Cancer Prevention and Wellness Clinic | Principal Investigator: Dr. Erin Kobetz | Director of Clinical Operations: Toni Pryor Leavitt
Facilitate firefighter access to cancer education, research, and screenings (such as breast, skin, esophageal, prostate, testicular, and thyroid cancer screenings).

Firefighter Cancer Prevention Educational Curriculum | Principal Investigator: Dr. Natasha Schaefer Solle | Project Manager: Lilli Resto
The Educational Curriculum project team is collaborating with the Gordon Center for Research in Medical Education and Florida fire departments to develop a curriculum for cancer prevention in the fire service. The knowledge gained during the Health Communication project has helped inform the development of this curriculum. The study aims to increase firefighters’ knowledge on cancer prevention strategies and encourages healthy behaviors to decrease their cancer risk by receiving a cancer education course, downloading and using a health app on their mobile device and/or using a decontamination bucket.

HER Cohort Study | Principal Investigator: Dr. Natasha Schaefer Solle | Project Manager: Lilli Resto
The purpose of the Health, Exposure & Reproduction- Occupational Investigation of a Statewide Examination of Florida Women Firefighters (HER) is to understand occupation and lifestyle cancer exposure risks in Florida women firefighters. We aim to collect gynecological health information of women firefighters and examine the association between occupational exposure and change in the vaginal microbiome.

Mental Health Concerns of USAR Firefighters: A Qualitative Study | Principal Investigator: Dr. Natasha Schaefer Solle Project Manager: Emilie Brown
The purpose of this pilot study is to learn through the collection of qualitative data more about urban search and rescue (USAR) firefighters and the mental health concerns they may experience due to the performance of their duties in urban search and rescue scenes with the hope of creating manuals/guidelines on what they can do and where to go to improve their mental health.

Firefighter Cancer Survivorship Program | Principal Investigator: Dr. Natasha Schaefer Solle | Project Manager: Cynthia Beaver
The purpose of the Firefighter Cancer Survivorship Program is to create and implement firefighter specific cognitive-behavioral stress and self-management (CBSM) intervention to improve the health-related quality of life (HRQoL) in firefighter cancer survivors. This intervention includes a 10-week program tailored to firefighters led by an interventionist in a group setting and gives participants access to cancer survivorship education modules, including videos, activities and resources.

Assessment of Firefighter Diet Quality and Lifestyle Behaviors | Principal Investigator: Dr. Natasha Schaefer Solle | Project Manager: Lilli Resto
The purpose of this study is to collect baseline health information and cancer risk factors (ex: social and behavioral factors, etc.) of fire rescue workers and look for potential associations between health history, lifestyle behaviors including diet, exercise and cancer risk.

Occupational Chemical Exposures and the Vaginal Microbiome of Female Firefighters | Principal Investigator: Dr. Natasha Schaefer Solle | Completed
The purpose of the proposed study is to examine the association between exposure to polycyclic aromatic hydrocarbons (PAH) and change in the vaginal microbiome of female firefighters in Florida.

PBDE & Thyroid Function | Principal Investigator: Dr. Natasha Schaefer Solle | Completed
Investigators examined the association between PBDE levels and thyroid function of active South Florida firefighters. The project worked to describe and characterize the quality and quantity of PBDE present in the blood of firefighters by type of occupational exposure (i.e., years in the fire service, job title, firefighter duties).

Understanding Retired Firefighters' Perceptions of Cancer and Wellness | Principal Investigator: Dr. Natasha Schaefer Solle | Completed
The purpose of this pilot study is to collect qualitative data using focus groups to learn about the perceptions of health and cancer risk of retired firefighters from fire departments in Palm Beach County. This study will provide an opportunity to better understand how firefighter retirees’ prior workplace hazards may have impacted their current health and cancer screening practices.

Addressing Cervical Cancer in Female Firefighters | Principal Investigator: Dr. Natasha Schaefer Solle | Completed
The Firefighter Cancer Initiative (FCI) research team studied cervical cancer risk in female firefighters. The NIOSH-funded project, “Addressing Cervical Cancer in Female Firefighters” led by Dr. Natasha Schaefer Solle, provided US female firefighters with a one-time, free home-based HPV test as well as other tests for research. Participants also received educational materials on HPV and cancer prevention.

Facilitators and Barriers to Cancer Screening Among Black firefighters | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
The goals of this pilot study are to 1) identify and prioritize facilitators and barriers to cancer screening among Black firefighters in Florida, and 2) discuss preferred interventions that can improve cancer screening practices for high-risk cancers among Black firefighters in Florida, therefore, reducing the burden of cancer among the firefighter workforce long-term.

