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

Excretion of toxicants accumulated from firefighter exposures through breastmilk represents a potential hazard. We investigated if firefighting exposures could increase the concentration of polybrominated diphenyl ethers (PBDEs) and aryl hydrocarbon receptor (AhR) activation in excreted breastmilk. Firefighters and nonfirefighters collected breastmilk samples prior to any firefighting responses (baseline) and at 2, 8, 24, 48, and 72 h after a structural fire (firefighters only). Five PBDE analytes (BDEs 15, 28, 47, 99, and 153) detected in at least 90% of samples were summed for analyses. The AhR in vitro DR CALUX bioassay assessed the mixture of dioxin-like compounds and toxicity from breastmilk extracts. Baseline PBDEs and AhR responses were compared between firefighters and nonfirefighters. Separate linear mixed models assessed changes in sum of PBDEs and AhR response among firefighters over time and effect modification by interior or exterior response was assessed. Baseline PBDE concentrations and AhR responses did not differ between the 21 firefighters and 10 nonfirefighters. There were no significant changes in sum of PBDEs or AhR response among firefighters over time postfire, and no variation by interior or exterior response. Plots of sum of PBDEs and AhR response over time demonstrated individual variation but no consistent pattern. Currently, our novel study results do not support forgoing breastfeeding after a fire exposure. However, given study limitations and the potential hazard of accumulated toxicants from firefighter exposures excreted via breastfeeding, future studies should consider additional contaminants and measures of toxicity by which firefighting may impact maternal and child health. [ABSTRACT FROM AUTHOR]

This study used secondary data analysis from three national firefighter studies of almost 1,900 veteran and nonveteran firefighters to compare and explain the impact of six personal demographic factors, two occupational characteristics, and 11 health outcomes on each group. Univariate data analysis showed veteran and nonveteran firefighters in our sample shared a large number of similarities. They reported significant statistical differences in only three of the 19 demographic, occupational, and health outcome variables. Veteran firefighters were older than nonveterans and less likely to have a college or advanced degree. Firefighters with military service were also significantly more likely to have a history of divorce. The means or percentages were not statistically significant in the other 13 univariate comparisons. The similarities between veteran and nonveteran firefighters included three demographic characteristics (race, ethnicity, and marital status); both occupational characteristics (rank and years of service); and all 11 health outcomes (previous anxiety diagnosis, previous depression diagnosis, CESD-10, work stress, work stress interference with duties, cigarette smoking, smokeless tobacco use, alcohol use, binge drinking, body mass index, and waist circumference). A multivariate analysis did show, however, that when controlled for age and educational attainment, one health outcome—a previous anxiety diagnosis—became statistically significant. An analysis of 66 combat veterans found that veterans who had conducted combat patrols or performed other dangerous duties had 3.4 times the rate of diagnosed anxiety disorders than nonveteran firefighters. However, there was no significant difference in the rates of previously diagnosed anxiety disorders between nonveterans and veterans without combat experience. These last two findings carry important policy and training implications for the fire service. [ABSTRACT FROM AUTHOR]

This study investigated the prevalence of post-traumatic stress disorder (PTSD) and mental health comorbidities among career firefighters in the U.S. and examined occupational factors related to PTSD. A total of 624 male career firefighters completed questions regarding PTSD and mental health conditions. Nearly 7% met the criteria for being in the range of concern for PTSD, and among those, 87% screened positive for at least one other mental health condition. Those with PTSD also reported significantly higher occupational stress and duty-related incident stress, having a lower perception of self-efficacy to manage stress/trauma exposure and lower perceptions of support from their department and peers than those without PTSD. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study was twofold. First, we identified post-fire suppression contamination control procedures used in 10 New Jersey volunteer fire departments. These decontamination (decon) procedures remove hazardous contaminants from firefighters' gear and equipment (see Burgess et al., 2020; Fent et al., 2017; Fent et al., 2020), Second, we determined the challenges these 10 departments faced in implementing the decon best practices recommended by NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting and several academic studies. Data was gathered using semi-structured telephone interviews with a member of the leadership team in each of the 10 New Jersey volunteer departments. Thematic analysis of these interviews revealed significant variation in the post-fire suppression contamination control practices implemented by the 10 departments. Although the interview participants were highly aware of the health risks that firefighters face and the importance of decon control measures, many departments did not implement the recommended best practices. Financial and time constraints were identified as significant challenges to implementing comprehensive decontamination control procedures. [ABSTRACT FROM AUTHOR]

