Understanding Cancer Survivorship among Firefighters: A Mixed-Method Study

Background: Firefighters are exposed to a unique set of carcinogens through their work environment that predispose them to several cancers, yet there is limited research related to cancer survivorship amongst this occupational group. Methods: A mixed-method approach was used to assess cancer survivorship amongst firefighters. Four focus groups and one in-depth interview were conducted with 29 active and retired firefighters who have been diagnosed with cancer to understand the experiences and challenges associated with cancer survivorship in the fire service and desired resources. Qualitative data were analyzed using Nvivo software. All participants completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey to assess their quality of life. Results: The primary themes that emerged from the focus groups included managing health and well-being changes, navigating support systems in place, and accessing new resources. FACT-G scores (mean ± standard deviation) of the firefighter cancer survivor sample demonstrate relatively lower levels of emotional well-being (19.26 ± 4.67) and higher quality of life in the physical well-being (23.67 ± 5.08), social well-being (23.38 ± 4.16), and functional well-being (22.6 ± 4.966) domains. Conclusions: Firefighters requested curated resources, such as support groups and department training resources, supporting the need for more cancer survivorship resources specific to firefighters

Making a Positive Change: A Qualitative Study of Homeless Women’s Perceptions and Experiences of Shelter Living

The primary objective of this dissertation was to address factors that influenced homeless women’s health behaviors based on the theory of gender and power (TGP). A total of 18 participants described their experiences of being homeless, living in a shelter and its impact on their HIV risk behaviors. The interviews were framed by the constructs of the TGP, which included economic, physical, and social risk factors. The TGP describes the multiple social and structural factors that impact homeless women and their health risks. The TGP was chosen because of its adaptation by Wingood and DiClemente (2000), who exclusively tailored it to women, identifying poverty, homelessness and a history of abuse as health risk factors for women (Wingood & DiClemente, 2000). According to the theory, three major structures characterize the gendered relationships between men and women: (a) the sexual division of labor, which examines the economic inequities favoring males; (b) the sexual division of power, which examines inequities and abuses of authority and control in relationships and institutions favoring males; and (c) cathexis, which examines social norms and affective attachments. Women residing in an all-women’s shelter in Miami-Dade County were recruited for individual in-depth interviews. Participants were eligible if they were 18 years or older, currently living in a designated homeless shelter, spoke and understood English, and self-reported a negative HIV status. Content analysis and constant comparison techniques (Miles, Huberman, & Saldana, 2014) were used to analyze the data. The data were broken down into discrete incidents and then were coded into categories. Each category was compared to previously coded categories to establish relationships and elicit overall themes. The results of the study illustrated the themes of “making a positive change” and “breaking the chains.” “Making a positive change” was described as both a reason for coming to the shelter and a result of living in the shelter. The women of the shelter stated that it provided an opportunity for independence, safety and growth. Since living in the shelter, women stated their lives improved with regard to their basic needs, their emotional and mental states, and their sexual health. Women also indicated the hardest part of being homeless revolved around their roles as mothers. The main theme regarding motherhood was “breaking the chains,” women wanting to change their lifestyles for the sake of their children. All of the women discussed their struggles with motherhood and histories of violence in their lifetimes, including child abuse, partner abuse and sexual abuse, as factors that impeded their abilities to provide for their children. The women’s current struggles and histories of violence victimization hindered their abilities to raise their children in a positive environment. The findings of this dissertation suggest that homeless women are trying to make positive changes in their lives. For many of the women, they aspired for independence, safety and personal growth, which extended to their desire for a better life for their children. This study also showed the significant role sheltered living played in the growth of the women. The findings have implications for practice, research and policy concerning homeless women and victims of abuse. The high prevalence of violence among homeless women indicates an ongoing need for awareness and more importantly, prevention of violence and abuse toward women and children. Future work is needed in order to address and understand the complexity of violence victimization and its long-term impact on homeless women, specifically homeless mothers

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

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

Subclinical Hearing Deficits in Noise-Exposed Firefighters

Noise-induced hearing loss (NIHL) is the most prevalent occupational disease in the world and firefighters are at increased risk of NIHL due to their frequent exposure to hazardous levels of noise during service. Adverse effects of NIHL include acceleration of age-related hearing loss and an increased risk of cognitive decline. A critical challenge in addressing NIHL is the delayed clinical presentation of symptoms and lack of sensitive tools for early detection. To study the early clinical symptoms of NIHL in this high-risk group, we collected hearing function data including behavioral audiometric thresholds and distortion product otoacoustic emissions (DPOAEs) in 176 firefighters during annual physical assessments. Results revealed significant deficits in cochlear outer hair cell function in the presence of normal audiograms. Additionally, 55% of firefighters self-reported changes in hearing, while 20% self-reported concerns about their balance. This study is the first to characterize DPOAEs in firefighters who display decreased DPOAE amplitudes with increasing years in the fire service. These effects were observed even when controlling for hearing loss and age and are suggestive of a link between hearing loss and occupational exposure to hazardous noise

Experiences of Pre-Licensure and Post-Licensure Nurses Participating in Mindfulness Training: A Qualitative Study

