Meta-Analysis of Incidence and Mortality of Firefighter Cancer: An Update on Emerging Science.

BACKGROUND: Firefighters are faced with a broad range of toxic exposures during their work, including known and suspected carcinogens. The current study is an update to the previously published meta-analysis of cancer risk among firefighters by Soteriades and colleagues, and focuses on studies published from 2008 to 2020. METHODS: A comprehensive search of the literature was conducted, including electronic databases and bibliographies of recently published papers. Analyses include stratification of studies conducted in the United States (US) versus other countries. Cancer incidence and mortality rates were compared to the relevant general population. Random effects models were used to calculate summary risk estimates and their 95% confidence intervals. RESULTS: A total of 24 studies were included in the meta-analysis. Among the 42 cancer types covered, incidence was associated with firefighting in US samples for colon, kidney, large intestine, pleura, and prostate cancer, as well as malignant melanoma. There was an increased incidence of Hodgkin's Disease and malignant melanoma and a significantly lower risk of kidney cancer for non-US samples. Significant cancer mortality estimates for US samples included oral/buccal/mouth, other parts of the buccal cavity, pharynx, colon, esophagus, large intestine, lung, Non-Hodgkin's Lymphoma, pancreas, pleura, rectum, and soft tissue sarcoma. No cancer had a significantly higher rate of mortality among non-US samples. CONCLUSIONS: The findings underscore the global cancer burden among firefighters, and indicate that geographically stratifying studies afford a more nuanced risk perspective. Further research should investigate why US firefighters exhibit higher cancer mortality rates compared to international counterparts.

High-Intensity Functional Training (HIFT): Definition and Research Implications for Improved Fitness.

High-intensity functional training (HIFT) is an exercise modality that emphasizes functional, multi-joint movements that can be modified to any fitness level and elicit greater muscle recruitment than more traditional exercise. As a relatively new training modality, HIFT is often compared to high-intensity interval training (HIIT), yet the two are distinct. HIIT exercise is characterized by relatively short bursts of repeated vigorous activity, interspersed by periods of rest or low-intensity exercise for recovery, while HIFT utilizes constantly varied functional exercises and various activity durations that may or may not incorporate rest. Over the last decade, studies evaluating the effectiveness of HIIT programs have documented improvements in metabolic and cardiorespiratory adaptations; however, less is known about the effects of HIFT. The purpose of this manuscript is to provide a working definition of HIFT and review the available literature regarding its use to improve metabolic and cardiorespiratory adaptations in strength and conditioning programs among various populations. Additionally, we aim to create a definition that is used in future publications to evaluate more effectively the future impact of this type of training on health and fitness outcomes.

Consequences of Inconsistency in Air Force Tobacco Control Policy.

OBJECTIVES: Although the United States Air Force (USAF) has been a leader in efforts to reduce tobacco use among service members, tobacco continues to be a problem and initiatives to decrease tobacco use further require buy-in from leadership. We explored line leaderships' perspectives on tobacco. METHODS: A diverse group of 10 senior commissioned and 10 non-commissioned personnel were interviewed. RESULTS: Respondents reported substantial changes in the culture of tobacco use during their years of service, from near ubiquity to restricted use areas. They also perceived mixed messages coming from the USAF, including simultaneous discouragement of and accommodations for tobacco use, and variability in policies and enforcement. Many respondents indicated that allowing tobacco use creates conflict and undermines military discipline and suggested that a tobacco-free policy would be the best way to eliminate these contradictions. CONCLUSION: Although there has been substantial movement away from a culture of tobacco in the USAF, current policies and variable enforcement of these policies create unnecessary contradictions. Establishing a tobacco-free service would resolve these issues in addition to improving the health of service members and veterans.

Firefighting and mental health: Experiences of repeated exposure to trauma.