The percentage of females in the U.S. fire service is low. In 2018, only 8% of firefighters were women (National Fire Protection Association [NFPA], 2020). To better understand the reasons for this low participation rate, we analyzed responses from telephone interviews and focus groups conducted with 87 firefighters and fire service leaders in 2013. Analysis of these responses identified several reasons why it is so difficult to recruit and retain women firefighters. A better understanding of these reasons, including the unique challenges that women firefighters face, is essential to increasing and supporting their active participation in this profession. Tactics used to improve the recruitment and retention of women in the fire service are also discussed. [ABSTRACT FROM AUTHOR]

Background: Evidence from previous studies suggests that women firefighters have greater risk of some adverse reproductive outcomes. The purpose of this study was to investigate whether women firefighters had greater risk of miscarriage compared to non-firefighters and whether there were occupational factors associated with risk of miscarriage among firefighters.Methods: We studied pregnancies in the United States fire service using data from the Health and Wellness of Women Firefighters Study (n = 3181). We compared the prevalence of miscarriage among firefighters to published rates among non-firefighters using age-standardized prevalence ratios. We used generalized estimating equations to estimate relative risks (RRs) and 95% confidence intervals (CIs) between occupational factors (employment (career/volunteer), wildland firefighter status (wildland or wildland-urban-interface/structural), shift schedule, fire/rescue calls at pregnancy start) and risk of miscarriage, adjusted for age at pregnancy, education, gravidity, BMI, and smoking. We evaluated if associations varied by age at pregnancy or employment.Results: Among 1074 firefighters and 1864 total pregnancies, 404 pregnancies resulted in miscarriages (22%). Among most recent pregnancies, 138 resulted in miscarriage (13%). Compared to a study of US nurses, firefighters had 2.33 times greater age-standardized prevalence of miscarriage (95% CI 1.96-2.75). Overall, we observed that volunteer firefighters had an increased risk of miscarriage which varied by wildland status (interaction p-value< 0.01). Among structural firefighters, volunteer firefighters had 1.42 times the risk of miscarriage (95% CI 1.11-1.80) compared to career firefighters. Among wildland/wildland-urban-interface firefighters, volunteer firefighters had 2.53 times the risk of miscarriage (95% CI 1.35-4.78) compared to career firefighters.Conclusions: Age-standardized miscarriage prevalence among firefighters may be greater than non-firefighters and there may be variation in risk of miscarriage by fire service role. Further research is needed to clarify these associations to inform policy and decision-making. [ABSTRACT FROM AUTHOR]

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

INTRODUCTION The prevalence of smokeless tobacco (SLT) use among firefighters is substantially higher than the general population and similar occupational groups. Despite the significant health risks associated with SLT and its impact on occupational readiness, there are no occupationally-tailored SLT education or treatment programs for the fire service. The purpose of this study was to beta test QUIT SPIT!, a self-help SLT cessation program that is culturally tailored for the US fire service and firefighters who are interested in quitting. METHODS After development and tailoring the QUIT SPIT! SLT cessation program for firefighters, the feasibility and acceptability of the program were evaluated in a sample of eleven SLT-using firefighters who wanted to quit. The primary outcome was a 7-day point prevalence of SLT abstinence measured at 4 and 12 weeks post-enrollment follow-up assessments. RESULTS Four firefighters reported having quit SLT (7-days point prevalence) at follow-up at 12 weeks. Those who did not achieve SLT abstinence reported reductions in frequency and quantity in SLT use and demonstrated a decrease in nicotine dependence. Firefighters also reported being satisfied with the QUIT SPIT! cessation program. CONCLUSIONS The results provide strong support for the feasibility and acceptability of the QUIT SPIT! in SLT-using firefighters interested in quitting. The findings provide critical information about the next steps for further development and evaluation of the QUIT SPIT! program. [ABSTRACT FROM AUTHOR]

