Journal of Occupational and Environmental Medicine Identifies Key Predictors of PFAS Exposure in US Firefighters

What Are PFAS and Why Are Firefighters at Elevated Risk?

Per- and polyfluoroalkyl substances (PFAS), often dubbed "forever chemicals" due to their remarkable persistence in the environment and human body, have become a pressing concern in occupational health. These synthetic compounds, characterized by strong carbon-fluorine bonds that resist breakdown, were widely used in products designed for water, oil, and stain resistance. In the firefighting profession, PFAS entered the scene primarily through aqueous film-forming foam (AFFF), a firefighting agent effective against fuel-based blazes but laden with these chemicals. Turnout gear, gloves, hoods, and station environments also harbor PFAS from past exposures.

Firefighters face disproportionate exposure compared to the general population. During fire suppression, AFFF deployment contaminates gear and skin directly. Post-fire overhaul—where hidden flames are extinguished—amplifies contact as soot and residues cling to protective clothing. Over time, these accumulate in serum, the liquid component of blood, posing long-term health threats. Studies consistently show firefighters' PFAS blood levels exceed national averages, underscoring the urgency of understanding exposure pathways.

This vulnerability stems from career demands: structural firefighters respond to diverse incidents, from structure fires to vehicle extrications, often in PFAS-rich scenarios like airports or industrial sites. Unlike civilians, their repeated, high-intensity encounters compound risks, making targeted interventions essential.

🚒 Breaking Down the Journal of Occupational and Environmental Medicine Study

A groundbreaking cross-sectional analysis published in January 2026 in the Journal of Occupational and Environmental Medicine has pinpointed precise predictors of serum PFAS concentrations in U.S. career firefighters. Led by Reagan Conner from the University of Arizona's Mel and Enid Zuckerman College of Public Health, the study drew from the Fire Fighter Cancer Cohort Study (FFCCS), involving 2,056 participants across seven states. Blood samples collected between July 2023 and October 2024 were analyzed for 20 PFAS analytes using Centers for Disease Control and Prevention (CDC) protocols, focusing on eight with detectable levels in over 75% of samples.

Participants, mostly male, White, non-Hispanic, averaged 40 years old with 14 years of service. Surveys captured demographics, lifestyle, occupational histories, and agency policies. Statistical models, including linear regression and mixed-effects accounting for agency clustering, revealed nuanced associations—expressed as percent changes in geometric mean concentrations—highlighting how everyday practices influence body burdens.

The FFCCS, a national effort funded partly by FEMA and the Arizona Board of Regents, exemplifies community-engaged research, partnering with fire departments for actionable insights. Co-authors from Arizona State University and local fire services, like Tucson and Scottsdale, bridged academia and the field.

Demographic and Lifestyle Factors Shaping PFAS Levels

Individual traits emerged as foundational predictors. Age positively correlated with all measured PFAS, as cumulative exposure builds over decades. Females exhibited significantly lower concentrations across analytes, possibly due to physiological differences or less intensive roles, though female firefighters number around 5% nationally.

Blood and plasma donations proved a potent mitigator, strongly linked to reduced levels—plasma donation especially for certain compounds. This process physically removes PFAS-laden serum, offering a practical, immediate step. Military service, common among firefighters (up to 20% in some departments), associated with elevated measures, likely from AFFF training at bases.

Drinking water sources varied impacts: well water raised levels for select PFAS, reflecting groundwater contamination; bottled water lowered others like perfluorooctanoic acid (PFOA) relatives and perfluorononanoic acid (PFNA). Reverse osmosis filtration at stations further curbed intake. These findings empower personal choices amid broader contamination.

• Donate blood or plasma regularly to flush PFAS.
• Opt for filtered or bottled water over wells.
• Account for military history in risk assessments.

Occupational Practices: Fireground and Gear Handling Insights

Workplace behaviors drove substantial variance. Longer service duration and higher rank—indicating more leadership exposures—elevated PFOA-related analytes. Current AFFF use spiked these, affirming foam as a primary vector despite phase-outs.

Protective actions shone: post-fire on-scene decontamination (wiping gear with wipes or water) lowered multiple PFAS. Participation in hood swap or cleaning programs reduced concentrations, as hoods trap residues near the face. Gear storage and transportation practices mattered—washing before storage and using dedicated bags prevented station contamination.

Rank influenced exposure via oversight duties, like incident command, prolonging site time. These predictors underscore modifiable routines: a department mandating decon could slash collective burdens.

Agency Policies and Environmental Controls

Departmental protocols proved pivotal. Frequent living quarters dusting lowered PFNA; gear bags and pre-storage washing benefited several analytes. Reverse osmosis systems cut intake, while carpeted areas—trapping particulates—raised levels.

Unexpectedly, marked contamination zones linked to higher perfluorohexane sulfonic acid (PFHxS), perhaps from prolonged presence. Less frequent dusting boosted perfluoroheptane sulfonic acid (PFHpS). Policies like PFAS-free gear procurement and ventilation upgrades align with National Fire Protection Association (NFPA) standards.

Fire chiefs can audit: Does your station dust weekly? Provide bags? These low-cost shifts yield high returns. For research-oriented professionals exploring such interventions, opportunities abound in research jobs at universities.

📊 Health Implications of PFAS Accumulation

PFAS bioaccumulate, persisting years and disrupting hormones, immunity, cholesterol, and fertility. Firefighters' elevated levels heighten cancer risks—testicular, kidney, prostate—beyond general populations. Epigenetic changes accelerate biological aging, per FFCCS extensions. A 9-14% higher cancer diagnosis rate plagues the profession, with PFAS implicated alongside smoke.

Testicular cancer links trace to PFOS; immune suppression impairs vaccine response. Pregnant firefighters risk preeclampsia. These underscore prevention's imperative, informing presumptive coverage under workers' comp.

Public health careers addressing these thrive; explore higher ed jobs in occupational medicine.

Practical Strategies to Minimize PFAS Exposure

Evidence-based actions abound. Individuals: donate plasma quarterly, filter water, avoid non-stick cookware. Departments: enforce gross decon at scenes—wet wipes remove 50-90% residues—swap hoods post-call, wash gear separately.

Invest in PFAS-free AFFF alternatives like fluorine-free foams (F3), tested NFPA-compliant. Ventilate stations, ban carpets, dust HEPA-filtered. Wipe tests detect gear contamination swiftly. Training: simulate decon drills quarterly.

• Implement on-scene decon protocols universally.
• Procure gear bags and extractors.
• Monitor via annual biomonitoring.
• Advocate policy via IAFF.

Read the full JOEM study abstract or University of Arizona release.

Future Directions and Industry Response

The study calls for longitudinal follow-ups to track interventions' efficacy. FFCCS expands, eyeing wildland-urban interface risks. Regulations accelerate: EPA phases out AFFF by 2024, states ban gear PFAS. Fire services transition, with Rhode Island, NYC mandating PFAS-free gear.

Academia-fire service collaborations proliferate, fostering academic CVs for public health roles. Share experiences on Rate My Professor or pursue university jobs.

In summary, this JOEM research equips firefighters to reclaim control. Explore higher ed jobs, rate your professors, or career advice at AcademicJobs.com for occupational health advancement. Visit FFCCS site for more.