BACKGROUND: Firefighters must be ready to respond to a broad range of emergencies every duty day. In the course of many of these emergencies, firefighters witness events which have the potential to induce emotional trauma, such as badly injured people, deceased children, and individuals who are highly distraught. Previous research suggests that repeated exposure to these traumas (RET) may have negative impacts on the emotional and mental health of fire service personnel. Research on the mental health of firefighters has been limited to small surveys reporting the prevalence of specific mental health problems such as depression and post-traumatic stress disorder among firefighters. OBJECTIVE: Despite the likelihood that RET leads to negative outcomes in firefighters, data is lacking on how exposure impacts fire service personnel. The current study examines the experiences of firefighters related to RET. METHODS: Using formative research methods, we examined the beliefs and experiences of firefighters and administrators from across the United States regarding the impact of RET on firefighter health. RESULTS: Study findings highlight the cumulative psychological toll of repeated exposure to traumatic events including desensitization, flashbacks, and irritability. CONCLUSION: Results of the current study suggest that RET is a significant concern for emergency responders that warrants additional research and attention. It is likely that the long term consequences of RET are closely intertwined with other mental health outcomes and general well-being of this important occupational group.

High-intensity Fitness Training Among a National Sample of Male Career Firefighters.

Obesity and fitness have been identified as key health concerns among USA firefighters yet little is known about the current habits related to exercise and diet. In particular, high-intensity training (HIT) has gained increasing popularity among this population but limited quantitative data are available about how often it is used and the relationship between HIT and other outcomes. Using survey methodology, the current study evaluated self-reported HIT and diet practice among 625 male firefighters. Almost one-third (32.3%) of participants reported engaging in HIT. Body composition, as measured by waist circumference and percentage body fat, was significantly related to HIT training, with HIT participants being approximately half as likely to be classified as obese using body fat [odds ratio (OR) = 0.52, 95% confidence interval (CI) = 0.34-0.78] or waist circumference (OR = 0.61, 95% CI = 0.37-0.98). Those who engaged in HIT were more than twice as likely as those who did not (OR = 2.24, 95% CI = 1.42-3.55) to meet fitness recommendations. Findings highlight directions for future prevention and intervention efforts.

Injury among a population based sample of career firefighters in the central USA.

BACKGROUND: Rates of occupational injuries among firefighters are high because of the physically demanding and variable tasks required by their job. While descriptive data about injuries exist, few studies have explored individual risk factors and their relationship to occupational injury. METHODS: The current study presents data from a population-based sample of 462 career firefighters from 11 randomly-selected fire departments in the Missouri Valley region of the USA (Kansas, Missouri, Iowa, North Dakota, South Dakota, Colorado, Wyoming, Nebraska) who participated in a study evaluating risks for negative cardiovascular outcomes and injury. Relationships were examined between injury and demographic characteristics, body composition, fitness, and health behaviours. RESULTS: Participants were most likely to be injured during physical exercise and those who reported regular on-duty exercise had a fourfold increase in risk for exercise-related injury compared with those who did not exercise on duty (OR=4.06, 95% CI 1.73 to 12.24). However, those who exercised were half as likely to sustain non-exercise injuries (OR=0.53, 95% CI 0.32 to 0.85). CONCLUSIONS: Findings highlight the benefit of physical training for firefighters despite the risk of injury during exercise.

Mission essential fitness: comparison of functional circuit training to traditional Army physical training for active duty military.

Appropriate and effective physical fitness training is imperative for soldier survival and mission success. The purpose of this study was to determine the effects of Mission Essential Fitness (MEF) circuit-style training program compared to standard Army Physical Readiness Training (APRT) on fitness, physiological, and body composition changes. Active duty Army personnel were randomly assigned to two groups (MEF = 34 or APRT = 33) for 8 weeks of training (15 sessions each). The MEF program included functional movements focused on strength, power, speed, and agility. Fifteen exercises were performed continuously for 60 to 90 seconds for 45 minutes. Baseline and post-test measures included the Army physical fitness test, physiological indicators, body composition, and additional fitness indicators. One-way analysis of covariance models indicated that MEF participants significantly increased their push-ups (p = 0.033), bench press (p = 0.001), and flexibility (p = 0.003) and significantly decreased their 2-mile run (p = 0.003) and step test heart rate (p = 0.004) compared to participants doing APRT. Both groups maintained body composition (p > 0.05) and reported no injuries. The MEF training program safely improved muscular strength and endurance, cardiovascular endurance, and flexibility, supporting functional fitness circuit-style exercise training for military personnel.

The impact of smoking status on the health status of heart failure patients.