Firefighters and EMS personnel are regularly tasked with dangerous and unpredictable incidents, but the COVID-19 pandemic has required an unprecedented response from first responders and continues to change how they operate. This article explains how COVID-19 has impacted the fire service, discusses some of the current research on COVID-19 in the fire service, and presents a research agenda to build on lessons learned during the pandemic. [ABSTRACT FROM AUTHOR]

Firefighters face a broad range of health risks including the deleterious effects of shift work, exposure to carcinogens, strenuous activities, and significant exposures to trauma. As a result, there is evidence firefighters experience increased rates of cancer, behavioral health issues, and significant risk of duty-related cardiovascular events. Due to these risks and outcomes, there has been a growing discussion centered on the need for annual medical evaluations for all firefighters. This article provides a summary on the state of the science, barriers, and types of medical evaluations being delivered. Future directions and noted research needs are presented. [ABSTRACT FROM AUTHOR]

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

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

Introduction: Prevalence rates of smokeless tobacco (SLT) use and late initiation among firefighters (ie, starting use as an adult after joining the fire service) are remarkably high, 10.5% and 26.0%, respectively. The purpose of this study is to examine characteristics associated with late SLT initiation in a sample comprised of male career firefighters from two large cohort studies.Methods: We examined correlates of late SLT initiation in a secondary analysis of data combining the baseline evaluations of two published firefighter health studies with 1474 male career firefighters in the United States.Results: Fourteen percent of participants were current SLT users. Among this group, the unadjusted rate of firefighters who initiated SLT use after joining the fire service was 15.9%, while the age-standardized rate was 38.2%; this is substantially higher than the national adjusted late initiation rate among adult males (0.8%). In addition, firefighters demonstrated higher rates of late SLT initiation (15.9% unadjusted; 18.4% age-standardized) when compared to males in the military overall (13.8%).Conclusions: The exceptionally high prevalence of SLT use overall and late initiation in the fire service suggest that joining the fire service in the United States is a risk factor for SLT use. There is a need to develop interventions aimed at reducing SLT use in the fire service that are specifically tailored for this occupational group.Implications: The high prevalence of late SLT initiation (ie, starting use as an adult after joining the fire service) among firefighters should be addressed by both researchers and fire service organizations given the significant health risks associated with SLT and its impact on occupational readiness. There is a need for developing intervention programs aimed at reducing SLT use in the fire service. Interventions would need to be specifically tailored for this occupational group and their unique culture, given that joining the fire service appears to be a risk factor for SLT initiation among firefighters who did not use tobacco prior to joining the fire service. [ABSTRACT FROM AUTHOR]

Research presented here examines how the demands of fire fighting uniquely affect women. A national sample of 73 female firefighters and fire-service leaders participated in focus groups and key informant interviews. Participants were asked about perceived threats to safety and standard operating procedures (SOPs) that lead to injury regarding gender differences. A thematic qualitative analysis was conducted and the following six themes were identified: (1) impact of working in a male-dominated field, (2) harassment, (3) similar rates/types of injury, (4) inadequate training, (5) ill-fitting gear, and (6) functional techniques/endurance. Both chronic and acute injuries/causes were discussed. Future direction will require diversity education and new training methodologies for the fire service. [ABSTRACT FROM AUTHOR]

It is a common belief in the fire service that the divorce rate for firefighters is higher than that in the general population. However, no data exists to substantiate this concern. We conducted surveys in 31 U.S. fire departments to assess relationship status, history of divorce, and key health outcomes. Prevalence of divorce among male firefighters was similar to the general population. In contrast, age-standardized prevalence of current divorce among female fighters (32.1%) was more than three times that for females in the general population (10.4%). Prevalence of ever divorce was substantially higher among female (40.0%) compared with male firefighters (24.4%). Married firefighters were less likely to report heavy alcohol use or depression, whereas single firefighters had more favorable body composition. These findings suggest that the rate of divorce among male firefighters is similar to that found in the general public. In contrast, female firefighters report high rates of divorce. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

