Exploring the criteria and factors affecting firefighters' resilience: A qualitative study.

PURPOSE: Firefighters are exposed to high levels of occupational risk factors, such as safety risks, chemical, ergonomic, and physical hazards that may jeopardize their lives. To overcome these hazards, firefighters must be physically, mentally, and personally fit to work. This study aimed to explore the criteria and factors affecting firefighters' resilience based on stakeholders' experiences. METHODS: This qualitative study was carried out using conventional content analysis. In total, 21 face-to-face interviews were conducted by firefighters who were experienced in the field. The interviews were carried out from July 2019 to January 2020. The data were collected using 3 unstructured interviews and then resumed by 18 semi-structured interviews. Data analysis was done using Graneheim method. RESULTS: The participants had more than 5 years of experience in the field of search and rescue. The extracted codes through data analysis were classified into 3 main categories (individual, organizational, and social factors), 9 sub-categories (mental, physical, occupational, managerial, colleagues-related, equipment-related, environmental, community-related, and family-related factors), as well as 19 sub-sub-categories and 570 codes. CONCLUSION: Firefighters' personality, physical condition, behavior and psychological characteristics can affect their resilience along with organizational and management factors that play significant role in people's safety. Developing a tool for assessing resilience can help decision makers to have a real depict of firefighters' job qualifications.

Rejection of workers' compensation claims may increase depressive symptoms among firefighters with occupational injury: a nationwide study in South Korea.

OBJECTIVES: This study sought to examine whether the experience of occupational injuries was associated with depressive symptoms and whether the rejection of workers' compensation claims was associated with depressive symptoms among Korean firefighters. METHODS: We conducted a nationwide survey of 6793 Korean firefighters in 2015. Based on the experience of occupational injuries and workers' compensation claims over the past year, respondents were classified into four groups: "Not injured", "Injured, not applied", "Injured, applied, but rejected" and "Injured, applied, and accepted." Depressive symptoms over the preceding week were assessed using the 11-item version of the Centers for Epidemiologic Studies Depression Scale. RESULTS: Compared to firefighters who did not get injured, injured firefighters had a higher prevalence of depressive symptoms (PR 2.01, 95% CI 1.83, 2.22) after controlling for confounders including job assignment. Also, when we restricted the analysis to injured firefighters, a higher prevalence of depressive symptoms was observed among "Injured, applied, but rejected" (PR 1.70, 95% CI 1.11, 2.59) group, compared to "Injured, applied, and accepted" group. CONCLUSIONS: This finding suggests that rejection of workers' compensation claims, as well as the experience of occupational injuries, may increase the risk of depressive symptoms among Korean firefighters.

Work-Related Psychological Distress and Its Management: The Perspective of Employees in the Financial Industry Compared With Those in Human Services.

OBJECTIVE: Investigate psychological distress and its link to stress management interventions in the financial industry (FI) in comparison to the human services (HS) sector. METHOD: Observational study across participating organizations in FI (66) and HS (81). Web-based version of depression anxiety stress scales (21 questions) and eight questions related to stress prevention interventions adopted by employers. RESULTS: Indicated that FI workers are twice as likely as HS employees to present with stress and depression. Differences emerged on the availability of support at the workplace: FI workers reporting total lack of psychological support, although other forms of wellbeing promotion were more frequent. Close to 60% of individuals in the HS group reported no support (48% in the FI). CONCLUSION: Workers in the FI industry have increased levels of workplace stress that could be possibly attributed to absence of prevention interventions at the workplace.

Barriers and solutions to improving nutrition among fire academy recruits: a qualitative assessment.

The primary health concerns among US firefighters are cardiovascular disease, cancer, and depression and occur in an occupational setting where dietary habits are suboptimal. To understand if a diet or lifestyle modification works in a fire academy training setting, it is important to evaluate the cultural barriers and challenges that might be faced. A semi-structured telephone interview method followed by a focus group was used to gather common themes among fire service leaders. Twelve leaders participated in the telephonic interviews and a subset of five in the subsequent group session. Five main themes were identified. The study identified a need for staff and recruits to develop a cohesive culture that facilitates long-term change. Participants reported that incentives for good choices and the elimination of certain poor choices from the food environment would promote healthier choices. The study supports an intervention using education of fire recruits and modifications of the fire academy food environment.

