About

Judith Graber, Ph.D., M.S., is a professor at Rutgers University – School of Public Health, within the Department of Biostatistics and Epidemiology, and is affiliated with EOHSI – Environmental and Population Health. Her research focuses on cancer risk and risk factors among volunteer and career firefighters, including the adverse effects of occupational dust exposure and interactions with modifiable personal risk factors such as tobacco, alcohol use, and obesity. She investigates health outcomes related to exposure to per- and poly-fluoroalkyl substances (PFAS) in occupational and community settings, with a particular emphasis on perfluorononanoic acid (PFNA). Her work aims to reduce cancer incidence and mortality among firefighters and to evaluate associations between health outcomes and multiple estimates of PFAS exposure in highly exposed communities. Additionally, she evaluates the contribution of World Trade Center-related exposure to head and neck cancers, considering the etiologic roles of tobacco, heavy alcohol use, and oral HPV infection. Dr. Graber has contributed to understanding the long-term health effects of environmental exposures, with a focus on occupational health and environmental epidemiology.

Research topics

• Medicine
• Environmental health
• Demography
• Internal medicine
• Family medicine

Selected publications

• Differences in MicroRNA Expression in Firefighters Responding to a Train Derailment and Fire in East Palestine, Ohio

  Epigenomes · 2026-02-03 · 1 citations

  articleOpen access

  Background/Objectives: High-risk, low-frequency incidents such as building collapses and large chemical fires can result in acute, high-dose exposures to toxic agents for first responders and the surrounding community. While these exposures may last for hours to days, their contribution to firefighters’ risks for cancer and other diseases is relatively unknown. In February 2023, a freight train transporting chemicals derailed and caught fire in East Palestine, Ohio, US. More than 350 firefighters, primarily volunteer, responded to the incident. In this cross-sectional study, we evaluated epigenetic markers of toxicity in responding firefighters. We hypothesized that exposures from responding to the train derailment would alter the expression of microRNAs (miRNAs) linked to carcinogenesis. Methods: We enrolled 62 responding firefighters and a comparison group of 26 firefighters from the same region who did not respond to the incident. We measured the relative expression of 800 miRNAs in blood samples using the nCounter Human v3 miRNA expression panel. We compared the expression of miRNA between exposure groups in negative binomial regression models, adjusting for potential confounders. Results: At a false discover rate cut-off of 5% (q-value < 0.05), 16 miRNAs had significantly higher expression and one significantly lower among firefighters that responded to the incident. Top disease-related pathways in which these miRNAs were enriched included those relevant to neurodegenerative diseases, vascular disease, and multiple cancer sites. Conclusions: Overall, results suggest responding to one large incident can have non-transient impacts on miRNA expression. Whether this translates into longer-term health risks or adaptive responses to exposures is unclear.

  PublisherOA PDFDOI

• Urinary Biomarkers of PAHs, VOCs, OPEs, and Metal(loid)s in Firefighters Responding in the Wildland Urban Interface (WUI)

  SSRN Electronic Journal · 2026-01-01

  preprintOpen access
  PublisherDOI

• Impact of regulatory actions to establish maximum contaminant levels on per- and polyfluoroalkyl substances in New Jersey public water systems

  Environment International · 2026-02-28

  articleOpen access

  BACKGROUND: The U.S. Environmental Protection Agency set drinking water Maximum Contaminant Levels (MCLs) for several PFAS in 2024, yet few evaluations of earlier state regulations have been conducted. We evaluated the impact of regulatory actions taken by the New Jersey Department of Environmental Protection (NJDEP) to set PFAS drinking water standards in NJ community water systems (CWS). METHODS: The NJDEP performed statewide testing of CWS PFAS levels in 2006 and 2009-2010, which were supplemented by additional CWS data reported to NJDEP and federal monitoring from 2013 to 2015 using methods including EPA method 537 and 537.1. The NJ Drinking Water Quality Institute formally recommended MCLs to NJDEP for PFNA (13 ng/L) in July 2015, for PFOA (14 ng/L) in March 2017, and PFOS (13 ng/L) in June 2018. Routine CWS monitoring began in 2019, covering the study period of 2006-2025. Quarterly PFOA, PFOS, and PFNA testing results were obtained from 47 CWS with monitoring data before and after the MCL recommendations. Using linear regression, we fit interrupted time series models to estimate the change and trend in PFAS levels following proposed MCLs. RESULTS: We obtained 4,150, 4,086, and 4,053 monitoring results for PFOA, PFOS, and PFNA, respectively. We observed declines in the proportion of PFOA (49.3% v s 14.9%), PFOS (11.6% vs 3.5%), and PFNA (23.6% vs 1.5%) results above the MCL following recommendation of PFAS regulations (chi-squared P < 0.001). There was a 55% (95% CI: 11%, 77%) and 50% (95% CI: 14%, 71%) decline in PFOA and PFNA levels, respectively, following recommendation of MCLs. There were declines in quarterly trend in PFOS (2%, 95% CI: 0%, 5%) and PFNA levels (6%, 95% CI: 2%, 9%). DISCUSSION: Regulated PFAS levels declined following formal recommendation of MCLs to NJDEP. Actions taken toward establishing regulations to limit drinking water PFAS exposures can achieve substantial reductions.