\In occupations such as the military, police, and fire service, leaders play an important role in promoting the health and safety of their employees. A growing body of research suggests that United States (US) fire service personnel face a host of health and safety challenges, including high rates of obesity, low physical fitness, and binge drinking. In order to address these health issues effectively, strong fire service leadership is needed on these issues. However, little data exists on the attitudes and opinions of fire service leaders regarding health and safety. This study presents data from part of a large, national, qualitative study on the health of firefighters. Themes related to the role of leadership and management as well as effective messages for motivating firefighters to be healthy were identified. The critical role of leadership (e.g., fire chiefs, company officers) in modeling and promoting health and safety practices was a prevalent theme across fire departments. Participants also noted that framing health and safety initiatives as important for the sake of your crew rather than for individual gain was an effective motivational tool for fire service leaders. Findings highlight the importance of engaging leadership in effecting department-level change for firefighter health. [ABSTRACT FROM AUTHOR]

Firefighters face a number of occupational risks including the impact of being exposed to traumatic experiences. Critical incident stress debriefing (CISD) was previously introduced as a viable option for intervention postincident; however, concern has been raised about the efficacy of such debriefings. This study uses focus groups and key informant interviews with a national sample of firefighters to examine firefighters’ perceptions about behavioral health interventions. Although some firefighters reported positive experiences with CISD, other personnel reported finding the intervention intrusive and reported feeling more distressed after the intervention than before. Personnel reported experiencing benefits from peer support and using the crew for bonding after negative incidents as particularly useful. Findings suggest that while components (e.g., peer debriefing) of CISD may be useful, caution is warranted in employing the CISD model as designed. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

Little is known about smokeless tobacco (SLT) use in the fire service, whose personnel need to maintain high levels of health and fitness given the rigorous physical and mental job requirements. We examined the relationships among variables associated with SLT use and dual tobacco use (SLT and smoking) among 353 male career firefighters. Around 13% of male career fire fighters reported being current exclusive SLT users, and 2.6% used both cigarettes and SLT. Age-adjusted models revealed that race, binge drinking, and dietary fat consumption were positively associated with exclusive SLT use when compared to nontobacco users. SLT users were much more likely to binge drink (OR = 3.98, P < .01) and consume high fat foods (OR = 1.94, P < .05). Only high dietary fat consumption was a strong correlate (OR = 8.41, P < .05) of dual use when compared to nontobacco users. SLT and dual tobacco use are associated with significant health risks. Detailed information on the predictors of SLT use among fire fighters will aid in developing more effective tobacco prevention and cessation intervention in fire service. [ABSTRACT FROM AUTHOR]

Background: Despite statements from national fire service organizations, including the International Association of Fire Fighters (IAFF) and the International Association of Fire Chiefs (IAFC), promoting a diverse work force related to gender within the fire service, rates of women firefighters remain very low. Thus, research into why this extensive gender disparity continues is a high priority. Recent years have seen a number of large scale studies on firefighter health and health risk behaviors however, none have focused on the health of women firefighters and nearly all have eliminated women from the sample due to small sample size. Data from the present report is drawn from all females in a large, randomly selected cohort of firefighters in an epidemiological study designed to assess health outcomes and health risk behaviors identified as most important to the fire service. Methods: Data reported for the present study were collected as baseline data for the Firefighter Injury and Risk Evaluation (FIRE) Study, a longitudinal cohort study examining risk factors for injury in both career and volunteer firefighters in the IAFC Missouri Valley Region. Of the departments assessed, only 8 career and 6 volunteer departments had any women firefighters. All the women solicited for participation chose to enroll in the study. The number of women ranged from 1 to 7 in career departments and 1 to 6 in volunteer departments. Results: Where possible, comparisons are made between female firefighters and published data on male firefighters as well as comparisons between female firefighters and military members. Compared to male firefighters, females had more favorable body composition among both career and volunteer firefighters. Tobacco use rates were generally higher among females than males and rates among female firefighters were similar to the rates of female military members. While rates of alcohol use were higher than the general population, only one of the participants evidenced responses in the range of concern on the CAGE screening. Conclusions: In general, the findings offer an interesting glimpse of the health of women in the fire service as a generally healthy occupational workforce with some unique health risk behavior challenges. They also highlight some of the similarities and differences between male and female firefighters and bolster the argument for studying female firefighters as a unique occupational sub-population. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity has reached epidemic proportions worldwide, and is also increasing among public safety professionals like firefighters who are expected to be fit and more active. The present study evaluates the associations among Body Mass Index (BMI), weight perception and cardiovascular risk factors in 768 male career firefighters from two Midwestern states in the United States. Methods: A physical examination was performed and fasting blood samples were taken. Cardio-respiratory fitness (CRF) was determined from symptom- limited maximal treadmill exercise testing with electrocardiogram (ECG) monitoring and estimation of oxygen consumption (metabolic equivalents, METS) using the Bruce protocol. A health and lifestyle questionnaire was administered with standardized written instructions for completion. Self-reports of weight perception were extracted from responses to the completed multiple choice questionnaire. Baseline characteristics were described using the mean (standard deviation) for continuous variables and frequency for categorical variables. Group comparisons were calculated using analysis of variance (ANOVA). Linear models and logistic regression models were used to adjust for possible confounders. Logistic regression analyses were used to calculate the odds ratios of underestimating one's weight category. Results: A high proportion of overweight and obese male career firefighters underestimate their weight categories (68%). The risk of underestimating one's weight category increased by 24% with each additional unit of increasing BMI after adjustment for age and CRF. When divided into six groups based on combinations of measured BMI category and weight perception, there were significant differences among the groups for most cardiovascular risk factors. After adjustment for age and BMI, these differences remained statistically significant for CRF, amount of weekly exercise, prevalence of Metabolic Syndrome (MetSyn), body fat percentage and cholesterol measurements. Conclusion: A high proportion of overweight and obese male career firefighters underestimate their measured BMI categories. As a result, they are unlikely to fully appreciate the negative health consequences of their excess weight. The results of this study emphasize the importance of objectively measuring BMI and then informing patients of their actual weight status and the associated disease risks. [ABSTRACT FROM AUTHOR]