Experiencing External Workplace Violence: Differences in Indicators Between Three Types of Emergency Responders.

Police officers, firefighters, and emergency medical workers are at a relatively high risk of experiencing external workplace violence (EWPV), that is, violence initiated by people outside the organization. Based on criminal opportunities theories, the aim of this research was to study to what extent socio-demographic and work characteristics are related to experiencing EWPV. In addition, the aim was to explore how these relations differ between the three types of emergency responders. Data from a workplace violence survey of the Ministry of the Interior and Kingdom Relations of the Netherlands was used, from which emergency medical workers ( n = 264), firefighters ( n = 255), and police officers ( n = 296) were selected. Results indicated that police officers experienced most and firefighters experienced least EWPV. Younger professionals and professionals who have more frequent and risky contact experienced more EWPV. The expectations that males and those with less skills or experience to avoid EWPV experience more EWPV were not convincingly supported. The relationships between characteristics and EWPV, and the explanatory power of the models, differed between types of emergency responders. The studied characteristics best explained variations in EWPV of police officers, and therefore prevention of EWPV by addressing these characteristics will be most successful for police officers. The prediction of EWPV should be improved, for example, by studying the relationship with "attractiveness" or "vulnerability" of the possible victim, such as psychological characteristics of professionals. The study showed that research about indicators and prevention of EWPV should be aimed at separate professions.

Perceived Stress in Black and Latino Male Firefighters: Associations with Risk and Protective Factors.

Objective: To compare the prevalence of work-related protective and risk factors among Black and Latino male firefighters and to examine the association of these factors to perceived stress among both ethnic groups. Design Setting Participants: Participants included 1,036 male, career firefighters who self-identified as Black (n=477) or Latino (n=559) from a large fire department in a major metropolitan city in the southwestern United States. As part of a department-wide suicide prevention program conducted in 2008, participants completed an anonymous and voluntary mental health needs survey. Measures: The needs survey included questions regarding prevalence of work-related protective and risk factors, the RAPS-4 to assess substance abuse problems, and the 10-item Perceived Stress Scale. Results: Results of regression analyses indicated that for both Black and Latino male firefighters, alcohol abuse (ß =.13, ß =.22), self-reported good health (ß = -.23, ß =-.24) and a positive partner/spouse relationship (ß =-.14, ß = -.15) were related to perceived stress. In addition, having a second job (ß = .12) and a sense of life calling (ß =-.10) were related to perceived stress only among Latino firefighters. All associations were in the expected direction as indicated by the signs of the standardized beta coefficients (ß). Conclusion: Black and Latino male firefighters reported relatively high levels of perceived stress. However, there were both differences and similarities in the factors associated to perceived stress among the ethnic groups. Therefore, interventions to help firefighters reduce or manage stress need to take into account that factors associated with perceived stress may vary by ethnic group.

Designing smartphone mental health applications for emergency service workers.

BACKGROUND: Emergency service workers are often exposed to trauma and have increased risk of a range of mental health (MH) conditions. Smartphone applications have the potential to provide this group with effective psychological interventions; however, little is known about the acceptability and preferences regarding such initiatives. AIMS: To describe the preferences and opinions of emergency service workers regarding the use of smartphone MH applications and to examine the impact of age on these preferences. METHODS: Participants were recruited from four metropolitan Fire and Rescue NSW stations and responded to questionnaire items covering three key domains: current smartphone use, potential future use and preferences for design and content as well as therapeutic techniques. RESULTS: Overall, approximately half the sample (n = 106) claimed they would be interested in trying a tailored emergency-worker MH smartphone application. There were few differences between age groups on preferences. The majority of respondents claimed they would use an app for mental well-being daily and preferred terms such as 'well-being' and 'mental fitness' for referring to MH. Confidentiality, along with a focus on stress, sleep, exercise and resiliency were all considered key features. Behavioural therapeutic techniques were regarded most favourably, compared with other therapies. CONCLUSIONS: Emergency workers were interested in utilizing smartphone applications focused on MH, but expressed clear preferences regarding language used in promotion, features required and therapeutic techniques preferred.