Smoking is a major risk factor for the development of heart failure (HF). Yet, little is known about smoking's effects on the health status of established HF patients. HF patients were recruited from outpatient clinics across North America. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess disease-specific health status. Smoking behaviors were classified as never having smoked, prior smoker, and as having smoked within the past 30 days. Risk-adjusted multivariable regression was used to evaluate the association of smoking status with baseline and 1-year KCCQ overall summary scores. Smoking was not associated with baseline health status. However, a significant effect was observed on 1-year health status among outpatients with HF with current smokers reporting significantly lower KCCQ scores than never smokers or ex-smokers. These findings highlight an additional adverse consequence of smoking in HF patients not previously discussed.

How does the built environment relate to body mass index and obesity prevalence among public housing residents?

PURPOSE: This study examined associations of environmental variables with obesity prevalence and individual body mass index (BMI) among impoverished residents of public housing developments. DESIGN: Cross-sectional data were drawn from two studies in the same Midwestern metropolitan area of participants within neighborhoods. SETTING: Pathways to Health interviewed housing development residents and Understanding Neighborhood Determinants of Obesity assessed built environment factors in the surrounding neighborhoods (i.e., 800-m radius from center of housing development). SUBJECTS: Four hundred twenty-one residents participated (mean age = 43.8 years; 72.0% women, 59.6% high school degree, 79.6% African-American). Fifty-five physical activity resources were identified and assessed. MEASURES: Demographics and measured weights and heights were obtained for participants. The Physical Activity Resource Assessment measured the type, accessibility, features, amenities, qualities, and incivilities of physical activity resources. Neighborhood street connectivity was also measured. RESULTS: Average age-adjusted BMI was 31.4 (SD = 1.3), with 45% of residents obese. High negative correlations were found between BMI and street connectivity (p = .05) and between obesity prevalence and resource accessibility (p = .09), number of amenities (p = .04), and amenity quality (p = .04). Higher resource accessibility, feature quality, number of amenities, and fewer incivilities per resource accounted for 71% of obesity variance (p < .05). Male gender and higher feature quality, F(11, 407) 37.19 and 12.66, p < .001, predicted lower BMI among residents. CONDUSION: Supportive neighborhood environments were related to lower obesity prevalence and lower BMI among residents.

Associations between the built environment and physical activity in public housing residents.

BACKGROUND: Environmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments. METHODS: Physical activity data from 452 adult residents residing in 12 low-income housing developments were combined with measured environmental data that examined the neighborhood (800 m radius buffer) around each housing development. Aggregated ecological and multilevel regression models were used for analysis. RESULTS: Participants were predominately female (72.8%), African American (79.6%) and had a high school education or more (59.0%). Overall, physical activity rates were low, with only 21% of participants meeting moderate physical activity guidelines. Ecological models showed that fewer incivilities and greater street connectivity predicted 83% of the variance in days walked per week, p < 0.001, with both gender and connectivity predicting days walked per week in the multi-level analysis, p < 0.05. Greater connectivity and fewer physical activity resources predicted 90% of the variance in meeting moderate physical activity guidelines, p < 0.001, and gender and connectivity were the multi-level predictors, p < 0.05 and 0.01, respectively. Greater resource accessibility predicted 34% of the variance in days per week of vigorous physical activity in the ecological model, p < 0.05, but the multi-level analysis found no significant predictors. CONCLUSION: These results indicate that the physical activity of low-income residents of public housing is related to modifiable aspects of the built environment. Individuals with greater access to more physical activity resources with fewincivilities, as well as, greater street connectivity, are more likely to be physically active.

Results of an intensive school-based weight loss program with overweight Mexican American children.

Childhood overweight has increased significantly in the past 20 years, with the highest rates noted among Mexican Americans. Schools are an optimal setting for intervention efforts; however, few programs have demonstrated actual decreases in weight. This study evaluated an intensive school-based program designed to result in weight reduction for overweight Mexican American children. A total of 71 children (32 males, 48%) between the ages of 10 and 14 at or above the 85th percentile for body mass index (BMI) were randomized into a six-month intensive intervention (II) or self-help (SH) condition. Results revealed that children in the II condition significantly reduced their standardized BMI (zBMI) when compared with the children in the self-help condition (F(2,62)=6.58, p=0.003). The change in zBMI was significantly different at both 3 and 6 months (F(1,63)=5.74, p=0.019, F(1,63)=12.61, p=0.001, respectively) with II participants showing greater decreases in weight. The 3-month change in zBMI for the II participants was a decrease of 0.07 compared with a decrease of 0.01 for SH participants. The 6-month change in zBMI was a decrease of 0.11 for II and an increase of 0.03 for SH. Overall, the results are promising, suggesting that an intensive school-based intervention may be an effective means for promoting weight loss in overweight Mexican American children.