Mary E. Mckay, DNP, ARNP, CNE School of Nursing and Health Studies, University of Miami School of Nursing and Health Studies, Coral Gables, FL Jill Steiner Sanko, BA, BSN, RN, ARNP-BC, CHSE-A University of Miami School of Nursing and Health Studies, University of Miami School of Nursing and Health Studies, Coral Gables, FL Scott Rogers, JD, MS, BS, . School of Law, University of Miami School of Law, Coral Gables, FL Natasha Schaefer Solle, BSN, RN School of Nursing, University of Miami School of Nursing and Health Studies, Coral Gables, F

A mixed-methods approach to understanding perceptions of hepatitis B and hepatocellular carcinoma among ethnically diverse Black communities in South Florida

Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC), disproportionately affects minorities. Compared to other races, Blacks more often present with advanced HCC and have decreased survival. We observed higher HBV-associated HCC rates among Blacks than reported nationally. In our center, Haitian Blacks had the highest rates of HBV-associated HCC and shorter survival compared to other Blacks. We investigated knowledge and perceptions regarding HBV and HCC among Blacks born in the United States or Haiti. Using community partnerships, participants were recruited via word of mouth, email, social media or from Hepatology clinic. Focus groups were conducted in Haitian Creole or English and stratified by birthplace, gender and infection status. Discussions were audio-recorded and transcribed verbatim. A constant comparative method was used for data analysis; themes are based on conversational details. There were 55 participants; 49% were male and 27% had chronic HBV. Only 42% of Haitian Blacks knew about HBV prior to participation vs. 78% of African Americans, p 0.03. Both groups expressed that fear, mistrust of the medical establishment, denial and stigma might compel persons to avoid seeking care. Both groups attributed higher rates of late stage HCC diagnosis in Blacks to inadequate financial resources and education. Those with HBV reported confusion regarding their infection and suboptimal communication with healthcare providers. In two communities disproportionately affected by HBV, misconceptions about disease transmission, stigma, low health literacy and decreased access to care may limit detection for HBV. Culturally relevant community-based interventions are needed to increase HBV detection

Alcohol misuse, depressive symptoms, and HIV/STI risks of US Hispanic women

Objectives: Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study's objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors. Design: Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors. Results: Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR = 2.15) and better HIV/STI knowledge (β = −.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR = 1.76) and worse HIV/STI knowledge (β = .37). Conclusions: Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women's health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women

1012 Opportunities for worksite-based cervical cancer screening among female firefighters

Introduction Recent studies have documented differences in cancer rates between female and male U.S. firefighters, including cervical cancer. Despite heightened concern that firefighters may have an increased cancer risk, few studies have examined the cancer prevention strategies pertinent to female firefighters. Cervical cancer is among one of the most common cancers diagnosed in this cohort. Screening underutilization likely accounts for most of the observed, excess cervical cancer risk. This study aims to circumvent the barriers of shift work with the implementation of a Human Papillomavirus (HPV) self sampler in a sample of active female firefighters in Florida, United States. Methods Female firefighters were recruited from their departments during station visits and cancer eductaion seminars. Women completed eligibility screeners and informed consent prior to participation. If eligible, women received a HPV self-sampler to complete at home or at the fire station. Specimens were returned to the lab for analysis. HPV results were given over the telephone and those who screened HPV positive were referred for folllow-up care with their primary physician. Result A total of 251 female firefighters were screened for eligibility, of whom 31 (12.3%) were eligible and interested in participating. Self-sampling kits were sent to 31 of the eligible subjects; 14 (45.0%) participants returned the kits, and 1 (7.0%) received a positive HPV result. Particpants felt self-sampling was easy to self-administer and would repeat the use of the self-sampler as per national screening guidelines. Discussion Female firefighters who completed the self sampling kit in this pilot study reported preference for work-site based education and screening options as compared to a traditional women’s health exam with a healthcare provider. Further strategies to increase cancer screeining among female firefighters engaging in shift work may be helpful in reducing the cervical cancer burden in the fire service

Characterizing the Health and Safety Concerns of US Rideshare Drivers: A Qualitative Pilot Study

Background: Despite the growth and popularity of gig work, limited information exists about the occupational health and safety concerns faced by individuals who are employed through ridesharing online applications. In this qualitative study, we characterized the perceived health and safety concerns of drivers employed by rideshare companies. Methods: During September-October 2019, we requested car rides, using digital rideshare platforms. During the ride, drivers responded verbally to a brief closed-end sociodemographic and work characteristics survey. A semi-structured interview script was used to collect rideshare driver perceptions on health and safety risks. Findings: A total of 35 rideshare drivers of group mean age of 43.1 +/- 11.2 years were interviewed, of whom 77.1% were male and 82.9% identified as Latino. Sixty percent of participants reported rideshare as their primary job, working an average of 47.9 +/- 19.6 hours weekly (minimum = 6 hours, maximum = 84 hours). Drivers enjoyed job autonomy yet faced stressors such as passenger risky behavior, car accidents, and lack of policies that protect the driver. Rideshare drivers also raised concerns about their current health status, economic pressures, and worker safety. Conclusion/Application to Practice: Drivers are forced to extend work hours to support themselves financially, exacerbating their current health concerns and safety risks as it means more time spent working in their sedentary job, compromising their mental and physical health as well as their safety. Occupational health and safety programs geared toward workers in the gig economy are needed