Implementing risk management to reduce injuries in the U.S. Fire Service.

INTRODUCTION: Risk management, a proactive process to identify and mitigate potential injury risks and implement control strategies, was used to reduce the risk of occupational injury in a fire department. The objective of this research was to study the implementation of the risk management process for future replication. A second objective was to document changes in fire personnel's knowledge, attitudes, and behaviors related to the selected control strategies that were implemented as part of the risk management process. METHOD: A number of control strategies identified through the risk management process were implemented over a 2-year period beginning in January 2011. Approximately 450 fire personnel completed each of the three cross-sectional surveys that were administered throughout the implementation periods. Fire personnel were asked about their awareness, knowledge, and use of the control strategies. RESULTS: Fire personnel were generally aware of the control strategies that were implemented. Visual reminders (e.g., signage) were noted as effective by fire personnel who noticed them. Barriers to use of specific control strategies such as new procedures on the fireground or new lifting equipment for patient transfer included lack of knowledge of the new protocols, lack of awareness/access to/availability of the new equipment, and limited training on its use. Implementation challenges were noted, which limited self-reported adherence to the control strategies. CONCLUSIONS: Fire personnel generally recognized the potential for various control strategies to manage risk and improve their health and safety; however, implementation challenges limited the effectiveness of certain control strategies. The study findings support the importance of effective implementation to achieve the desired impacts of control strategies for improving health and safety. PRACTICAL APPLICATIONS: Employees must be aware of, have knowledge about, and receive training in safety and health interventions in order to adopt desired behaviors.

Assessment of Acute Trauma Exposure Response for FIRE-EMS Personnel.

PURPOSE: The purpose of this study was to develop an instrument that measures response to acute trauma exposure for firefighter and emergency medical service (EMS) personnel. The Acute Trauma Exposure Response Scale (ATERS) was intended to assess firefighter and EMS personnel response to acute trauma exposure from analytical, emotional, and physical perspectives. METHODS: Data were analyzed on 97 firefighter and EMS personnel employed by a fire department in a mid-sized city in a western state. Principal component analysis (PCAR) using Winsteps software was employed to discover which variables in the set formed logical subsets that were independent of one another and included item analyses and assessment of internal consistency reliability (Cronbach's alpha). Rasch analysis included examination of dimensionality, person and item reliability, scale use and function, and construct validity including person-item fit statistics. RESULTS: Principal component analyses of residuals (PCAR) revealed three primary scales which were termed Emotional Psyche, Coping Ability, and Support Systems. Rasch analyses showed the ATERS performance to be acceptable as a new pilot measure with three distinct scales through reliability of person separation of .81 for Emotional Psyche, .66 for Coping Ability, and .63 for Support Systems, respectively (Nunnally and Bernstein, 1994; Carmines and Zeller, 1979; Devellis, 2012). The Rasch item reliability was .96 for Emotional Psyche, .95 for Coping Ability, and .97 for Support Systems. Response scale use and function was appropriate for each subscale. Validity was supported through PCA by evidence of good internal consistency. High item correlations indicated the items for each subscale were measuring a single construct. Likewise, Rasch analyses provided evidence of validity through an even spread of person ability to item difficulty for each of the three constructs. Good item fit provided proof of construct relevant variance and the absence of gaps along the unidimensional continuum indicated each construct to be represented adequately. CONCLUSION: The ATERS performs well as a measure of acute trauma exposure response for three primary constructs: Emotional Psyche, Coping Ability, and Support Systems with good Rasch person internal consistency reliability and factor structure. Items were deleted for each scale following PCA and Rasch analyses due to misfit and low loadings. Further research is recommended to optimally represent each construct in regards to person-item fit. Fire departments may utilize results of this study to assess current program effectiveness. Through evaluation, departments may incorporate programs and resources that are more effective at reducing stress associated with acute trauma, thereby increasing employees overall job satisfaction and performance.