Characterizing Hearing and Balance Function Loss in Populations with Exposure to Hazardous Noise | Principal Investigator: Dr. Natasha Schaefer Solle | Completed
The purpose of this study is to characterize and assess the burden of hearing and balance function loss in populations with occupational exposure to hazardous noise.

Psychometric Evaluation of a Survey Measuring Facilitators and to Maintaining a Healthy Weight among Firefighters | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
The aim of this study is to develop and psychometrically evaluate a survey that will measure the facilitators and barriers to maintaining a healthy weight among firefighters.

Health Communication | Principal Investigator: Dr. Tyler Harrison | Completed
The Health Communication project investigators worked to understand firefighter culture, work, and knowledge about cancer. They also designed education and behavior change campaign materials.

Guardrails | Principal Investigator: Wes Smith | Completed
In year three of the Firefighter Cancer Initiative (2017-2018), the cancer screening project incorporated the Guardrails project, which was initially included as part of the initiative in 2016. The Guardrails Wellness Program used customized nutrition and exercise recommendations to optimize health and combat cancer risk in firefighters.

Annual Cancer Survey | Principal Investigator: Dr. Natasha Schaefer Solle | Project Manager: Ashley Gray
The Annual Cancer Screening (ACS) survey study aims to annually assess cancer risk factors among Fire Rescue workers, particularly focusing on firefighters. The survey will inquire about various factors such as family history, social behaviors, work history, military experience, and exposures encountered during their careers. The goal is to identify interventions to decrease cancer risk by understanding work-related exposures. By collecting surveys at a national level, the study seeks to compare risk factors and behaviors among Florida firefighters with those across the country, aiding in the development of specific cancer prevention interventions tailored to their environmental exposures and work environments. Active firefighters from fire departments across the United States are invited to participate in the ACS survey.

Fire Investigator and Inspector Comprehensive Occupational (FI2CO) Assessment | Principal Investigator: Dr. Alberto Caban-Martinez | Project Manager: Dr. Maria Montoya
Fire investigators play a crucial role in determining the causes of fires, yet their health and safety risks remain poorly understood. Unlike firefighters, they often spend extended periods at fire scenes, increasing their exposure to harmful substances and elevating their risk for health issues such as cancer, heart disease, musculoskeletal disorders, and mental health challenges. This FEMA-funded research project seeks to gather critical health and safety data from fire investigators across the United States. The project team will collaborate with scientists, clinicians and industry experts to design a study that tracks these professionals' health over time. The study will first employ qualitative methods to explore fire investigators' perceptions of occupational health and safety risks. Subsequently, 200 fire investigators from various regions nationwide will be enrolled and monitored for over a year to assess their occupational exposures and health conditions. A combination of surveys, focus groups, health assessments, and environmental and biological sampling will provide a comprehensive evaluation of their health and safety risks. The ultimate goal is to develop a robust health and safety framework that enhances fire investigators' well-being and informs future safety protocols.

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F2IRE Cohort | Principal Investigator: Dr. Alberto Caban-Martinez | Project Manager: Ashley Gray
The Florida Firefighter Integrated and Representative Epidemiologic (F2IRE) Cohort Study aims to annually collect health information and assess cancer risk factors among Florida firefighters. Upon enrollment, firefighters will complete a baseline survey covering a range of exposures encountered, cancer screening practices, work history, and relevant factors such as military experience. The data gathered will aid in identifying interventions to mitigate cancer risk and improve screening behaviors. Specifically, the study seeks to understand the cancer risks of active firefighters and explore how occupational exposures may contribute to specific cancers more significantly than in the general population The goal is to develop targeted cancer prevention interventions based on environmental exposures and work environments.

Advancing Epidemiology of Retired Firefighters Aging Longitudinally (AERIAL) Cohort Study | Principal Investigator: Dr. Natasha Schaefer Solle | Project Manager: Addison Testoff
The Advancing Epidemiology of Retired Firefighters Aging Longitudinally (AERIAL) Cohort Study aims to gather health information and assess cancer risk factors among retired Fire Rescue workers, including both retired firefighters and those in the Deferred Retirement Option Program (DROP). Participants will complete a survey covering various factors such as family history, social behaviors, exposure types encountered during their careers, as well as their cancer screening practices. The study seeks to improve the understanding of cancer risks and prevalence among retired firefighters.