  PublisherDOI

• Serum PFAS in Aircraft Rescue and Firefighting (ARFF) Firefighters From Six U.S. Airport Fire Departments

  American Journal of Industrial Medicine · 2026-04-26

  articleOpen access

  INTRODUCTION: Use of aqueous film-forming foam (AFFF) is a source of exposure to per- and polyfluoroalkyl substances (PFAS) for firefighters working in aircraft rescue and firefighting (ARFF) settings. However, data characterizing the association between serum PFAS concentrations and exposure risk factors for ARFF firefighters are limited. METHODS: In this cross-sectional study, ARFF firefighters (N = 193) from six U.S. commercial airports provided serum for quantification of nine PFAS and completed a survey in 2019-2020. A drinking water sample from each fire station was also analyzed for 29 PFAS. Serum PFAS concentrations were compared with demographically-similar participants from the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020. Multivariable linear regression was used to identify factors associated with serum PFAS concentrations. RESULTS: Geometric mean serum concentrations of perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS) branched isomers, and perfluoroundecanoic acid (PFUnDA) were statistically higher in ARFF firefighters compared with NHANES participants. PFAS were detected in tap water at three fire departments, but only one department was characterized by detection of select PFAS (perfluorooctanoic acid (PFOA), PFOS, and PFHxS) in both water and serum. Past employment, detection of PFAS in drinking water, and age were positively associated with select PFAS concentrations; a recent change in workplace AFFF behavior or practice, female sex, and Black race exhibited inverse associations. CONCLUSIONS: Participants reporting changes in workplace behavior, policy, or practice had lower summed PFAS concentrations, suggesting these measures may help reduce exposure. Continued research is needed to evaluate exposure reduction strategies for firefighters, particularly those working in ARFF settings.

  PublisherDOI

• The Fire Fighter Cancer Cohort Study: Protocol for a Longitudinal Occupational Cohort Study

  JMIR Research Protocols · 2025-03-07 · 7 citations

  articleOpen access

  BACKGROUND: Firefighters are at an increased risk of cancer and other health conditions compared with the general population. However, the specific exposures and mechanisms contributing to these risks are not fully understood. This information is critical to formulate and test protective interventions. OBJECTIVE: The purpose of the Fire Fighter Cancer Cohort Study (FFCCS) is to conduct community-engaged research with the fire service to advance the evaluation and reduction of firefighter exposures, along with understanding and mitigating effects leading to an increased risk of cancer and other health conditions. This involves establishing a long-term (>30 years) firefighter multicenter prospective cohort study. METHODS: The structure of the FFCCS includes a fire service oversight and planning board to provide guidance and foster communication between researchers and fire organizations; a data coordinating center overseeing survey data collection and data management; an exposure assessment center working with quantitative exposure data to construct a firefighter job exposure matrix; and a biomarker analysis center, including a biorepository. Together, the centers evaluate the association between firefighter exposures and toxic health effects. Firefighter research liaisons are involved in all phases of the research. The FFCCS research design primarily uses a set of core and project-specific survey questions accompanied by a collection of biological samples (blood and urine) for the analysis of biomarkers of exposure and effect. Data and samples are collected upon entry into the study, with subsequent collection after eligible exposures, and at intervals (eg, 1-2 years) after enrollment. FFCCS data collection and analysis have been developed to evaluate unique exposures for specific firefighter groups; cancer risks; and end points in addition to cancer, such as reproductive outcomes. Recruitment is carried out with coordination from partnering fire departments and eligible participants, including active career and volunteer firefighters in the United States. RESULTS: The FFCCS protocol development was first funded by the US Federal Emergency Management Agency in 2016, with enrollment beginning in February 2018. As of September 2024, >6200 participants from >275 departments across 31 states have enrolled, including recruit and incumbent firefighters. Biological samples have been analyzed for measures of exposure and effect. Specific groups enrolled in the FFCCS include career and volunteer structural firefighters, women firefighters, trainers, fire investigators, wildland firefighters, firefighters responding to wildland-urban interface fires, and airport firefighters. Peer-reviewed published results include measurement of exposures and the toxic effects of firefighting exposure. Whenever possible, research results are provided back to individual participants. CONCLUSIONS: The FFCCS is a unique, community-engaged, multicenter prospective cohort study focused on the fire service. Study results contribute to the evaluation of exposures, effects, and preventive interventions across multiple sectors of the US fire service, with broad implications nationally. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/70522.