Expecting the unexpected: A mixed methods study of violence to EMS responders in an urban fire department.

BACKGROUND: Struck by injuries experienced by females were observed to be higher compared to males in an urban fire department. The disparity was investigated while gaining a grounded understanding of EMS responder experiences from patient-initiated violence. METHODS: A convergent parallel mixed methods design was employed. Using a linked injury dataset, patient-initiated violence estimates were calculated comparing genders. Semi-structured interviews and a focus group were conducted with injured EMS responders. RESULTS: Paramedics had significantly higher odds for patient-initiated violence injuries than firefighters (OR 14.4, 95%CI: 9.2-22.2, P < 0.001). Females reported increased odds of patient-initiated violence injuries compared to males (OR = 6.25, 95%CI 3.8-10.2), but this relationship was entirely mediated through occupation (AOR = 1.64, 95%CI 0.94-2.85). Qualitative data illuminated the impact of patient-initiated violence and highlighted important organizational opportunities for intervention. CONCLUSIONS: Mixed methods greatly enhanced the assessment of EMS responder patient-initiated violence prevention.

Pain, health perception and sleep: impact on the quality of life of firefighters/rescue professionals.

OBJECTIVE: To evaluate the quality of life of firefighters and rescue professionals, and characterize their socio-demographic, health, work and lifestyle profile. METHODS: Cross-sectional study that used a socio-demographic, lifestyle, health, work data questionnaire and the WHOQOL-BREF quality of life aspects, in Fire Department bases, Civil Air Patrol Group of the Military Police and Rescue Group of Emergency Services. RESULTS: Ninety professionals participated in this study - 71 firefighters, 9 nurses, 7 doctors and 3 flight crew members. The average age of the group was 36.4 ± 7.8 years; they worked about 63.7 hours per week; 20.2% reported pain in the last week and 72.7% had body mass index above 25 kg/m2. The average of the WHOQOL-BREF domains was: physical (74.6), psychological (75.2), social (76.5) and environmental (58.7). Significant association was found (Mann-Whitney test and Spearman correlation) between the WHOQOL-BREF domains and pain in the past six months, in the last week, health perception, job satisfaction, hours of sleep, domestic tasks and study. CONCLUSION: The main factors related to quality of life were presence of pain, health perception, sleep and domestic activity.

Pain, health perception and sleep: impact on the quality of life of firefighters/rescue professionals / Dor, percepção de saúde e sono: impacto na qualidade de vida de bombeiros/profissionais do resgate / Dolor, percepción de la salud y del sueño: impacto en la calidad de vida de bomberos y profesionales del rescate

Objective: to evaluate the quality of life of firefighters and rescue professionals, and characterize their socio-demographic, health, work and lifestyle profile. Methods: cross-sectional study that used a socio-demographic, lifestyle, health, work data questionnaire and the WHOQOL-BREF quality of life aspects, in Fire Department bases, Civil Air Patrol Group of the Military Police and Rescue Group of Emergency Services. Results: ninety professionals participated in this study - 71 firefighters, 9 nurses, 7 doctors and 3 flight crew members. The average age of the group was 36.4 ± 7.8 years; they worked about 63.7 hours per week; 20.2% reported pain in the last week and 72.7% had body mass index above 25 kg/m2. The average of the WHOQOL-BREF domains was: physical (74.6), psychological (75.2), social (76.5) and environmental (58.7). Significant association was found (Mann-Whitney test and Spearman correlation) between the WHOQOL-BREF domains and pain in the past six months, in the last week, health perception, job satisfaction, hours of sleep, domestic tasks and study. Conclusion: the main factors related to quality of life were presence of pain, health perception, sleep and domestic activity.