Characteristics of Air Force personnel who choose pharmacological aids for smoking cessation following an involuntary tobacco ban and tobacco control program.

OBJECTIVE: The objective of this study was to compare characteristics of smokers who did and did not report use of cessation aids as part of a tobacco control program in a military setting (n = 8994). DESIGN: The study is a longitudinal epidemiological study where the relationship between smoking status at follow-up and use of pharmacologic aids to quit smoking were assessed. MAIN OUTCOME MEASURES: Smoking cessation, post baseline use of cessation aids to quit smoking. RESULTS AND CONCLUSIONS: Individuals remaining abstinent were 70% less likely to have used NRT/pharmacological aids compared to those that relapsed. NRT/pharmacological aid users were more likely to report plans to smoke after military training, to have friends who smoke, and to accept a cigarette from a friend. NRT/pharmacological aid users were more likely to believe that using NRT was safer than smoking and to have engaged in harm reduction strategies. Our findings suggest that selection bias related to such characteristics may explain some of the discrepancies between effect sizes reported in efficacy compared to effectiveness studies of NRT and smoking outcomes currently reported in the literature.

Tobacco use and perceived financial strain among junior enlisted in the U.S. Military in 2002.

OBJECTIVE: The detrimental health effects of tobacco use have long been documented and accepted. Recent research has begun to explore the financial strain that tobacco places on those who use it (e.g. Mokdad, A.H., Marks, J.S., Stroup, D.F., Gerberding, J.L., 2004. Actual causes of death in the United States, 2000. J. Am. Med. Assoc. 291, 1239-1245). The issue of this financial burden is particularly salient for young enlisted in the military who often struggle with financial issues and who continue to use tobacco at relatively high rates. METHODS: Using the 2002 Department of Defense Survey of Health Related Behaviors among Military Personnel, the current study examines the percentage of income young military members spend on tobacco given varying levels of consumption. In addition, a representative sample of junior enlisted (E1-E4) from all four military branches were surveyed about their tobacco use and their experiences of financial strain and experienced stress from financial problems. RESULTS: Adjusted logistic models demonstrated that smokers reported substantially higher amounts of both financial strain and stress from financial problems then those who did not smoke. CONCLUSIONS: This study suggests there is a relationship between financial stress and tobacco use among junior military members.

Treatment of obesity in the primary care setting: are we there yet?

Obesity is a significant public health issue in the US constituting an independent risk factor for morbidity and mortality as well as complicating the management of other medical conditions. Yet, traditionally most physicians receive little training in evidence-based obesity interventions. Previous literature suggests many physicians believe they do not have effective tools to address obesity and/or that obesity management is not within their scope of practice. Given the new emphasis from NIH and AAFP urging physicians to conceptualize and treat obesity as a chronic medical condition, we examined obesity-related knowledge and practices among military and civilian primary care physicians. Results were similar across these two physician groups in suggesting many physicians still may be ill-prepared to manage obesity in the primary care setting. Implications for patient care and future research are discussed.

Impact of obesity on the health status of heart failure patients.

BACKGROUND: Obesity is a recognized, preventable risk factor for the development of heart failure (HF); however, little is understood about its effects on patients with established HF. Furthermore, few researchers have assessed obesity's effect on the health status of established HF patients. This study evaluated the influence of obesity on the health status, at baseline and 1 year later, on patients with established HF. METHODS AND RESULTS: Comprehensive clinical data, health status, and obesity classification of 543 HF outpatients from 13 centers was assessed at baseline and 1 year later. Health status was quantified with the generic Short Form-12 and disease-specific Kansas City Cardiomyopathy Questionnaire Overall Summary score. Cross-sectional and longitudinal risk-adjusted general linear models were computed comparing the health status of patients who were classified as either underweight, normal weight, overweight, or obese. Obesity classification was not significantly associated with patients' baseline health status and did not predict 1-year health status. CONCLUSIONS: Although obesity has been reported to confer a survival advantage to patients with HF, it was not associated with better health status at baseline, or after 1 year, in our cohort. Better understanding of the relationship among HF, body weight, and health status is needed before evidence-based recommendations can be made regarding weight management for HF patients.

Parental socialization of smoking initiation in Latino youth.

