies are limited by relatively small samples, with virtually no data on the cancer experience of female firefighters. This study examines cancer risk in over 100,000 career Florida firefighters including 5000 + females assessed over a 34-year period. Florida firefighter employment records (n = 109 009) were linked with Florida Cancer Data System registry data (1981-2014; ~3.3 million records), identifying 3760 male and 168 female-linked primary cancers. Gender-specific age and calendar year-adjusted odds ratios (aOR) and 95% confidence intervals for firefighters vs non-firefighters were calculated. Male firefighters were at increased risk of melanoma (aOR = 1.56; 1.39-1.76), prostate (1.36; 1.27-1.46), testicular (1.66; 1.34-2.06), thyroid (2.17; 1.78-2.66) and late-stage colon cancer (1.19;1.00-1.41). Female firefighters showed significantly elevated risk of brain (2.54; 1.19-5.42) and thyroid (2.42; 1.56-3.74) cancers and an elevated risk of melanoma that approached statistical significance (1.68; 0.97-2.90). Among male firefighters there was additional evidence of increased cancer risk younger than the age of 50 vs 50 years and older for thyroid (2.55; 1.96-3.31 vs 1.69; 1.22-2.34), prostate (1.88; 1.49-2.36 vs 1.36; 1.26-1.47), testicular (1.60; 1.28-2.01 vs 1.47; 0.73-2.94), and melanoma (1.87; 1.55-2.26 vs 1.42; 1.22-1.66) cancers. Male career firefighters in Florida are at increased risk for five cancers with typically stronger associations in those diagnosed younger than the age of 50, while there was evidence for increased thyroid and brain cancer, and possibly melanoma risk in female firefighters. Larger cohorts with adequate female representation, along with the collection of well-characterized exposure histories, are needed to more precisely examine cancer risk in this occupational group.

Risk Factors Associated with Non-Compliance with Respiratory Protection Programs among Firefighters

Non-compliance with respiratory protection programs among firefighters may put them at increased risk of injury and illness from occupational exposures during fire extinguishing activities. This research aims to characterize respiratory protection practices among Florida firefighters. This information will allow better understanding of factors that are associated with non-compliance with respiratory protection guidelines. A survey questionnaire was used to characterize Florida fire departments in this cross-sectional study. Four hundred and seventy-seven surveys were administered to Florida firefighters both in person and electronically to collect information regarding firefighter knowledge and participation in their respective respiratory protection programs during the past twelve months. Survey questions were developed from the model set by the National Fire Protection Association (NFPA) which provides standards and regulations regarding firefighter protections. Summary statistics regarding firefighter department size, coverage area, and firefighter employment type were produced. Multinomial logistic regression analysis was performed to evaluate factors that impact respiratory protection programs. The 477 respondents were 91% male with a mean age of 39 years old (range 21 - 65 years). The majority of respondents, 76%, were non-smokers, 21% former smokers, and 3% current smokers. In regard to ethnicity, respondents were 77% Caucasian, 13% Hispanic, 3% African American, and 4% other. Most respondents were career firefighters, 97%, with less than ten years of experience, 44%, working in a fire department with at least 21 firefighters, 98%. Most respondents, 80%, had a written respiratory program in place. The most cited reason for not having implemented a written respiratory protection program was lack of knowledge related to the program. Multinomial logistic regression analysis of departments with response areas of at least 250,000 square miles produced a statistically significant 0.444 (0.219 - 0.901 CI) odds ratio for having a written respiratory program as compared to those with a less than 10,000 square miles response area. Additional resources need to be given to Florida fire departments to ensure that all firefighters receive adequate respiratory protection in accordance with NFPA guidelines. There is an association between fire departments with large response areas and non-compliance with respiratory protection guidelines in regard to: having a written respiratory program, the frequency of respiratory fit testing, and the frequency of medical fitness testing. This suggests that rural fire departments need additional resources to ensure firefighters are adequately protected. Additional research should focus on why these differences exist in the rural fire departments. Respondents stating a lack of knowledge or no requirement for a written respiratory program suggest that future efforts should focus on respiratory protection education and training.

Availability and accuracy of occupation in cancer registry data among Florida firefighters.

