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While firefighters currently have low smoking rates, rates of smokeless tobacco (SLT) use among this population are remarkably high and substantially greater than similar occupational groups, and the general population. This study explored determinants associated with SLT use, barriers to cessation, and motivators for SLT cessation in the fire service. Key informant interviews were conducted in 23 career firefighters who were current (n = 14) and former (n = 9) SLT users from across the U.S. Discussions were recorded and independently coded according to questions and themes. Major themes that developed among firefighters regarding SLT use determinants included positive perceptions of SLT products, social influences from their peers and family members, acceptability of SLT use in the fire service, and a coping resource for job stress. Firefighters discussed several barriers to SLT cessation, including intrapersonal barriers such as SLT use habits and its dependency, concerns about withdrawal symptoms; and social-environmental barriers including lack of support from health and other services providers, and lack of enforcement of existing tobacco policies regarding SLT use. Firefighters also mentioned both internal and external motivators for cessation. Internal motivators included self-motivation and their health concerns while external motivators included friends and family support, incentives or rewards, and price of SLT products. Findings provide unique perspectives from firefighters on factors that influence SLT use and barriers and motivators to SLT cessation. These are insufficiently assessed and considered by the fire service organizations and their health care providers. Thus, the organizations must understand these issues in order to mitigate barriers and motivate the personnel to quit using SLT. Information gained from firefighters who were current and former SLT users can be used to develop an effective, culturally-tailored intervention that is acceptable to fire service personnel.

Background Firefighting is a dangerous occupation with high rates of injuries and fatalities, with the majority of line of duty fatalities due to cardiovascular events. Additionally, firefighters struggle with poor health/low levels of fitness, including high (> 80%) rates of overweight and obesity. Limited resources exist for fire departments that are tailored to the culture and work requirements of these “tactical athletes”. Though there has been increasing interest in high intensity functional training (HIFT) programs, research data are lacking among firefighters and few studies have focused on training recruits. The purpose of this pilot investigation was to examine a novel HIFT program (TF20) on fire academy recruits’ health, fitness, and performance as determined by a simulated fire ground test (SFGT), as well as determining the program’s acceptability and feasibility. Methods Thirteen participants were recruited from an entry level fire academy and were randomly assigned to the control (CG, n  = 6) or HIFT group (TF20, n  = 7). The CG was asked to continue current exercise habits. TF20 was provided a 10-week online based training program that included periodized workouts, nutritional information, and mental readiness education. Due to attrition within the first two weeks of the study, 10 male fire recruits (23 ± 3 years) completed the study (CG, n  = 3, TF20, n  = 7). All 10 participants completed baseline and follow-up assessments. Results The TF20 group showed improvement on numerous outcome measures including SFGT (40% passing at baseline, 86% passing post-intervention). TF20 participants significantly increased estimated VO2max ( p  = 0.028), improved body composition (p = 0.028), and improved grip strength ( p  = 0.018). The CG did not experience any significant changes. The TF20 group completed approximately 75% of the assigned workouts. Conclusion While TF20 participants showed significant fitness gains, the small sample size limited direct comparisons to the CG. TF20 was well-received although there may be a better way to implement the intervention to increase participation. This investigation provides promising outcomes, useful information about implementation, feasibility, and acceptability for the TF20 HIFT program among firefighter recruits. IRB #8063 APPROVED 01/04/2016. Trial registration NCT03319394 . Registered 28 September 2014. Retrospectively registered.

Studies showed that tobacco use and excessive alcohol consumption frequently occur, and both are significant causes of preventable morbidity and mortality. Data were collected as part of a national online study of the health of women in the fire service. Multinomial logistic regression was employed to determine factors associated with smoking and drinking characteristics. A total of 2330 women firefighters completed questions regarding tobacco and alcohol use; 3.2% (n = 75) were concurrent users, 0.9% (n = 22) were smokers only, 49.4% (n = 1150) were heavy drinkers only, and 46.5% (n = 1083) were low-risk users. Compared with those who neither smoked nor binge drank, concurrent users were more likely to be younger and live alone or not married. The findings also suggested that smokers, heavy drinkers, or those who were both were more likely to report symptoms of depression and PTSD and a history of physician diagnosis of anxiety disorder compared to low-risk users. Smoking rates are relatively low among women firefighters; however, mental health risks are prevalent, particularly for those who both smoked and drank heavily. Results can be potentially used to inform prevention and treatment research to better address the unique condition of this occupational group.

