Occupational Stress and Burnout in the Fire Service: Examining the Complex Role and Impact of Sleep Health.

The occupational stress inherent in firefighting poses both physiological and psychological risks to firefighters that have been found to possess a reciprocal nature. That is, the nature of these relationships in terms of indicator and impact are elusive, especially as it relates to sleep health (e.g., quality, quantity, hygiene, etc.) as a specific physiological risk and burnout as a specific psychological risk. A series of mediation models were assessed to examine the reciprocal relationships between occupational stress, burnout, and sleep health in a sample of 161 career firefighters. The mediation models confirmed reciprocity among the variables in so much that relationships were best described by the underlying mechanism at work. Comprehensive assessments of both subjective and objective markers of sleep health should be incorporated into firefighter research to supplement behavioral health assessments and interventions, especially related to burnout and occupational stress.

Evaluating the impact of the live healthy, work healthy program on organizational outcomes: A randomized field experiment.

The prevalence of chronic health conditions is increasing, with over half the current workforce attempting to manage one or more chronic conditions. The Live Healthy, Work Healthy (LHWH) program is a version of the Chronic Disease Self-Management Program translated to the workplace, with the goal of improving and sustaining the health, well-being, and productivity of employees living with chronic health conditions. Using organizational support theory as a theoretical framework and a clustered randomized controlled trial design, this article demonstrates how the LHWH program positively impacts work-related quality of life, orientations toward the organization, and organizational cognitions and behaviors. Participants in the program experienced increases in perceived organizational support (POS), with a large intervention effect. Direct intervention effects were also found for burnout, work engagement, work ability, affective organizational commitment, and organizational citizenship behaviors. Within-person changes in POS during the intervention was a key mechanism through which participants of the program experienced changes in organizationally relevant outcomes. Finally, offering the program on work time strengthened these effects indirectly through greater changes in POS during the intervention period. This article provides evidence to researchers and organizational decision-makers that offering the LHWH program not only improves the health and well-being of employees but also improves important organizational outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reach, Uptake, and Satisfaction of Three Delivery Modes of FUEL Your Life.

Background. FUEL Your Life (FYL) is a worksite translation of the Diabetes Prevention Program (DPP). In a randomized controlled trial, participants in a phone coaching condition demonstrated greater weight loss compared to participants in a group coaching or self-study condition. The purpose of this article is to describe the differences in participant reach, intervention uptake, and participant satisfaction for each delivery mode. Method. Employees who were overweight, obese, or at high risk for diabetes were recruited from city-county governments. Process evaluation data were collected from health coach records, participant surveys, and research team records. Differences between groups were tested using Pearson chi-square test and one-way analysis of variance. Results. Employee reach of targeted enrollment was highest for the self-study condition. Overall, intervention uptake was highest in the phone coaching condition. Participants who received phone coaching had increased uptake of the participant manual and self-monitoring of food compared to participants who received group coaching or self-study. Discussion. FYL demonstrated that DPP could be effectively delivered in the worksite by three different modalities. When implemented in a self-study mode, reach is greater but intervention uptake is lower. Phone health coaching was associated with greater intervention exposure.

Translating CDSMP to the Workplace: Results of the Live Healthy Work Healthy Program.

PURPOSE: Report the results of a randomized, controlled trial of Live Healthy, Work Healthy (LHWH), a worksite translation of the Chronic Disease Self-Management Program (CDSMP). DESIGN: 14 worksites were randomly assigned to LHWH, standard CDSMP (usual care) or no-intervention (control) group. SETTING: The diverse set of work organizations centered around a rural community in SE US. SUBJECTS: 411 participants completed baseline data with 359 being included in the final analyses. INTERVENTION: LHWH had been adapted to fit the unique characteristics of work organizations. This translated program consists of 15 sessions over 8 weeks and was facilitated by trained lay leaders. MEASURES: The primary outcomes including health risk, patient-provider communication, quality of life, medical adherence and work performance were collected pretest, posttest (6 mos.) and follow-up (12 mos.). ANALYSIS: Analyses were conducted using latent change score models in a structural equation modeling framework. RESULTS: 79% of participants reported at least one chronic condition with an average of 2.7 chronic conditions reported. Results indicated that LHWH program demonstrated positive changes in a most outcomes including significant exercise (uΔ = 0.89, p < .01), chronic disease self-efficacy (uΔ = 0.63, p < .05), fatigue (uΔ = -1.45, p < .05), stress (uΔ = -0.98, p < .01) and mentally unhealthy days (uΔ = -3.47, p < .001). CONCLUSIONS: The translation of LHWH is an effective, low cost, embeddable program that has the potential to improve the health and work life of employees.