ObjectivesOccupational exposures significantly contribute to the risk of adverse cancer outcomes, and firefighters face many carcinogenic exposures. Occupational research using cancer registry data, however, is limited by missing and inaccurate occupation-related fields. The objective of this study is to determine the frequency and predictors of missing and inaccurate occupation data for a cohort of career firefighters in a state cancer registry.MethodsWe conducted a linkage between data from the Florida Cancer Data System (1981–2014) and the Florida State Fire Marshal’s Office (1972–2012). The percentage and the odds of having a firefighting-related occupation code in the cancer record were calculated, adjusting for other occupation and cancer-related factors.ResultsAmong 3,928 career firefighters, nearly half (47%) were missing a registry-dervived occupation code and only 17% had a firefighting-related code. Males were more likely to have a firefighting-related code (OR = 2.31;95%CI: 1.41–3.76), as were those with more recent diagnoses (OR1992-2002 = 2.98;95%CI: 1.57–5.67; OR2003-2014 = 11.40;95%CI: 6.17–21.03), and those of younger ages (OR45-64y = 1.26;95%CI: 1.03–1.54; OR20-44y = 2.26;95%CI: 1.73–2.95).ConclusionsAccurate occupation data is key for identifying increased risk of advserse cancer outcomes. Cancer registry occupation fields, however, are overwhelmingly missing for firefighters and are missing disproportionally by sociodemographic and diagnosis characteristics. This study highlights the lack of accurate occupation data available for hypothesis-driven cancer research. Cancer registry linkage with external occupational data sources represents an essential resource for conducting studies among at-risk populations such as firefighters.

Abstract 4249: Disparities in cancer screening between Latino and non-Latino firefighters: Evidence from the Sylvester Firefighter Cancer Initiative

Abstract Firefighters face an increased risk for work-related exposures to hazardous environmental carcinogens during fire incidence response. A growing body of epidemiologic studies suggest that firefighter site-specific cancer incidence and mortality rates are higher when compared to the general US population. As the fastest-growing ethnic subgroup in the US, Latinos have been increasingly represented in the first responder workforce. Latinos relative to non-Latinos vary in cancer-related risk factors including rates of smoking, alcohol consumption, physical activity patterns, and rates of cancer morbidity and mortality. Despite these differences in risk factors, there is limited literature on the cancer screening behavior of Latino firefighters who may be at an increased risk for cancer. In the present study, we characterize sociodemographic and work characteristics in addition to cancer screening behaviors between Latino and non-Latino active firefighters. The Annual Cancer Survey (ACS) research project of the Firefighter Cancer Initiative launched with a 127-item comprehensive cancer questionnaire administered online to a non-probabilistic sample of firefighters employed in South Florida. We present ACS data collected during the first 12-months of this cross-sectional, convenience sample. Firefighters were invited and consented by the study team to complete the ACS using a secure iPad device during their regular work shift. Univariable and multivariable logistic regression models were fitted to predict history of cancer screening behaviors. Among the 3,152 study participants, the mean age was 40.4 years (± 9.1 years standard deviation), 34.3% were Latino, 10% female, and had been employed on average 14.0 years (± 8.6) as a firefighter. The number of Latino firefighters who had not seen a doctor in the past 12 months (5.1%) or visited a primary care physician for routine care (25.5%) was significantly more relative to non-Latino Firefighters (4.2% and 19.3%, respectively; both p<0.01). Across cancer screening behaviors, the number of Latino firefighters who ever had a PSA test to screen for prostate cancer (24.7% vs 38.1%, p<0.01) and a colonoscopy (20.0% vs. 29.0%, p<0.01) was significantly less than non-Latino firefighters. Latino firefighters are significantly less likely than their non-Latino colleagues to report a full body skin exam by their doctor (adjusted odds ratio 0.35; 95% CI 0.29-0.42) while controlling for age, gender, race, educational attainment, household income, health insurance type, routine access to primary care and tenure as a firefighter. Florida firefighters of Latino ethnicity tend to participate less in routine cancer screening practices. Strategies at the fire station or at the individual worker-level are needed to improve cancer screening disparities within this high-risk minority workforce. Citation Format: Alberto J. Caban-Martinez, Natasha Schaefer Solle, Tulay Koru-Sengul, Katerina M. Santiago, Kevin J. Moore, Feng Miao, David J. Lee, Erin N. Kobetz. Disparities in cancer screening between Latino and non-Latino firefighters: Evidence from the Sylvester Firefighter Cancer Initiative [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4249.

Safety Gear Decontamination Practices Among Florida Firefighters: Analysis of a Text-Based Survey Methodology.

Despite the National Fire Protection Association (NFPA) 1851 Personal Protective Equipment Care and Maintenance guidelines, little is known about the routine cleaning of firefighter bunker gear. In collaboration with a large Florida firefighter union, a mobile phone text survey was administered, which included eight questions in an item logic format. In total, 250 firefighters participated in the survey of which 65% reported cleaning their bunker gear in the past 12 months. Approximately 32% ( n = 52) indicated that they had above average confidence in gear cleaning procedures. Arriving at a fire incident response was a significant predictor of gear cleaning in the 12 months preceding survey administration. Using mobile phone-based texting for periodic queries on adherence to NFPA cleaning guidelines and safety message distribution may assist firefighters to increase decontamination procedure frequency.

Firefighter Skin Cancer and Sun Protection Practices

This survey study examines skin cancer history, skin cancer screening, and sun protection habits among active Florida firefighters.