Objetivo: avaliar a qualidade de vida de bombeiros e profissionais do resgate e caracterizar o perfil sociodemográfico, de saúde, trabalho e estilo de vida. Método: estudo transversal que utilizou o questionário de dados sociodemográficos, estilo de vida e aspectos da saúde e do trabalho e o de qualidade de vida WHOQOL-BREF, nas bases do Corpo de Bombeiros, no Grupamento de Rádio e Patrulha Aérea da Polícia Militar e no Grupo de Resgate de Atendimento as Urgências. Resultados: 90 profissionais participaram do estudo - 71 bombeiros, nove enfermeiros, sete médicos e três tripulantes de voo. A idade média foi de 36,4±7,8 anos; trabalhavam em média 63,7 horas por semana; 20,2% relataram dor na última semana e 72,7% apresentavam índice de massa corpórea acima de 25kg/m2. A média dos domínios do WHOQOL-BREF foi: físico (74,6), psicológico (75,2), relações sociais (76,5) e ambiental (58,7). Houve associação significante (teste de Mann-Whitney e correlação de Spearman) entre domínios do WHOQOL-BREF e dor nos últimos seis meses, na última semana, percepção de saúde, satisfação com o trabalho, horas de sono e realizar trabalho doméstico e estudar. Conclusão: os principais fatores relacionados à qualidade de vida foram presença de dor, percepção de saúde, sono e trabalho doméstico.

Objetivo: evaluar la calidad de vida de bomberos y profesionales del rescate y caracterizar el perfil sociodemográfico, de salud, trabajo y estilo de vida. Métodos: estudio transversal utilizando la encuesta de datos sociodemográficos, de estilo de vida y aspectos de la salud y del trabajo, además del cuestionario de calidad de vida WHOQOL-BREF, en las bases del Cuerpo de Bomberos, en el Agrupamiento de Radio y Patrulla del Aire de la Policía Militar y en el Grupo de Rescate de Atención de Urgencias. Resultados: en este estudio participaron 90 profesionales-71 bomberos, 9 enfermeras, 7 médicos y 3 miembros de la tripulación de vuelo. La media de edad fue de 36,4 ± 7,8 años y la del trabajo 63,7 horas por semana; el 20,2% de ellos informaron dolor en la última semana y el 72,7% tenían índice de masa corporal por encima de 25 kg/m2. La media de los dominios WHOQOL-BREF fue: físico (74,6), psicológico (75,2), relaciones sociales (76,5) y ambientales (58,7). Hubo asociación significativa (test de Mann-Whitney y correlación de Spearman) entre dominios del WHOQOL-BREF y el dolor en los últimos seis meses, en la última semana, la percepción de la salud, la satisfacción con el trabajo, el hecho de dormir y realizar los estudios y el trabajo doméstico. Conclusión: los principales factores relacionados con la calidad de vida fueron la presencia de dolor, percepción de la salud, sueño y trabajo doméstico.

Fatigue risk management by volunteer fire-fighters: Use of informal strategies to augment formal policy.

An increasing number and intensity of catastrophic fire events in Australia has led to increasing demands on a mainly volunteer fire-fighting workforce. Despite the increasing likelihood of fatigue in the emergency services environment, there is not yet a systematic, unified approach to fatigue management in fire agencies across Australia. Accordingly, the aim of this study was to identify informal strategies used in volunteer fire-fighting and examine how these strategies are transmitted across the workforce. Thirty experienced Australian volunteer fire-fighters were interviewed in August 2010. The study identified informal fatigue-management behaviours at the individual, team and brigade level that have evolved in fire-fighting environments and are regularly implemented. However, their purpose was not explicitly recognized as such. This apparent paradox - that fatigue proofing behaviours exist but that they are not openly understood as such - may well resolve a potential conflict between a culture of indefatigability in the emergency services sector and the frequent need to operate safely while fatigued. However, formal controls require fire-fighters and their organisations to acknowledge and accept their vulnerability. This suggests two important areas in which to improve formal fatigue risk management in the emergency services sector: (1) identifying and formalising tacit or informal fatigue coping strategies as legitimate elements of the fatigue risk management system; and (2) developing culturally appropriate techniques for systematically communicating fatigue levels to self and others.