Stress, burnout and diminished safety behaviors: An argument for Total Worker Health® approaches in the fire service.

INTRODUCTION: Firefighting is stressful work, which can result in burnout. Burnout is a safety concern as it can negatively impact safety outcomes. These impacts are not fully understood within the fire service. Further, the fire service needs support that safety strategies are needed to protect and promote the health and wellbeing of firefighters. METHODS: Structural equation modeling was completed to examine a hypothesized model that linked stress and burnout to diminished safety behavior outcomes among a sample of career firefighters. RESULTS: Findings support a full mediation model. Firefighter stress perceptions were positively associated with burnout and burnout was negatively associated with safety compliance behavior, personal protective equipment behavior, safe work practices, and safety citizenship behavior. CONCLUSIONS: These results illustrate the negative impact of health impairment on firefighter safety behaviors. Practical Applications: These outcomes suggest that interventions aimed at protecting and promotion firefighter health are needed. Total Worker Health® (TWH) approaches may provide the framework for these interventions.

Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters.

Traditionally, safety-related research on firefighting has focused on fires and fireground smoke as the primary source of non-fatal firefighter injury. However, recent research has found that overexertion and musculoskeletal disorders may be the primary source of firefighter injury. This study aimed to provide an update on injury occurrence among career firefighters. Injury data were collected over a two-year period from two large metropolitan fire departments in the U.S. Injury data were categorized based on the Bureau of Labor Statistics' Occupational Injury and Illness Classification System. Cross-tabulations and Chi-square tests were used to determine the primary causes of injury, as well as the injury region. Between the two fire departments, there were 914 firefighters included in the analysis. The median age was 40.7 years old with those aged 40-49 as the largest age group for injury cases (38.3%). The most frequently reported cause of injury was 'overexertion and bodily reaction' (n = 494; 54.1%). The most reported injury region was in 'multiple body parts' (n = 331; 36.3%). To prevent subsequent musculoskeletal disorders that may arise due to overexertion, initiatives that promote enhanced fitness and ergonomics based on an analysis of the physical demands of firefighting are suggested.

Safety specific transformational leadership, safety motivation and personal protective equipment use among firefighters.

Personal protective equipment (PPE) use, although normally the last line of preferred hazard control, is vital to protecting firefighters. It is vital that research identify factors that positively influence firefighter behaviors associated with PPE use. Data were collected from 742 career firefighters working for metropolitan fire departments in both the eastern and western United States. Structural equation modeling was used to assess the hypothesized model and relationships between safety-specific transformational leadership, safety motivation and effective use of personal protective equipment. Safety-specific transformational leadership was positively associated with firefighter safety motivation and safety motivation was positively associated with personal protective equipment use. There was also a significant direct relationship between safety-specific transformational leadership and personal protective equipment use. Transformational leadership has not been an emphasis in the fire service because of its hierarchical structure and paramilitary-like traditions. Current fire service stakeholders have called for changes in leadership strategies and the overall culture within the fire service. This research provides additional evidence that safety-specific transformational leadership can bolster safety motivation among firefighters and can result in enhanced safety performance, including the proper and effective use of personal protective equipment.

Multi-level safety climate associations with safety behaviors in the fire service.