Firefighters are vulnerable to opioid misuse given the adverse effects their occupation has on mental and physical health. Yet there are limited data on opioid misuse within this population. This study examined the prevalence of illicit prescription opioid use among a nationally representative sample of U.S. firefighters and factors related to opioid misuse. Data were collected through reliable questionnaires from 617 firefighters prior to participating in an intervention designed to mitigate the negative impacts of trauma. The lifetime prevalence of illicit prescription opioid use was 14% compared to 13% in the general U.S. population. The most commonly misused opioids were hydrocodones with trade names Vicodin, Lortab, and Lorcet (72% of those illicitly using opioids). Illicit prescriptions opioid use was not significantly correlated with any demographics examined. However, firefighters who engaged in illicit opioid use exhibited poorer mental health, more alcohol-related problems, and an increased likelihood of misusing other prescription medications. In a regression analysis, alcohol consumption issues, Post-Traumatic Stress Disorder (PTSD), and the illicit use of sedatives and tranquilizers emerged as significant predictors of illicit prescription opioid use. Illicit prescription opioid use by firefighters is a potential problem especially when considered along with other factors such as mental health. Longitudinal studies are needed to further deepen our knowledge about this issue.

Intro. Both discrimination and harassment directly impact mental and physical health. Further, workplace discrimination degrades workplace culture and negatively impacts health behaviors, job-related outcomes, and family dynamics. Women represent a small proportion of the fire service and are often the targets of discrimination/harassment, yet little research documents the impact of such experiences. The purpose of this study was to evaluate the relationship between chronic work discrimination and/or harassment and women firefighters’ (FFs) physical and mental health, substance abuse, and job efficacy, stress, and satisfaction. Methods. Snowball sampling was used to solicit participation from women career FFs. Participants completed an online survey regarding physical and mental health, health behavior, job efficacy/stress/satisfaction, and family well-being. Logistic regression examined the impact of work discrimination-harassment severity on dichotomous variables. Results. 1,773 had complete data on their experiences with work-related discrimination and harassment. Women reported experiencing verbal (37.5%) and written (12.9%) harassment, hazing (16.9%), sexual advances (37.4%), and assaults (5.1%) in the fire service. FFs in the highest tertile of work discrimination-harassment severity reported over 40% more poor health days in the last 30 days (OR=1.42; 95%CI=1.33-1.51; p<0.001). Women who experienced moderate and severe discrimination/harassment had negative mental health outcomes including higher prevalence of depressive symptoms, anxiety, and PTSD symptoms. Those who experienced high rates of discrimination and/or harassment also were more likely to report issues with alcohol consumption. Conclusion. The impact of discrimination and harassment, related negative physical and mental outcomes, low levels of job satisfaction, and negative impact of these experiences on family/home stress likely take a significant toll on women in the fire service. Findings confirm and extend previous work suggesting there is a need to improve the mental and physical health of women FFs. Future work should examine the prospective relationship between discrimination/harassment and poor health outcomes and potential policies/practices to reduce these negative behaviors.

OBJECTIVE:To determine the prevalence and severity of excessive daytime sleepiness (EDS) in a population-based sample of firefighters. METHODS:Sleepiness was assessed using the Epworth Sleepiness Scale in a sample of male career firefighters (n = 458) from 11 randomly selected fire departments in the Midwestern United States. RESULTS:Unadjusted EDS rates (13.7% and 14.0% for on- and off-duty, respectively) were similar to the general US population and comparable occupational groups. Factors associated with EDS included 48-hour work shifts, non-private department sleep areas, and working a second job outside the fire service (P < 0.05). CONCLUSION:Given firefightersʼ important role in public safety, concerns have been raised about whether firefightersʼ work schedules result in high rates of excessive sleepiness. Nevertheless, firefighters in this study did not have high rates of EDS despite their extended work schedule.

