Incomplete burning of wood in traditional fish smoking kilns releases aerosol particulates carrying health destructive species including metals. This study evaluated the potential carcinogenic risk of occupational fish smokers' exposure to trace metals in outdoor fine particulates (PM2.5) in southern Apam, Ghana. Additionally, it examined self-reported health effects among fish smokers resulting from smoke exposure. PM2.5Ìýsamples were collected during fish smoking activities from July 2022 to June 2023, which covered 70 sampling days. A Gent sampler, equipped with a Gast pump and stacked filter unit, was employed to collect PM2.5Ìýparticulates over 24-hour periods. The black carbon (BC) and elemental analyses of particulate samples were conducted usingÌýa smoke stain reflectometer and an Ag-anode X-ray tube spectrometer, respectively. A 41-item closed-ended questionnaire was administered to 372 randomly selected fish-smoking workers.ÌýThe US EPA health risk appraisal model andÌýthe European Community Respiratory Health Survey questions were used to explore the health hazards associated with trace metals and self-reported health outcomes, respectively. The analysed data showed that the average PM2.5 concentration (24.5 µg/m3)Ìýexceeded the WHO safe limit of 15 μg/m3. Notably, average Cr (94.70 ng/m3) and Ni (133.31 ng/m3) concentrations substantially exceeded US EPA regulatory limits of 12 ng/m3Ìýand 0.24 ng/m3, respectively. A strong correlation between Cr, Ni, Mn, Fe, V, Cu, K, and BC suggested their significant release from a combustion source. The carcinogenic metalsÌýposed a greater risk to adult fish smokers compared to children via dermal contact. Besides, 84-95 out of every 10,000 fish smokers might experience cancer dangers due to trace metals exposure via ingestion. Fish smokers frequently reported eye irritation and respiratory infection symptoms. Statistically, there was a significant link between hours spent in smoke per day and respiratory health symptoms<0.05). Adopting sustainable fish smoking technology is imperativeÌýto reduce excessiveÌýPM2.5 exposure and protect public health

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