A consistent relationship has been demonstrated between obesity and absenteeism in the workplace. However, most studies have focused on primarily sedentary occupational groups. Firefighting is a physically demanding profession that involves significant potential for exposure to dangerous situations and strenuous work. No studies to date have evaluated the impact of obesity on risk for absenteeism among firefighters. We examined the cross-sectional association between BMI and obesity and injury-related absenteeism. BMI, body fat percentage (BF%), waist circumference (WC), injury, and injury-related absenteeism were assessed in 478 career male firefighters. One hundred and fifteen firefighters reported an injury in the previous year and the number of days absent from work due to their injury. BMI was an independent predictor of absenteeism due to injury even after adjustment for confounding variables. Firefighters meeting the definition of class II and III obesity had nearly five times (odds ratio (OR) = 4.89; 95% confidence interval (CI) = 3.63-6.58) the number missed work days due to injury when compared to their normal weight counterparts and their elevated risk was greater than firefighters with class I obesity (OR = 2.71; 95% CI = 2.01-3.65) or those who were overweight (OR = 2.55; 95% CI = 1.90-3.41). The attributable per capita costs of class II and III obesity-related absenteeism over the last year were $1,682.90 per firefighter, $254.00 per firefighter for class I obesity, and $74.41 per firefighter for overweight. Our findings suggest that class II and III obesity were associated with substantial attributable costs to employers and our cost estimates probably underestimate the actual financial burden. [ABSTRACT FROM AUTHOR]

Background This study provides a comprehensive, population-based examination of tobacco use among both career and volunteer firefighters. Methods Data are from a population-based cohort study of randomly selected career (N = 11) and volunteer (N = 13) departments comprised of 677 male firefighters. Results Unadjusted rates of smoking were 13.6% and 17.4% for career and volunteer firefighters, respectively. Smoking rates were less than a comparable occupational group (military personnel) and adult males in the states represented. Smokers were more likely to have been diagnosed with an anxiety disorder (OR = 5.8; P = 0.010), have an elevated CAGE alcohol problem score (OR = 2.9; P = 0.040), and more likely to report driving after drinking too much (OR = 4.5; P = 0.020) compared to never-smokers. Large percentages of career (18.4%) and volunteer (16.8%) firefighters used smokeless tobacco. Conclusions Smokin g among firefighters is associated with other significant health and safety risks. High rates of smokeless tobacco use suggest that the fire service is an important target for intervention. Thus, despite strong statements against smoking by the fire service, the need to maintain high levels of health and fitness and relatively low smoking rates, a significant proportion of firefighters continue to use tobacco products. Am. J. Ind. Med. 54:697-706, 2011. © 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

