Wildfire smoke, risk mitigation behaviors, and cancer risk: A community-based study.

e23152 Background: California’s San Joaquin Valley has the worst air quality in the U.S., exacerbated by hazards, such as wildfires. Wildfire smoke is associated with increased risks of lung and other cancers. Outdoor workers, children, older adults, and those with pre-existing health conditions are most at-risk, compounded by inequitable access to healthcare and preventive services, such as lung cancer screening. This qualitative and expert panel methods study aimed to (1) examine impacts of wildfire smoke on at-risk populations, particularly regarding cancer risks, and (2) identify and prioritize solutions to reduce health impacts. The overall objective is to identify modifiable solutions that can be implemented, tested, and advocated for by community members for local policy change. Methods: We collaborated with a Community Advisory Board (CAB) comprised of multi-level interested groups to conduct semi-structured interviews in English and Spanish with 48 community members, outdoor workers, employers, clinicians, payers, and policymakers. Interviews explored health impacts and solutions to poor air quality in the region exacerbated by seasonal wildfire smoke. We used thematic analysis to identify key challenges and solutions. Using RAND Expert Panel Modified Delphi Methods, with our CAB, we rated effectiveness, feasibility, and implementation costs of proposed solutions on a 10-point scale (0 being least effective, feasible, and most costly and 10 being most effective, feasible, and least costly). After initial ratings, the panel refined their ratings through group discussion to achieve consensus. Results: We identified the following themes 1) concerns about impacts on youth; 2) limited awareness of health impacts; and 3) local healthcare shortages and lack of affordable care. Solution themes included: 1) adaptable work schedules for outdoor workers; 2) stricter regulation of pesticide use and industrial emissions; 3) targeted education on air quality risks and 4) expanded access to affordable lung cancer screening. Solutions agreed upon by the expert panel as most effective included: 1) training Community Health Workers to bridge care gaps (mean ± SD, 8.9 ± 1.4); 2) development of comfortable, heat-feasible protective equipment (8.9 ± 1.1); 3) provision of air purifiers (8.7 ± 1.3); 4) utility discounts for households with air filter use (8.7 ± 1.0), and, 5) training for outdoor workers on risks and protective equipment use (8.6 ± 1.0). Conclusions: Community-driven strategies that are identified and agreed upon across multi-level interested groups are urgently needed to address cancer risks posed by poor air quality due to wildfires.