Objectives Despite increasing attention to the occupational impact of firefighting, little is known specific to the health of women firefighters. In particular, quantitative data is lacking on the impact firefighting has on maternal and child health for women who become pregnant while working as firefighters. Methods A total of 1821 women firefighters responded to requests to complete a self-report survey of questions about pregnancy. Women answered questions about their departments’ policies and practices and their own experiences of pregnancy. Those participants who reported a pregnancy while serving as a firefighter were asked detailed questions about their pregnancy and outcomes. Results Female firefighters reported that nearly a quarter of their first pregnancies while in the fire service ended in miscarriage and that increased to a third of pregnancies by the fourth. Rates of pre-term delivery also were high among this population. Conclusions Findings have important implications for policy and practice among women who become pregnant while actively serving in the fire service.

Background Firefighters suffer from high prevalence of obesity, substandard fitness, and cardiovascular-related deaths. There have been a limited number of firefighter health promotion programs that have been developed and empirically-tested for this important occupational group. We evaluated the health of firefighters from departments with well-developed health promotion programs and compared them with those from departments not having such programs using a large national sample of career fire departments that varied in size and mission. We measured a broad array of important individual firefighter health outcomes (e.g., body composition, physical activity, and general and behavioral health) consistent with national fire service goals and addressed significant statistical limitations unaccounted for in previous studies. Methods Using the approach of purposive sampling of heterogeneous instances, we selected and conducted a national evaluation of 10 departments already implementing wellness and fitness programs (Wellness Approach; WA) with 10 departments that did not (Standard). Participants were 1,002 male firefighters (WA n = 522; Standard n = 480) who underwent assessments including body composition, fitness, and general/behavioral health (e.g., injury, depressive symptoms). Results Firefighters in WA departments were healthier than their Standard department counterparts. For example, they were less likely to be obese (adjusted [A]OR = 0.58; 95% CI = 0.41-0.82), more likely to meet endurance capacity standards for firefighting (AOR = 5.19; 95% CI = 2.49-10.83) and have higher estimated VO 2max (40.7 ± 0.6 vs. 37.5 ± 1.3 for firefighters in Standard departments; p = 0.001). In addition, WA firefighter were substantially less likely to smoke (AOR = 0.30; 95% CI = 0.17-0.54) or ever have been diagnosed with an anxiety disorder (AOR = 0.27; 95% CI = 0.14-0.52) and they expressed higher job satisfaction across several domains. However, WA firefighters were somewhat more likely to have reported an injury to Workers’ Compensation (AOR = 1.74; 95% CI = 1.05-2.90). It was notable that both groups evidenced high prevalence of smokeless tobacco use and binge drinking. Conclusions Firefighters in departments selected based on having strong wellness programs (WA) were healthier along a number of dimensions important to firefighter wellness and operational readiness. However, several health areas require greater attention including problematic alcohol consumption and smokeless tobacco use, suggesting that more emphasis on these behavioral health issues is needed in the fire service.

OBJECTIVE:The aim of this study was to determine the efficacy of an occupationally tailored, web-based health and wellness program, The First Twenty® (TF20), for weight change among volunteer firefighters. METHODS:The impact of TF20 on firefighters’ 6-month weight change was tested in a cluster, randomized controlled trial, using a crossover design of firefighters in 10 departments. TF20 has web-based nutrition, physical activity, and behavioral health components. RESULTS:An adjusted treatment-induced weight loss from 1.7 to 2.8 lb was observed for all participants and 2.3 to 3.1 lb among overweight and obese participants. An average weight gain was observed among firefighters in the control condition and weight loss for those in the treatment condition. CONCLUSIONS:TF20 supports firefighters’ weight loss. Firefighters need wellness interventions to improve nutrition and physical activity given their high prevalence of obesity.

Objective: To document weight changes in a population-based cohort of male career firefighters and evaluate the impact of health surveillance on subsequent participant behavior and body composition. Methods: Body mass index, waist circumference, and body fat percentage were assessed longitudinally in 311 male firefighters. Results: Firefighters who reported making no changes after the baseline assessment (42.1%) experienced a 0.64 ± 3.1 kg average weight gain, whereas firefighters who reported making one or more health behavior change (ie, changing their diet, increasing their physical activity, or both; 52.1%) lost an average of -1.3 kg. Conclusions: Regular health surveillance may motivate some firefighters to make health behavior changes. Although it is not currently the norm, fire departments should provide firefighters with annual health assessments including body composition and fitness measures, consistent with those recommended by the fire service's Wellness and Fitness Initiative.