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A study of 1,400 adults enrolled in Maui 6 to 18 months after the August 2023 wildfires found several urinary metals above U.S. reference levels and an association between higher combined metal burden and abnormal spirometry. It cannot determine how much of that burden came from the fires: participants had no pre-fire biomonitoring, and the results describe a cohort, not an individual diagnosis or prediction.
What the Maui study measured
The community-engaged Maui Wildfire Exposure Study (MauiWES) enrolled 1,400 adults 6 to 18 months after the August 2023 fires. At a single visit, researchers measured 24 metals in urine and conducted standardized spirometry, a test of lung function. The University of Hawaiʻi Economic Research Organization (UHERO) summarizes the study design and results in its September 30, 2026 research summary.
Because urine testing and spirometry took place at the same visit, this observational study can examine whether measurements were associated. It does not show how participants’ metal levels or lung function changed from before the fires, nor does it establish that metals caused any individual’s result.
Which urinary metals were elevated?
Compared with U.S. reference levels, the study summary reports the following differences:
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| Metal | Comparison reported by UHERO (2026) |
|---|---|
| Antimony | 40-fold higher than U.S. reference levels |
| Manganese | 3.8-fold higher than U.S. reference levels |
| Barium | 2.3-fold higher than U.S. reference levels |
| Arsenic | 2.2-fold higher than U.S. reference levels |
These are comparisons with reference levels, not clinical safety thresholds. The figures describe the study’s cohort-level findings; they do not establish that every participant had elevated levels.
How were metal mixtures associated with lung function?
Across three complementary mixture-modeling approaches, higher cumulative metal burden was consistently associated with greater odds of abnormal spirometry. In one approach, weighted quantile sum models, a one-quantile increase in the positive metal-mixture index was associated with higher modeled odds of results below the lower limit of normal:
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| Spirometry measure | Modeled odds ratio per one-quantile increase |
|---|---|
| FVC | 1.71 |
| FEV₁ | 1.53 |
| FEV₁/FVC | 1.83 |
| FEF25–75 | 1.84 |
These estimates are from UHERO’s 2026 study summary. They are modeled odds associations, not absolute probabilities, measures of how many people were affected, or estimates of causal effects. FVC is forced vital capacity; FEV₁ is forced expiratory volume in one second; FEV₁/FVC is the ratio of those measures; and FEF25–75 measures airflow through the middle portion of an exhalation.
Why findings differed by location
The Columbia University Mailman School of Public Health’s September 29, 2026 account describes different metal profiles and lung-function patterns across Maui communities. Lahaina participants showed relatively elevated arsenic and cadmium. Wailuku/Kahului had the highest median copper, iron, and molybdenum, and some of the highest prevalence of abnormal lung-function measures. Kula generally had the lowest prevalence of abnormal measures; Kula and Kihei had distinct metal profiles.
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These local comparisons do not yield one uniform exposure profile or island-wide risk estimate. They describe differences within the enrolled cohort, not predictions for every resident of a community.
What can—and cannot—be attributed to the fires
Without biomonitoring before the fires, researchers cannot determine precisely how much of the measured urinary metal burden came directly from wildfire exposure. Hawaiʻi’s geology, historic agricultural and industrial land use, diet, and other environmental factors may also contribute. A fire moving through a built environment could generate contaminants or disturb pollutants already in soil, dust, and infrastructure; fine particles resuspended later and contact with dust or debris are possible ongoing pathways. These are plausible contributors, not source apportionment for each participant.
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Kathrin Schilling, PhD, assistant professor of Environmental Health Sciences at Columbia Mailman School of Public Health, said: “The elevated metal burden likely reflects a complex mixture of exposures rather than a single source,”
Ruben Juarez, MauiWES co-director and UHERO–HMSA Distinguished Endowed Professor of Health Economics at UH Mānoa, said: “The biggest message is that exposure may not end when the smoke clears.”
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How to interpret the state’s air-monitoring results
Hawaiʻi Department of Health (DOH) community air sampling is a separate kind of evidence from urine biomonitoring. The Maui Data Portal says sampling ran from January 15, 2024, before debris removal began, through February 19, 2025, after Lahaina property debris removal was complete. For antimony, arsenic, cobalt, copper, and lead, the state reports that more than 1,000 air samples since the fires found amounts extremely low and not harmful to health.
The portal also identifies limited exceptions on August 25, 2024: manganese and nickel exceeded protective levels at Opukea Townhomes, and manganese exceeded the level at the Lahaina wastewater pump station. The cause was unclear; possible local contributors included windy conditions, metal grinding or cutting, and fertilizer use.
Air samples measure metals in ambient air at sampled locations and times; urine measurements reflect metals inside participants’ bodies. The measures cover different places, periods, and exposure pathways, so the air-monitoring results do not negate the urinary biomarker findings, and the urine results do not establish what was in the air at a particular location on a particular day.
Precautions around visible ash or disturbed dust
For areas where ash or dust is visible or may be disturbed, DOH advises temporarily leaving the area or wearing a snug-fitting dust mask or N95 with “NIOSH Approved” printed on it to limit the amount of metals breathed in. This is precautionary guidance for potential dust exposure, not a treatment for abnormal spirometry or a conclusion about any person’s health.
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