Associations between Awareness of the Risk of Exposure to Pollutants Occurring at Fire Scenes and Health Beliefs among Metropolitan Firefighters in the Republic of Korea

Abstract

Firefighters are repeatedly exposed to various pollutants that occur at fire scenes. There are three levels of exposure: primary exposure to pollutants, secondary exposure to pollutants on personal protective equipment (PPE), and tertiary exposure to contaminated fire stations and fire engines due to pollutants on PPE. Therefore, it is important for firefighters to be aware of the risk of exposure to pollutants and to practice health behaviors such as appropriate PPE management. No clear association has been established in the existing literature between firefighters’ risk perception level and their health beliefs about the health impact of awareness of exposure to hazardous substances at fire scenes. This study aims to evaluate the relationship between awareness of the exposure risk to primary, secondary, and tertiary pollutants and health beliefs. It was designed as a cross-sectional study, in which a web-based survey was conducted from 13 May to 31 May 2021. The analysis was conducted in 1940 firefighters working in the Seoul metropolis who agreed to participate in the research. Participants who perceived susceptibility were likely to be aware of the primary (adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI) 1.16–3.80), secondary (AOR = 2.77, 95% CI 1.77–4.32), and tertiary (AOR = 2.73, 95% CI 1.85–4.03) exposure risks. Participants who perceived barriers were unlikely to be aware of the risk of exposure to primary (AOR = 0.67, 95% CI 0.49–0.91), secondary (AOR = 0.77, 95% CI 0.61–0.96), and tertiary (AOR = 0.75, 95% CI 0.62–0.91) pollutants. Educational intervention is recommended to improve perceived susceptibility and awareness of the risk of exposure to pollutants and reduce perceived barriers. Consequently, educational intervention is expected to positively impact firefighters’ management of appropriate PPE. We confirmed an association between occupational exposure risk and firefighters’ health beliefs. In the health belief model (HBM), health beliefs that affect health behavior also affect awareness of the exposure risk level. Therefore, an intervention for health beliefs can also be used to raise job-related exposure risk awareness. Regular training on the health impacts of fire scenes is necessary for both newcomers and incumbents to enable firefighters to better recognize the risks of each occupational exposure level. Additionally, laws and regulations are necessary for the removal of harmful substances that contaminate PPE, such as self-contained breathing apparatus (SCBA), during exposure to a fire scene. Our research can be used as a basis for improving fire policies and education programs in the future.

Firefighters and Cancer: A Review of the Current State of Cancer Incidences and Recent Trends in Risk Perception and Risk Reduction Efforts

“…49 In contrast to findings by Oh about age influencing perceived cancer risk, age was not a factor in predicting decontamination behavior. 10 Bautista further found that peer-to-peer accountability was a strong facilitator, reinforcing the notion that the behavior of other firefighters is important to decontamination and risk reduction behaviors. 46 Aside from personal attitudes, beliefs, and norms, organizational factors can serve as facilitators for risk reduction.…”

“…While some cancers (such as mesothelioma) have received considerable attention, today there is growing recognition of the dangers of multiple types of cancers among firefighters. Specifically, studies have found linkages between firefighting and numerous cancers, for example, bladder, 4,5,6 colorectal, 7,8 brain and central nervous system, 9,10 non-Hodgkin's lymphoma, 5,11,12 skin melanoma, 4,5,13 prostate and testicular, 5,13,14 with most having an increased mortality rate when compared to the general population. 4 Kidney cancer has also been found at increased rates, however, findings are less consistent for kidney cancer and certain other cancers, including Hodgkin's lymphoma, 2,11,12 leukemia, 4,15,16 lymphosarcoma and reticulosarcoma, 4 multiple myeloma, 4,17,18 and pancreatic cancer.…”

“…45 Oh et al found that South Korean firefighters who had exposure risk awareness perceived higher levels of susceptibility and severity, but that it varied by age and years in service, with older and more experienced firefighters having lower risk perceptions. 10 Indeed, many firefighters expressed fatalistic views about their cancer risk, believing that it was inevitable they would get cancer 42,43 and that cancer would have severe impacts. 44 While studies of firefighter risk perceptions generally show high levels of concern for cancer risk, as well as specific beliefs about where those risk reside, not all firefighters are knowledgeable about exposure risk.…”

“…41,42,43,44,45,48 Oh et al breaks down these direct cancer risks into primary (exposure at fire scenes), secondary (contaminates on gear), and tertiary (cross contamination in engines and stations) exposure risks, and firefighters in South Korea had high awareness of these risk. 10 Aside from these primary, secondary, and tertiary exposure risks, Solle et al found that female firefighters also viewed exposure to chemicals used for cleaning fire apparatus, disinfectants from medical calls, and from turnout gear itself, which is constructed of material with flame retardant and other chemicals, to cancer risk. 41 For most firefighters, direct cancer risks are associated with performing key elements of their work using gear that is designed to protect them.…”

“…46 Aside from personal attitudes, beliefs, and norms, organizational factors can serve as facilitators for risk reduction. These include strong leadership support and specific policies regarding PPE use, availability of clean replacement turnout gear (a second set off turnout gear or a separate turnout room where gear could be checked out), and air monitors all positively influenced risk reduction behavior, 10 and training on cleaning procedures. 49,53 Additionally, Harrison et al found that social capital and the development of networks of expertise helped facilitate cultural changes, knowledge, and practice toward decontamination and cancer risk.…”