INTRODUCTION: Limited research associated with safety climate has been completed within the fire service. Given this dearth of information, the present study sought to identify a valid and reliable measure of safety climate at both the workgroup and organizational levels within the fire service. METHODS: Researchers surveyed 994 firefighters in two large metropolitan fire departments. Preliminary analyses including psychometrics, confirmatory factor analyses, and shared perception analyses were completed. A linear mixed model analysis was then completed to assess the relationships between workgroup safety climate, organizational safety climate, and safety behaviors, including both safety compliance and safety citizenship behaviors. RESULTS: Measures of safety climate at the workgroup (WGSC) and organizational levels (OSC) were derived. WGSC factors include supervisor support (α = 0.92), vertical cohesion (α = 0.89), and horizontal cohesion (α = 0.94). OSC factors include management commitment (α = 0.91), safety programs/policies (α = 0.89), perceived fairness (α = 0.86) and incident command (α = 0.90). Confirmatory factor analyses confirmed our multi-factor models were a good fit to the data. The linear mixed model analysis found that WGSC positively predicted safety compliance behavior (B = 0.13, p < .001) and safety citizenship behavior (B = 0.22, p < .001) and OSC positively predicted safety compliance behavior (B = 0.16, p < .001) and safety citizenship behavior (B = 0.15, p < .001). CONCLUSIONS: This work presents reliable and valid measures of both workgroup and organizational safety climate, which have positive relationships with safety behavior outcomes. Practical application: The measures, which were developed through an extensive multi-method process, provide a means for researchers and practitioners to assess safety climate in the fire service and provides guidance for future safety climate research, including informing intervention research, which could potentially bolster safety climate and enhance safety in the fire service.

The workplace health group: A case study of 20 years of multidisciplinary research.

The Workplace Health Group (WHG) was established in 1998 to conduct research on worker health and safety and organizational effectiveness. This multidisciplinary team includes researchers with backgrounds in psychology, health promotion and behavior, and intervention design, implementation, and evaluation. The article begins with a brief history of the team, its guiding principles, and stages of team formation and development. This section provides examples of the roles, team composition, structure, processes, cognition, leadership, and climate played in the various stages of team development, as well as how they influenced team effectiveness. The WHG formed with functional diversity-variety in knowledge, skills, and abilities-in mind, and the impact of this diversity is discussed throughout the article. Illustrations of how the functional diversity of the WHG has led to real-world impact are provided. The article concludes with some lessons learned and recommendations for creating and sustaining multidisciplinary teams based on the WHG's 20 years of experience and the team science literature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of work pressure, work stress and work-family conflict on firefighter burnout.

Little research has explored burnout and its causes in the American fire service. Data were collected from career firefighters in the southeastern United States (n = 208) to explore these relationships. A hierarchical regression model was tested to examine predictors of burnout including sociodemographic characteristics (model 1), work pressure (model 2), work stress and work-family conflict (model 3) and interaction terms (model 4). The main findings suggest that perceived work stress and work-family conflict emerged as the significant predictors of burnout (both p < .001). Interventions and programs aimed at these predictors could potentially curtail burnout among firefighters.

Impact of a Translated Disease Self-Management Program on Employee Health and Productivity: Six-Month Findings from a Randomized Controlled Trial.

Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [n = 72]) relative to CDSMP (‘Usual Care’ [n = 109]) to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%), non-Hispanic white (62%), and obese (73%). On average, participants were age 48 (range: 23⁻72) and self-reported 3.25 chronic conditions (range: 1⁻16). The most commonly reported conditions were high cholesterol (45%), high blood pressure (45%), anxiety/emotional/mental health condition (26%), and diabetes (25%). Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018), fatigue (uΔ = −2.88, p = 0.002), sedentary behavior (uΔ = −4.49, p = 0.018), soda/sugar beverage consumption (uΔ = −0.78, p = 0.028), and fast food intake (uΔ = −0.76, p = 0.009) from baseline to follow-up. Significant improvements in patient⁻provider communication (uΔ = 0.46, p = 0.031) and mental work limitations (uΔ = −8.89, p = 0.010) were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations (p < 0.05). The translation of Usual Care (content and format) has potential to improve health among employees with chronic conditions and increase uptake in workplace settings.

Does Organizational and Coworker Support Moderate Diabetes Risk and Job Stress Among Employees?