The relationship between parental socialization strategies and child smoking behavior was examined among 170 Latino parents and 85 index children. Maternal support was negatively associated with child smoking whereas siblings' and friends' smoking were positively associated. Studies with larger samples of Latino families are needed to replicate these findings.

Environmental Justice: Obesity, Physical Activity, and Healthy Eating.

BACKGROUND: The term "environmental justice" refers to efforts to address the disproportionate exposure to and burden of harmful environmental conditions experienced by low-income and racial/ethnic minority populations. METHODS: Based on computer and manual searches, this paper presents a review of articles in the published literature that discuss disparities in physical activity, dietary habits, and obesity among different populations. RESULTS: This paper provides evidence that economically disadvantaged and racial/ethnic minority populations have substantial environmental challenges to overcome to become physically active, to acquire healthy dietary habits, and to maintain a healthy weight. For example, residents living in poorer areas have more environmental barriers to overcome to be physically active. CONCLUSIONS: We propose a research agenda to specifically address environmental justice with regard to improving physical activity, dietary habits, and weight patterns.

Behavioral interventions for obesity.

Because of the increased risk of comorbid conditions such as type 2 diabetes, hypertension, and osteoarthritis, and the high health care costs associated with obesity, researchers and clinicians continually search for low-cost and effective treatments for weight loss and weight maintenance. In this article we provide an overview of the principles of behavior modification as applied to the treatment of obesity, examine the benefits of augmenting behavioral interventions with pharmacotherapy, and review the use of less-traditional applications of behavior modification in the treatment of obesity, specifically Internet interventions, meal replacements, and telephone interventions. Based on our review, we conclude that these less-traditional approaches can be used effectively to apply the principles of behavior modification, specifically stimulus control and self-monitoring, to obese patients. Future directions for research are outlined, which include examining the use of nontraditional behavioral interventions with children and the development of culturally sensitive interventions for racial and ethnic minority populations.

Obesity and the built environment.

Biological, psychological, behavioral, and social factors are unable to fully explain or curtail the obesity epidemic. In this article we review research on the influence of the built environment on obesity. Studies were evaluated with regard to their methods of assessing the environment and obesity, as well as to their effects. Methods used to investigate the relationships between the built environment and obesity were found to be dissimilar across studies and varied from indirect to direct. Levels of assessment between and within studies varied from entire counties down to the individual level. Despite this, obesity was linked with area of residence, resources, television, walkability, land use, sprawl, and level of deprivation, showing promise for research utilizing more consistent assessment methods. Recommendations were made to use more direct methods of assessing the environment, which would include specific targeting of institutions thought to vary widely in relation to area characteristics and have a more influential effect on obesity-related behaviors. Interventions should be developed from the individual to the neighborhood level, specifically focusing on the effects of eliminating barriers and making neighborhood level improvements that would facilitate the elimination of obesogenic environments.

Features of the neighborhood environment and walking by U.S. adults.

BACKGROUND: Manipulating the physical environment may be an efficacious way to promote physical activity. This study examined the relationships between features of the neighborhood environment and walking in the neighborhood by U.S. adults. METHODS: A random sample of women (n =266) and men (n =208) aged >18 years participated. Door-to-door interviews were conducted in 2003 to collect information about demographics, walking behavior, and features of the neighborhood environment. RESULTS: The analyses conducted in 2004 revealed that women were more likely to walk for exercise (odds ratio [OR]=4.6, 95% confidence interval [CI]=1.01-20.72) or walk a dog (OR=3.3, 95% CI=1.01-11.08) in the neighborhood if neighborhood safety was average as opposed to below average (p <0.05). Women with an average number of neighborhood destinations were more likely to walk for transportation in the neighborhood (OR=5.7, 95% CI=1.63-19.73) than women with a below average number of neighborhood destinations (p <0.01). In men, none of the neighborhood features were significantly associated with walking for exercise or walking a dog. Men were less likely to walk for transportation in the neighborhood if the functional (OR=0.22, 95% CI=0.06-0.89) or aesthetic (OR=0.17, 95% CI=0.03-0.89) features of the neighborhood were average versus below average. CONCLUSIONS: Prospective studies are needed to determine if changes in neighborhood safety and awareness of neighborhood destinations promote increases in walking by women. Evaluations of the relationships between other environmental features and walking behavior in men are warranted.