The use of assessment tools in a sample of Croatian professional fire-fighters.

BACKGROUND: This article aims at testing of psychometric characteristics of the Beck Depression Inventory (BDI) and the Defense Style Questionnaire - 40 (DSQ-40) in a sample of Croatian professional fire-fighters, so as to justify their use in Occupational Health. A pioneer effort to interrelate mental states and psychological job demands, ranked using the WAI questionnaire, was made as well. SUBJECTS AND METHODS: Upon informed consent, the tools were tested on a sample of 300 members of the operative fire-fighting squad of the City of Zagreb, all men (average age 43; average years of fire-fighting service 18.5). The participation was voluntary and anonymous. RESULTS: The average BDI score was 2.34, revealing a low representation of depression in the target population. The score indicating severe depression was seen in 0.7% of examinees only. Cronbach alpha of 0.92 showed satisfactory inner tool consistency. As for DSQ-40, mature, neurotic and immature defence mechanisms were evaluated. The highest mean score of 75.24 (±26.07) was obtained with immature defence (Cronbach alpha 0.87). Self-assessed current working capacity was revealed to be strongly dependent on total years of service (r=-0.134; p=0.021), while the representation of neurotic defence positively correlated with the respondents' age and total years of service. Immature defence strongly positively correlated with the total years of fire-fighting service. CONCLUSIONS: The employed tools were shown to be appropriate for use in Croatian professional fire-fighting population. Nevertheless, the interrelations disclosed by this pioneer research should be investigated further.

Circadian time organization of professional firemen: desynchronization-tau differing from 24.0 hours-documented by longitudinal self-assessment of 16 variables.

We investigated the circadian synchronization/desynchronization (by field-study assessment of differences in period, τ, of 16 coexisting and well-documented rhythms) of 30 healthy firemen (FM) exposed to irregular, difficult, and stressful nocturnal work hours who demonstrated excellent clinical tolerance (allochronism). Three groups of FM were studied (A = 12 FM on 24-h duty at the fire station; B = 9 FM on 24-h duty at the emergency call center; C = 9 day-shift administrative FM) of mostly comparable average age, body mass index, career duration, chronotype-morningness/eveningness, and trait of field dependence/independence. The self-assessed 16 circadian rhythms were (i) physiological ones of sleep-wake (sleep log), activity-rest (actography), body temperature (internal transmitter pill probe), right- and left-hand grip strength (hand dynamometer), systolic and diastolic blood pressure (BP) plus heart rate (ambulatory BP monitoring device); (ii) psychological ones (visual analog self-rating scales) of sleepiness, fatigue, fitness for work, and capacity to cope with aggressive social behavior; and (iii) cognitive ones of eye-hand skill and letter cancellation, entailing performance speed (tasks completed/unit time) and accuracy (errors). Data (4-6 time points/24 h; 2 591 480 values in total) were gathered continuously throughout two 8-d spans, one in winter 2010-2011 and one in summer 2011. Each of the resulting 938 unequal-interval time series was analyzed by a special power spectrum analysis to objectively determine the prominent τ. The desynchronization ratio (DR: number of study variables with τ = 24.0 h/number of study variables × 100) served to ascertain the strength/weakness of each rhythm per individual, group, and season. The field study confirmed, independent of group and season, coexistence of rather strong and weak circadian oscillators. Interindividual differences in DR were detected between groups and seasons (χ(2), correlation tests, analysis of variance [ANOVA]). Moreover, in each group, both in winter and summer, a normal distribution was observed in the number of FM with rhythms with τ = 24.0 h, e.g., ranging from 5/16 (large desynchronization) to 16/16 (no desynchronization). Such a normal distribution with intraindividual stability over time (i.e., seasons) is consistent with the hypothesis of an inherited origin of a differential propensity to circadian desynchronization and which is supported by the distribution of τs in winter and summer following the Dian-Circadian Genetic Model, i.e., with τ = 24.0 h, τ = 24.0 h + n(0.8 h), and τ = 24.0 h - n(0.8 h).