Firefighter Tumor Bank | Principal Investigator: Dr. Alberto Caban-Martinez | Project Manager: Ashley Gray
Firefighters are exposed to different harmful chemicals during fire incident response; these exposures give rise to different types of cancers in the firefighter workforce compared to the general population. The national firefighter tumor bank stores specimens for future evaluation of the molecular mechanisms of these tumors in an effort to understand cancer development in the fire service and improve treatment.

Surfside Assessment of First responders Exposures (SAFE) Cohort | Principal Investigator: Dr. Alberto Caban-Martinez | Project Manager: Ashley Gray
The main objective of this prospective, longitudinal cohort study is to provide biomonitoring surveillance for first responders and volunteers who were deployed to the Champlain building collapse in Surfside, FL. The study will follow these participants over the course of a year, during which they will be asked to complete surveys and provide toenail samples to assess their exposure to heavy metals. Participants located in Florida will also be invited to provide blood samples.

Heavy Metal Exposure Assessment using Toenails (HEAT) from Firefighters | Principal Investigator: Dr. Alberto Caban-Martinez | Project Manager: Ashley Gray
During their work, firefighters are exposed to a multitude of known or suspected carcinogens. One exposure of particular concern is the exposure to heavy metals. The HEAT project evaluates the use of toenails as a biomarker of long-term exposure to heavy metals in firefighters and characterizes the presence and quantity of heavy metals found in firefighters.

Aerosol Measurement and Characterization from Firefighter Training | Principal Investigator: Dr. Alberto Caban-Martinez, Dr. Biswas| Project Manager: Shruti Choudhary
Firefighters can be exposed to high concentration of toxic aerosols and gases via respiratory, oral and dermal routes. They are exposed to elevated levels of fine and submicron size aerosols during overhaul activities and also in areas of the firehouse where they spend a large proportion of their shift. The goal of this study is to use a suite of aerosol instrument to quantify and characterize firefighter aerosol exposure during their work duties.

Florida Firefighter Cancer Registry | Principal Investigator: Dr. David Lee | Completed
The Florida Firefighter Cancer Registry project, established in 2015, linked Fire Marshal certification records to Florida Cancer Data System records to identify cancers disproportionality impacting Florida firefighters. This has provided an updated analysis of a linkage done in 2006 that demonstrated elevated risks of several cancers, including bladder, testicular, and thyroid among males, and cervical, Hodgkin’s lymphoma, and thyroid among females.

Direct Respiratory Assessment of Firefighter Tactics (DRAFT) Cohort Study | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
The purpose of this study is to assess the lung health and cancer risk factors in firefighters who are also Emergency Medical Technicians (EMT) during the COVID-19 pandemic. The main objective is to examine lung function changes in firefighters/EMTs/First Responders in relation to SARS-CoV-2 infection and radon exposure over five years.

Firefighter Assessment of Strategies Trumping Cancer (FAST-C) | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
The purpose of this study is to identify factors contributing to cancer prevention in the Florida fire service. We will invite firefighters to answer questions about their fire services approach to occupational health and safety, worksite health promotion, and cancer prevention practices. Our goal is to understand how the fire departments’ organization, practices, and policies impact cancer prevention. This information may help us develop programs to change the types of resources, guidelines, and services offered in fire services.

Defining and Operationalizing the Well-Being of Firefighters/Emergency Medical Services (EMS) Workers | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
The purpose of this cross-sectional descriptive, exploratory study is to define and operationalize the well-being of firefighters from the perspective of Firefighters/Emergency Medical Services (EMS) Workers. A conceptual model will be designed and proposed from factors identified by the firefighter/EMS workers and used as a tool to frame the construct, “firefighter/EMS worker well-being.”

F-TRACE Firefighter Tracking, Resources, and Assessment of COVID-19 Epidemiology | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
This Study was to document the seroprevalence of SARS-CoV-2 in a first-responder workforce. As part of a multi-prong approach to COVID-19 surveillance and control for first responders, the F-TRACE project provided firefighters/paramedics with the resources and guidance to minimize the burden of COVID-19 within their workforce and the communities they serve.

Occupational and Non-Occupational Physical Activity Levels Among Firefighters | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
The goals of this pilot study were to (a) describe typical physical activity levels in professional paid firefighters and (b) assess their ability to estimate their own levels of physical activity.

