Firefighters Preventing Cancer
Firefighters have excess cancer risk. Laroche & L'Espérance (2021) examined 11 systematic reviews and found consistent excess of rectal, prostate, bladder and testicular cancers, mesothelioma and malignant melanoma in firefighters. Other cancers were cited less consistently. No systematic reviews and few studies are available specifically on women firefighters or other diverse populations.
Canadian workers’ compensation has presumptive legislation (Quebec uses an admin policy) that assumes that cancer was occupationally caused in firefighters if certain exposure and duration criteria are met. Fifteen cancers are included but each province differs in its coverage.
Volunteer firefighters are particularly important to target for prevention. There are about 126,650 volunteer firefighters (e.g., 83% of all Canadian firefighters) and 83.4% of the 3,672 fire departments are fully volunteer . All volunteer departments are in smaller, more rural/remote areas and have fewer resources, compared to career fire departments. Volunteer firefighters and their departments are represented by our partners, the Canadian Association of Fire Chiefs (CAFC) and the Canadian Volunteer Fire Services Association (CVFSA). Their goals are to provide policy, advocacy and lobbying support to their sector. Both are committed to reducing cancer risk and motivated the study and collaboration.
Prevention of cancers in firefighters requires significantly increasing firefighters’ understanding of preventive behavior including exposure control such as using appropriate gear, particulate blocking hoods, gear that is replaced as per National Fire Prevention Association (2021) standards and decontamination. It also requires education on long term effects of exposure to contaminants and appropriate monitoring for cancer. In volunteer departments, the firefighter is not a regular employee; may be independently coming to the scene for the call; may have non-firefighting duties immediately after a call; and may not have the same access to resources as in a career department. The focus of this grant is on changing individual intentions and behavior of firefighters and departmental chiefs in volunteer departments. Data from FPC/PPC will support the efforts of our partner organizations who will be working on overcoming institutional barriers.
Firefighters are highly motivated to be safe but need to know how to be safe. They need timely, effective education with actionable ideas on how to reduce exposures. Volunteer firefighters are widely geographically dispersed, busy volunteers with a limited tradition of cancer prevention but a strong commitment to education. Twice weekly, 90Second Health Letters will use Persuasive Design (PD) to convey health information to individuals via e-mail or text. Each letter has targeted information, action suggestions, a personal story, interactive assessment and evaluation. PD maximizes the impact of communication by incorporating ~25 design features such as personalization and reduction (simplicity of message). Several systematic reviews have shown that PD is effective. A Chat Room will encourage mutual support and exchange of ideas. A 45- minute video course will be sent to the experimental group of firefighters and a course completion certificate will be issued.
Objectives: 1. To develop, with our partners, a diversity-friendly program, including 90SecondFire Cancer, a Chat Room and a short consolidation course to improve awareness and support a change in culture. 2. To determine if this approach might be effective in a national campaign.
An Advisory Panel, selected to ensure diversity, of 20 chiefs and 20 firefighters, led by the knowledge users on the grant and, will help develop and evaluate all our intervention and evaluation materials.
We will develop the health letters, a short course and a Chat Room and will evaluate the intervention in a feasibility cluster randomized trial (n~40 clusters with up to 800 participants) in changing intentions related to carcinogen exposure. We will emphasize recruitment of racialized, indigenous and female participants.