Effect of different professions' clothing on children's height perception.

Height is a biological factor that can affect how others perceive and behave toward an individual. Height is a biological factor that can affect how others perceive and behave toward an individual. Clothing, as a non-biological factor, can affect these perceptions of height. In this study weClothing, as a non-biological factor, can affect these perceptions of height. In this study we investigated the effect of different professions' clothing on children's perceptions of height. One investigated the effect of different professions' clothing on children's perceptions of height. One hundred and eighty primary school students participated in this study and estimated the height of an actor in the clothing of four different professions which differed in terms of prestige. The results of study showed that the difference between the perceived and actual height was larger when participants estimated the height of socially esteemed professions. Also there was no difference between girls' and boys' estimation of different professions' height. The implications of these findings are discussed.

Body mass index as a predictor of firefighter injury and workers' compensation claims.

OBJECTIVE: To determine the relationship between lifestyle variables including body mass index and filing a workers' compensation claim due to firefighter injury. METHODS: A cross-sectional evaluation of firefighter injury related to workers" compensation claims occurring 5 years after the original Promoting Healthy Lifestyles: Alternative Models' Effects study intervention. RESULTS: A logistic regression analysis for variables predicting filing a workers' compensation claim due to an injury was performed with a total of 433 participants. The odds of filing a compensation claim were almost 3 times higher for firefighters with a body mass index of more than 30 kg/m than firefighters with a normal body mass index (odds ratio, 2.89; P < 0.05). CONCLUSIONS: This study addresses a high-priority area of reducing firefighter injuries and workers' compensation claims. Maintaining a healthy body weight is important to reduce injury and workers' compensation claims among firefighters.

A national qualitative study of tobacco use among career firefighters and department health personnel.

INTRODUCTION: Firefighters currently have substantially lower smoking rates than similar occupational groups and the general U.S. population. In contrast, firefighters have very high rates of smokeless tobacco (SLT). The reasons for this paradox have not been explored; thus, the current study examined firefighters' perspectives on tobacco use. METHODS: Key informant interviews and focus groups were conducted in a national, cross-sectional purposively sampled group of 332 career firefighters. RESULTS: Firefighters suggested several reasons for the decline in smoking in the fire service including changes in the fire service culture, concerns about the impact of smoking on their ability to perform their job, regulations aimed at reducing smoking in departments, and the costs of smoking. In contrast, they felt that the greater use of SLT was primarily due to increasing restrictions on smoking. CONCLUSIONS: The primary reasons cited for decreased smoking rates by firefighters in our study were policy implementation at the state and local levels that prohibit tobacco use as a condition of employment and related presumption laws. However, reasons beyond policy mandates such as witnessing the end results of tobacco use, fitness, greater education about the negative health effects of smoking, and awareness about increased risk of exposure to toxic products of combustions also were noted. The primary reason cited for increased SLT use was the greater restrictions on smoking.

The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) firefighter study: testing mediating mechanisms.

This paper examines the mechanisms by which PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects), a health promotion intervention, improved healthy eating and exercise behavior among firefighters, a population at high risk for health problems due to occupational hazards. In a randomized trial, 397 firefighters participated in either the PHLAME team intervention with their work shift or a control condition. Intervention sessions taught benefits of a healthy diet and regular exercise, and sought to improve social norms and social support from coworkers for healthy behavior. At posttest, team intervention participants had increased their fruit and vegetable consumption as compared to control participants. An increase in knowledge of fruit and vegetable benefits and improved dietary coworker norms partially mediated these effects. Exercise habits and VO2 max were related to targeted mediators but were not significantly changed by the team intervention. Partial support was found for both the action and conceptual theories underlying the intervention. Our findings illustrate how an effective program's process can be deconstructed to understand the underpinnings of behavior change and refine interventions. Further, fire stations may improve the health of firefighters by emphasizing the benefits of healthy diet and exercise behaviors while also encouraging behavior change by coworkers as a whole.