PURPOSE: Examine the moderating role of perceived organizational and coworker support on the relationship between job stress and type 2 diabetes risk among employees. DESIGN: A cross-sectional survey was administered to employees at the workplace. SETTING: One national retail organization. PARTICIPANTS: Baseline data were obtained from 1595 employees in 21 retail stores. MEASURES: Self-reported organizational and coworker support to encourage and fulfill job responsibilities and job stress. Diabetes risk was calculated using age, gender, race/ethnicity, blood pressure, physical activity, weight status, and self-reported diagnosed type 2 diabetes. ANALYSIS: Multilevel multiple regression was conducted to test the interaction effect of support on the association between job stress and diabetes risk. RESULTS: Mean age was 37.95 years (±12.03) and body mass index was 26.72 (±4.95). Three percent of participants reported diagnosed diabetes. Organizational support was positively associated with coworker support. Both were negatively associated with job stress. Organizational support, but not coworker support, moderated the relationship of job stress with diabetes risk. Participants with greater perceived organizational support had lower diabetes risk scores compared to those with lower perceived organizational support. CONCLUSION: Organizational support may be a key factor for workplaces to reduce stress and diabetes risk. Further testing of organizations' supportive role on employee health may be helpful in developing future workplace programs.

Cost Effectiveness of a Weight Management Program Implemented in the Worksite: Translation of Fuel Your Life.

OBJECTIVE: Conduct a cost-effectiveness analysis of the Fuel Your Life (FYL) program dissemination. METHODS: Employees were recruited from three workplaces randomly assigned to one of the conditions: telephone coaching, small group coaching, and self-study. Costs were collected prospectively during the efficacy trial. The main outcome measures of interest were weight loss and quality-adjusted life years (QALYs). RESULTS: The phone condition was most costly ($601 to $589/employee) and the self-study condition was least costly ($145 to $143/employee). For weight loss, delivering FYL through the small group condition was no more effective, yet more expensive, than the self-study delivery. For QALYs, the group delivery of FYL was in an acceptable cost-effectiveness range ($22,400/QALY) relative to self-study (95% confidence interval [CI]: $10,600/QALY-dominated). CONCLUSIONS: Prevention programs require adaptation at the local level and significantly affect the cost, effectiveness, and cost-effectiveness of the program.

Ethnic Disparities of Perceived Safety Climate Among Construction Workers in Georgia, 2015.

BACKGROUND: Safety climate involves worker perception about the relative importance where they work and safety climate and has been shown to be a reliable predictor of safety-related outcomes. METHODS: The primary objective of this study is to investigate ethnic differences in perceived safety climate among construction workers. Surveys (n = 179) that included a 10-item safety climate scale were administered in Athens, Georgia (GA), at local construction sites and home improvement stores during June-August, 2015. RESULTS: The majority of respondents were carpenters or roofers (39%), followed by laborers (22%), painters and dry wall workers (14%), other skilled trades (14%), and supervisors (11%); 32% were Hispanic. Hispanic ethnicity (p < 0.0001), drinking two or more alcoholic beverages per day (p < 0.0001), working for a company that does not provide health insurance (p = 0.0022), and working for a company with fewer than ten employees (p < 0.0001) were significantly associated with lower perceived safety climate scores. CONCLUSION: The lower perceived safety climate scores among Hispanic workers indicate that the perception of the importance of safety on the job site is lower among Hispanics construction workers than non-Hispanics construction workers.

Safety climate and firefighting: Focus group results.

BACKGROUND: Firefighting is a hazardous occupation and there have been numerous calls for fundamental changes in how fire service organizations approach safety and balance safety with other operational priorities. These calls, however, have yielded little systematic research. METHODS: As part of a larger project to develop and test a model of safety climate for the fire service, focus groups were used to identify potentially important dimensions of safety climate pertinent to firefighting. RESULTS: Analyses revealed nine overarching themes. Competency/professionalism, physical/psychological readiness, and that positive traits sometimes produce negative consequences were themes at the individual level; cohesion and supervisor leadership/support at the workgroup level; and politics/bureaucracy, resources, leadership, and hiring/promotion at the organizational level. A multi-level perspective seems appropriate for examining safety climate in firefighting. CONCLUSIONS: Safety climate in firefighting appears to be multi-dimensional and some dimensions prominent in the general safety climate literature also seem relevant to firefighting. These results also suggest that the fire service may be undergoing transitions encompassing mission, personnel, and its fundamental approach to safety and risk. PRACTICAL APPLICATIONS: These results help point the way to the development of safety climate measures specific to firefighting and to interventions for improving safety performance.

Factors Associated With Interest in Worksite Health-Related Discussions/Events Among Employed Adults With Chronic Conditions.

