Predictors of serum per- and polyfluoroalkyl substances (PFAS) levels among U.S. career firefighters

Abstract Objective To identify potential predictors of serum concentrations of per- and polyfluoroalkyl substances (PFAS) among a cohort of U.S. firefighters. Methods Serum PFAS concentrations were measured in 2,056 U.S. structural firefighters between July 2023 and October 2024. Data on demographics, lifestyle behaviors, occupational exposures, and fire agency policies were collected through individual and fire agency surveys and evaluated for associations with serum PFAS concentrations. Results Plasma and/or blood donation, drinking water source, military service, post-fire on-scene decontamination, turnout gear storage and transportation, rank, using aqueous film-forming foam, and carpet in fire station living quarters were all significant predictors of at least one PFAS chemical ( p ≤ 0.05). Conclusions Both individual and departmental predictors of serum PFAS concentrations were identified. These findings can help guide the selection of PFAS exposure reduction activities by firefighters.