Publications
(Kling H, Santiago K, Benitez L, Schaefer Solle N, Caban-Martinez AJ. Characterizing Objective and Self-Reported Levels of Physical Activity Among Florida Firefighters Across Weight Status Category: A Cross-Sectional Pilot Study. Workplace Health Saf. 2020;68(11):513-518. doi:10.1177/2165079920925505)

Personal Exposure Reporter (PER) | Principal Investigator: Dr. Barbara Millet | Project Manager: Dr. Alberto Caban-Martinez
FCI’s Personal Exposure Reporter (PER) allows firefighters to document occupational exposures to hazardous agents and facilitates access to exposure data on any internet-enabled device. The main objectives for PER are to collect data for detecting occupational hazard exposure and to analyze that data, allowing firefighters to gain greater awareness of their health and wellness and allowing researchers to identify health risks. Our research focuses on identification and validation of the PER reporting variables, informing the design of system features, and ensuring usability of the developed system. We will continue to validate system efficacy and explore system refinements to accommodate expansion of data collection to support other fire service roles and incident types and to enhance system features to include visual reporting and analysis.

Microbiome, GERD and esophageal cancer in Firefighters | Principal Investigator: Dr. Morgan Sendzischew | Completed
This study aims to analyze and characterize the oral microbiome of South Florida Firefighters. Additionally, we aim to develop a bio-repository of gastrointestinal tissue specimens for South Florida Firefighters with known risk factors for esophageal adenocarcinoma.

Addressing Colorectal Cancer in South Florida Firefighters | Principal Investigator: Dr. Erin Kobetz | Completed
The purpose of this pilot study is to examine the feasibility and acceptability of the Fecal Immunochemical Test (FIT) to screen for colorectal cancer in a sample of active firefighters in South Florida.

Recruited Firefighters’ Assessment of Safety and Health (ReFLASH) Pilot Study | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
The purpose of this study is to learn about the safety and health perceptions of newly recruited firefighters, especially how they plan to protect their health and reduce workplace hazards.

Firefighter Diversity and Inclusion Analysis | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
Diversity and inclusion in the workforce can lead to increased team synergy, efficiency, and innovative solutions to complex problems across varying organizations. In the U.S. fire service, the workforce demographics are largely homogenous, comprised predominantly of Caucasian males with limited diversity in racial and ethnic backgrounds and genders/non-genders. A strong fire department culture that invests in diversity and inclusion could provide competitive advantages that improve engagement in the communities they serve. The purpose of this analysis is to 1) describe the availability of diversity and inclusion leaders in fire services throughout the U.S., 2) describe characteristics of diversity and inclusion programs in the Fire Service, and 3) characterize and compare the impact of diversity and inclusion leaders within fire services.

Comprehensive De-Identified FCI Dataset for Secondary Analysis | Principal Investigator: Dr. Julia Seay | Completed
This secondary, retroactive data analysis will apply innovative random forest techniques to uncover complex associations between sociodemographic, behavioral, biological factors, and cancer among firefighters using data from previously IRB-approved Firefighter Cancer Initiative studies.

Environmental Sampling Program | Principal Investigator: Dr. Sylvia Daunert | Project Manager: Umer Bakali
The Environmental Sampling Program (ESP) is specialized in the development of field-deployable sampling techniques, including passive samplers and portable gas sensing systems, for the detection of toxic volatile and semi-volatile organic compounds in various firefighting groups. Notably, these include structural and wildland firefighters as well as fire investigators. In addition, the ESP also develops methods for detecting risk compounds and biomarkers in clinical samples collected from firefighters and provides analytical and instrumentation expertise for evaluating occupational chemical exposure in samples collected by the Firefighter Cancer Initiative at large.

Firefighter Wristband Exposure Survey | Principal Investigator: Dr. Alberto Caban-Martinez | Project Manager: Umer Bakali
Established in 2016, the Firefighter Wristband Exposure Survey employs a simple, lightweight, and non-invasive passive sampling methodology employing silicone wristbands for capture and analysis of structural firefighters’ occupational carcinogenic exposures. Exposures have been described at fire scenes, in fire stations, and from firefighter turnout gear. Silicone wristbands have since been used with other firefighting subgroups. Findings from this study were published in 2020 in Ecotoxicology and Environmental Safety.

Assessment of Wildland Firefighters’ Carcinogenic Exposures | Principal Investigator: Dr. Alberto Caban-Martinez | Project Manager: Umer Bakali
Wildland firefighters sustain significant and prolonged chemical exposure to wildland fire smoke during wildland fire and prescribed burn events. Compared to their structural firefighting counterparts in cities and towns, wildland firefighters don lighter personal protective equipment, making them more susceptible to dermal and inhalational exposures. Firsthand data on wildland firefighters’ exposures are difficult to acquire due to the danger and austerity of their occupational environments, which limit accessibility for researchers and scientific equipment. This project aims to assess wildland firefighters’ exposures using minimally-encumbering and non-invasive sampling methodologies, including silicone wristbands and dermal swabbing.