  PublisherDOI

• Multi-site study of communities with PFAS-contaminated drinking water: Methods, demographics, and PFAS serum concentrations

  Environment International · 2025-06-12 · 13 citations

  articleOpen access

  A nationwide cross-sectional study led by the Agency for Toxic Substances and Disease Registry in collaboration with research and community partners, was designed to investigate health outcomes linked to per- and polyfluoroalkyl substances (PFAS) exposure among residents of communities with contaminated drinking water. The objective was to describe the study design, methods, participant demographics, and PFAS serum concentrations. From 2019 to 2023, adult (18+) and child (ages 4-17) participants were recruited from communities with past or ongoing PFAS contamination of drinking water across eight sites in California, Colorado, Massachusetts, Michigan, New Hampshire, New York, New Jersey, and Pennsylvania. Data on demographics, lifestyle factors, and residential, occupational, and medical history were collected via questionnaires. Extensive clinical tests assessed cardiometabolic, liver, thyroid, kidney, glycemic, and immune parameters. Neurobehavioral tests were administered to children (ages 5-17). PFAS quantified in serum included MeFOSAA, PFHxS, PFOS, PFOA, PFNA, PFDA, and PFUnDA. Serum, whole blood, and urine samples were banked for future analyses. The study enrolled 5826 adults (geometric mean age: 53.6 years; 60.2 % female; 77.2 % non-Hispanic White) and 710 children (geometric mean age: 10.7 years; 48.5 % female; 69 % non-Hispanic White). Compared with NHANES data (2017-2020), adults showed elevated geometric mean concentrations of PFHxS and PFOA; only PFHxS was elevated in children. These serum concentrations reflect a wide range of PFAS exposures in communities affected by contamination from firefighting activities and industrial emissions, and other sources. This large study is a valuable resource for exploring associations between PFAS exposure and health effects in adults and children.

  PublisherDOI

• Per- and polyfluoroalkyl substances (PFAS) and microRNA: An epigenome-wide association study in firefighters

  Environmental Research · 2025-05-09 · 9 citations

  articleOpen access

  The occupation of firefighting is classified as a Group 1 carcinogen. Increased cancer risk among firefighters may be partly attributable to increased occupational exposure to a range of chemicals, including per- and polyfluoroalkyl substances (PFAS). Some PFAS are known and suspect human carcinogens. Investigating epigenetic response to these PFAS exposures in firefighters may help to identify biological pathways of specific cancers, and previously unidentified health outcomes that are associated with PFAS. We therefore investigated the associations of serum PFAS concentrations with miRNA expression in firefighters. Serum samples collected from 303 firefighters from 6 sites across the USA were analyzed for 9 PFAS along with miRNA expression. Covariate-adjusted linear regression was used to estimate associations between log PFAS and miRNA expression, with false discovery rate (FDR) set to 0.05 for significance, and an exploratory cutoff of FDR q < 0.20. Gene set enrichment analysis (GSEA) was performed using miRTarBase's miRWalk pathways. Age, race-ethnicity, BMI, fire department, and sex were controlled for in all models. At FDR<0.05, the linear isomer of perfluorooctane sulfonic acid (PFOS) was inversely associated with miR-128-1-5p expression (Beta = -0.146, 95 % CI -0.216, -0.076). At a relaxed FDR of 0.20, we observed inverse associations for the sum of branched isomers of PFOS (Sm-PFOS) with 5 miRNAs (let-7d-5p, let-7a-5p, miR-423-5p, let-7b-5p, miR-629-5p). Several pathways were enriched for multiple PFAS, including those correlated with certain cancers, blood diseases, thyroid disorders, autoimmune disorders, and neurological outcomes. Some PFAS in firefighters were found to be associated with alteration of miRNA consistent with increased risk for a range of chronic diseases.