OBJECTIVE: Worksite health promotion interventions have the potential to reach half of Americans nationally, but low participation rates hinder optimal intervention effectiveness. This study examines factors associated with employee interest in worksite health-related discussions/events. METHOD: We analyzed cross-sectional survey data from a representative sample of employed adults in California with one or more chronic conditions. An ordinal regression model was developed. RESULTS: Employees who reported more interest in worksite health-related discussions/events had higher coworkers support, perceived greater value from learning health-related knowledge and getting practical tips from others, and reported higher interest in health discussions/events held in community settings. CONCLUSION: Efforts are needed to enhance the culture of worksite health and encourage communication and support among workers. Practitioners should consider connecting different settings to enhance reach and accessibility, and applying multiple delivery strategies to increase employee interest and engagement.

Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases.

Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13), cardiovascular diseases (n = 8), and diabetes (n = 6). Intervention strategies included instructional education/counseling (n = 20), workplace environmental change (n = 6), physical activity (n = 10), use of technology (n = 10), and incentives (n = 13). Self-reported data (n = 21), anthropometric measurements (n = 17), and laboratory tests (n = 14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses.

Antineoplastic drugs pose risks to the healthcare workers who handle them. This fact notwithstanding, adherence to safe handling guidelines remains inconsistent and often poor. This study examined the effects of pertinent organizational safety practices and perceived safety climate on the use of personal protective equipment, engineering controls, and adverse events (spill/leak or skin contact) involving liquid antineoplastic drugs. Data for this study came from the 2011 National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers which included a sample of approximately 1,800 nurses who had administered liquid antineoplastic drugs during the past seven days. Regression modeling was used to examine predictors of personal protective equipment use, engineering controls, and adverse events involving antineoplastic drugs. Approximately 14% of nurses reported experiencing an adverse event while administering antineoplastic drugs during the previous week. Usage of recommended engineering controls and personal protective equipment was quite variable. Usage of both was better in non-profit and government settings, when workers were more familiar with safe handling guidelines, and when perceived management commitment to safety was higher. Usage was poorer in the absence of specific safety handling procedures. The odds of adverse events increased with number of antineoplastic drugs treatments and when antineoplastic drugs were administered more days of the week. The odds of such events were significantly lower when the use of engineering controls and personal protective equipment was greater and when more precautionary measures were in place. Greater levels of management commitment to safety and perceived risk were also related to lower odds of adverse events. These results point to the value of implementing a comprehensive health and safety program that utilizes available hazard controls and effectively communicates and demonstrates the importance of safe handling practices. Such actions also contribute to creating a positive safety climate.

A Prospective Programmatic Cost Analysis of Fuel Your Life: A Worksite Translation of DPP.

OBJECTIVE: An accounting of the resources necessary for implementation of efficacious programs is important for economic evaluations and dissemination. METHODS: A programmatic costs analysis was conducted prospectively in conjunction with an efficacy trial of Fuel Your Life (FYL), a worksite translation of the Diabetes Prevention Program. FYL was implemented through three different modalities, Group, Phone, and Self-study, using a micro-costing approach from both the employer and societal perspectives. RESULTS: The Phone modality was the most costly at $354.6 per participant, compared with $154.6 and $75.5 for the Group and Self-study modalities, respectively. With the inclusion of participant-related costs, the Phone modality was still more expensive than the Group modality but with a smaller incremental difference ($461.4 vs $368.1). CONCLUSIONS: This level of cost-related detail for a preventive intervention is rare, and our analysis can aid in the transparency of future economic evaluations.

Effect of Intensity and Program Delivery on the Translation of Diabetes Prevention Program to Worksites: A Randomized Controlled Trial of Fuel Your Life.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of the Fuel Your Life program, an adaptation of the Diabetes Prevention Program (DPP), utilizing implementation strategies commonly used in worksite programs-telephone coaching, small group coaching, and self-study. METHODS: The primary outcomes of body mass index and weight were examined in a randomized control trial conducted with city/county employees. RESULTS: Although the majority of participants in all three groups lost some weight, the phone group lost significantly more weight (4.9 lb), followed by the small groups (3.4 lb) and the self-study (2.7 lb). Of the total participants, 28.3% of the phone group, 20.6% of the small group, and 15.7% of the self-study group lost 5% or more of their body weight. CONCLUSIONS: Fuel Your Life (DPP) can be effectively disseminated using different implementation strategies that are tailored to the workplace.