Analyses of Volatilized Carcinogens in the Vicinity of Active Fire Situations | Principal Investigator: Dr. Sylvia Daunert | Project Manager: Umer Bakali
Carcinogens emitted during structural fires may migrate away from the fire scene and into the immediate surroundings, including in the cold zone and warm zone of these fire situations, in which no danger or a non-immediate threat to life exists, respectively. In these areas, firefighters may not be donning their full turnout gear or self-contained breathing apparatus, leading to an increased exposure risk to gases and particulate matter emitted by the fire. The goals of this project are to: 1) Determine the presence of volatilized carcinogens outside of the structure to help inform guidelines for determining the borders of the warm zone, and 2) Develop and refine portable solid-state sensing equipment that can be integrated into firefighter gear to help communicate the presence of toxic compounds in the air surrounding active fire situations. Findings from passive sampling of the warm and cold zones of fire situations were published in 2021 in Ecotoxicology and Environmental Safety.

Development of a Firefighter Cancer Risk Assessment Model from Clinical Samples | Principal Investigator: Dr. Sylvia Daunert
Polycyclic aromatic hydrocarbons (PAHs) are toxic byproducts of combustion and ubiquitous environmental pollutants, which can cause carcinogenesis through epigenetic modification. 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. The aim of this study is to develop a non-invasive risk assessment tool to evaluate firefighters’ health risk based on internalized polycyclic aromatic hydrocarbons (PAHs), expression of the DNA repair genes, and the presence of oxidative stress biomarkers in clinical samples, in addition to years of active firefighting service.

“Warm Zone” Cases: Environmental Monitoring Immediately Outside the Fire Incident Response Arena | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
Hazardous work zones (i.e., hot, warm, and cold) are typically established during HAZMAT calls but less consistently for fire responses to segment personnel and response activities in the immediate geographic area around the fire. Despite available national guidelines, some studies have documented inconsistent use of respiratory protective equipment by firefighters at the fire scene. These published cases suggest firefighters should implement strategies for multi-gas detector use within the warm zone and include respiratory protection in the warm zone to provide adequate safety from noxious gasses and cancer-causing particulate.

Evaluation of Urban Search and Response Personnel Exposures at the Surfside Condominium Collapse | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
In the early hours of June 24, 2021, the Champlain Towers South condominium complex collapsed in the town of Surfside, Florida. As part of rescue efforts, more than 80 Miami-Dade County and City of Miami fire rescue units were deployed at the scene of the collapse. Additionally, both domestic and international Urban Search and Response (USAR) teams were deployed to the site, working in alternating 12-hour shifts to search for survivors. The nature of this catastrophic collapse meant that significant amounts of suspended particulate matter and volatile organic compounds were present in the air, potentially exposing responders at the site. Passive sampling wristbands were deployed to determine first responders’ exposures. Data from this emergency initiative is pending the oversight of the State of Florida Fire Marshal.

Assessment of Fire Investigators’ Exposures during Post-Fire Scene Audits | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
Even after fires are extinguished, carcinogens continue to off-gas at post-fire scenes. This is a concern for fire investigators, who conduct in-depth forensic evaluations of post-fire scenes for prolonged periods of time. Compared to nearly 1.1 million firefighting personnel in the United States, the International Association of Arson Investigators (IAAI) estimates that there are approximately 7,000 to 9,000 fire investigators, making them a comparatively understudied portion of the overall firefighter population. This project aims to contribute evidence on the type and intensity of carcinogenic exposure sustained by fire investigators to help inform policy and improve fire investigators’ occupational hygiene.

Firefighter UV Safety Evaluation Study | Principal Investigator: Dr. Alberto Caban-Martinez | Completed
The occupational health and safety team is quantifying Ultraviolet (UV) exposure in firefighters through a wearable UV sensor to help characterize their environmental and occupational exposures.

Firefighter Stress and Immune Response | Co-Principal Investigator: Dr. Alberto Caban-Martinez and Dr. Firdaus Dhabhar | Completed
Firefighting is frequently reported as a highly stressful occupation. The job includes a wide range of physiological indicators (e.g., blood pressure, cortisol, skin conductance) of stress; however, relationships between stress exposure and immune response in firefighters remain understudied. In the present study, we use the firefighter training environment to evaluate stress exposure and the stress anticipation on firefighter immune system response.