Mental and Respiratory Health Impacts of the Maui WUI Fire in Children and Adults

ABSTRACT The wildland-urban interface (WUI) fire of August 8, 2023 in Maui has been the deadliest in US history. It completely swallowed the historical town of Lahaina, claimed > 100 human lives, burned > 2000 structures, and displaced thousands of people. The combustion of biomass, buildings, furniture, and automobiles generated a

complex mixture of toxic compounds including lead, arsenic, asbestos, cyanates, dioxins, and flame retardants. These compounds are enriched in the ashes, residues, and soils in the burn site and surrounding areas. As of January 2024, most of the burn site remained inaccessible to the public as residues/soils were deemed toxic.

Many of these toxic compounds are persistent in the environment, causing cumulative exposures years and even decades after the fire. The over goal of this time-sensitive R21 project is to address fire victims’ current and future health concerns. We formed an academia-government-community partnership to pursue the following

aims. Aim 1: To assess the impact of the fire on mental and respiratory health outcomes. We plan to enroll child and adult participants from 100 fire-displaced households and 100 nonaffected households. Respiratory symptoms, lung function, and mental health and wellness will be assessed using the NIEHS Disaster Research

Protocols (the RAPIDD toolkits) with modifications to clarify the specific disaster setting. We hypothesize that individuals who experienced displacement would have worse mental and respiratory health outcomes than individuals without displacement experience, adjusted by demographics, lifestyle, socioeconomics, pre-fire

environmental exposure history, and pre-fire health status. Aim 2: To assess the change in health outcomes one year later, relative to baseline impact assessed in Aim 1. We hypothesize that individuals affected more severely at baseline would have worse respiratory and mental health outcomes at follow-up compared to those

affected less severely. Aim 3: To collect house dust, wristband, and biological samples for future investigations of longer-term health effects of cumulative and/or changing exposures resulting from the disaster. These samples can be analyzed to capture important time windows of toxic exposure and biomarkers

indicative of toxicity and disease risk. They will be integrated in our planned R01 that aims to address lasting concerns of the victims while studying the interactions between respiratory and mental health outcomes in toxic exposure and disaster contexts. Overarching Aim: To report the study findings back timely to study

participants and the larger community. We will form a dissemination team with extensive experience in bi- directional communications between researchers and the community. This team will answer participants’ and community questions in a proper manner taking into considerations of culture sensitivity. The team will facilitate

receiving input from the community to help develop survey instruments and collect data and samples. The data and samples will be an invaluable resource that can be shared with other researchers who wish to study WUI fires that are becoming increasingly common. 1