  PublisherDOI

• Incentives and Barriers to Adopting Fluorine-Free Foams (FFFs) in Fire Training Facilities: Results of the First North American Survey

  Fire · 2025-11-23

  articleOpen access

  Fluorine-free foams (FFFs) have been introduced as alternatives to aqueous film-forming foams (AFFFs), which are based on per- and polyfluoroalkyl substances (PFASs). However, adoption of FFFs remains limited due to the lack of universal drop-in replacements and limited data on their health and environmental impacts. This study examined incentives and barriers to implementing FFFs in Fire Training Facilities (FTFs) to support the transition away from PFAS-based products. A survey was conducted from September 2022 to December 2023 across the U.S. and Canadian FTFs, including state-funded facilities, metropolitan fire departments, airports, military, and industrial brigades. Developed in partnership with fire service organizations, the survey assessed current foam use, motivations for transition, and associated challenges. Of all FTF training with Class B foams, 38% reported using FFF products. Primary incentives included environmental and health concerns, safety, and regulatory pressures. Key challenges were transition costs, training requirements, and uncertainties around disposal of foams. These findings highlight that while momentum toward FFF adoption is evident, ensuring products are genuinely PFAS-free and providing comprehensive training will be critical for effective, large-scale implementation. Fire training facilities can play a pivotal role in guiding this transition.

  PublisherOA PDFDOI

• A Cross-Sectional Assessment of the Individual- and Fire Department-Level Factors Affecting Volunteer Firefighter Cardiorespiratory Fitness

  Fire · 2025-08-11

  articleOpen accessSenior author

  Volunteer firefighters often have lower cardiorespiratory fitness (CRF) and less access to health monitoring and fitness programs than career firefighters, yet few studies explore how individual and departmental factors influence their CRF. This study assessed associations between CRF and both firefighter-level (e.g., years of service, firefighting calls, and firefighter rank) and department-level (e.g., department characteristics and fitness infrastructure) factors among volunteer firefighters. Surveys were administered to United States volunteer firefighters and departments, capturing CRF and related characteristics. CRF was analyzed as both a continuous and categorical variable (≤8, >8-<10, 10-<12, ≥12 METs) using bivariate analyses and mixed effects linear and logistic regression. Among 569 incumbent volunteer firefighters from 41 departments, 79.9% did not meet the recommended 12 METs threshold. Only 56.8% of departments provided routine physical exams; 35.1% had a wellness coordinator or committee; and 40.5% offered fitness resources. More years of service were associated with lower CRF and reduced odds of meeting the 12 METs benchmark, while more frequent training and responding to more calls were associated with better CRF. These findings highlight individual and structural challenges for CRF in volunteer fire service, underscoring the need for targeted fitness support to protect firefighter health and community safety.

  PublisherOA PDFDOI

• Examinee Nondisclosure of Relevant Medical Information During Transportation-Related Regulatory Examinations

  Journal of Occupational and Environmental Medicine · 2025-02-20 · 1 citations

  articleOpen access

  OBJECTIVE: In the past decade, US transport accidents have resulted in over 370,000 fatalities. Research on medical history nondisclosure during mandatory regulatory exams has been limited. This study used the National Transportation Safety Board's (NTSB) Case Analysis and Reporting Online (CAROL) database to: (1) identify nondisclosure, (2) Assess nondisclosure patterns, and (3) evaluate CAROL's research potential. METHODS: The CAROL database was searched for US cases (01/01/2010-01/29/2024) involving fatalities and medically related causes. Nondisclosure was defined as operators with undisclosed preexisting conditions or medications in NTSB reports. Twelve cases with recurring themes were described in detail. RESULTS: Of 3012 accidents, 258 met our criteria; 80 (31%) indicated examinee nondisclosure in the NTSB investigation. CONCLUSIONS: Operator nondisclosure in NTSB cases underscores CAROL's value for further investigations and highlights the risks nondisclosure poses to US transportation safety.

  PublisherDOI

Recent grants

• Head and neck cancer in the World Trade Center Health Program cohort; elucidating risk factors to reduce incidence and morbidity

  NIH · $694k · 2016–2018

Frequent coauthors

• K.S. Almberg

  Chicago Department of Public Health

  86 shared

• Robert A. Cohen

  Northwestern University

  82 shared

• Cecile S. Rose

  University of Colorado Denver

  77 shared

• Qingyu Meng

  68 shared

• Karen Worthington

  Melbourne Sexual Health Centre

  65 shared

• Kathleen Black

  Rutgers, The State University of New Jersey

  51 shared

• Iris Udasin

  Environmental and Occupational Health Sciences Institute

  50 shared

• Rima Khabbaz

  National Center for Emerging and Zoonotic Infectious Diseases

  38 shared