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

Objectives Given high levels of occupational stress and toxic exposures, firefighters have a relatively high prevalence of occupationally related medical and mental health disorders compared with the general public. Previous research found high rates of heavy and binge drinking among male firefighters. This study is the first to examine alcohol use among women firefighters. Methods Data were collected as part of a national online survey of women, career firefighters. Results A total of 1,913 women firefighters completed questions regarding alcohol use. Nearly 40% reported binge drinking in the previous month and 4.3% reported driving while intoxicated. Among those who drank, 16.5% screened positive for problem drinking. Problem drinkers were more than 2.5 times as likely to have been diagnosed with depression or have symptoms of posttraumatic stress disorder, and were approximately 40% more likely to have been injured on the job in the previous year, when compared with other women firefighters. Those who screened positive for problem drinking also were significantly less likely to say that they would recommend a fire service career to other women. Conclusions As with male firefighters, heavy and problem drinking are prevalent among women firefighters and are associated with negative occupational outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The high prevalence of overweight and obesity threatens the health and safety of the fire service. Healthcare professionals may play an important role in helping firefighters achieve a healthy weight by providing weight loss counseling to at-risk firefighters. This study characterizes the impact of healthcare professional weight loss advice on firefighter weight perceptions and weight loss behaviors among overweight and obese male firefighters.Methods: A national sample of 763 overweight and obese male firefighters who recalled visiting a healthcare provider in the past 12 months reported information regarding healthcare visits, weight perceptions, current weight loss behaviors, and other covariates in 2011-2012. Analyzed in 2013, four unique multilevel logistic regression models estimated the association between healthcare professional weight loss advice and the outcomes of firefighter-reported weight perceptions, intentions to lose weight, reduced caloric intake, and increased physical activity.Results: Healthcare professional weight loss advice was significantly associated with self-perception as overweight (OR=4.78, 95% CI=2.16, 10.57) and attempted weight loss (OR=2.06, 95% CI=1.25, 3.38), but not significantly associated with reduced caloric intake (OR=1.26, 95% CI=0.82, 1.95) and increased physical activity (OR=1.51, 95% CI=0.89, 2.61), after adjusting for confounders.Conclusions: Healthcare professional weight loss advice appears to increase the accuracy of firefighter weight perceptions, promote weight loss attempts, and may encourage dieting and physical activity behaviors among overweight firefighters. Healthcare providers should acknowledge their ability to influence the health behaviors of overweight and obese patients and make efforts to increase the quality and frequency of weight loss recommendations for all firefighters. [ABSTRACT FROM AUTHOR]

The article offers information on the study conducted by the authors related to relationship between physical activity (PA) and risk of cardiovascular disease (CVD) in firefighters. It states that 527 firefighters from Missouri and Kansas were recruited for the study. It mentions that they completed a multiple-choice survey related to exercise, health, work habits and sleep. It highlights that their height, weight and body mass index (BMI) were measured. It reports that frequency of PA was significantly associated with reduced total cholesterol-high density lipoproteins (HDL) ratio and increase in PA had beneficial effects on cardiorespiratory fitness (CRF).

The article presents a study which examines the prevalence of obesity and overweight in firefighters. It states that a total of 677 career and volunteer male fire fighters were enrolled in the study, wherein their waist circumference, body mass index (BMI), and body fat percentage (BF%) were assessed. Furthermore, the study reveals high prevalence rate of obesity and overweight among career and volunteer firefighters which demonstrated unfavorable profile of cardiovascular disease (CVD).

Objectives: Estimate the point prevalence of COVID-19 vaccine acceptability among US firefighters and Emergency Medical Services (EMS) workers. Methods: A cross-sectional study design was used to administer an anonymous online survey to a national non-probabilistic sample of firefighter and EMS workers. Results: Among the 3169 respondents, 48.2% expressed high acceptability of the COVID-19 vaccine when it becomes available, while 24.2% were unsure and 27.6% reported low acceptability. Using the "high COVID-19 vaccine acceptability" group as the reference category, the groups with greater odds of reporting low acceptability included those: 30 to 39 years of age (odds ratio = 3.62 [95% confidence interval = 2.00 to 6.55]), Black race (3.60 [1.12 to 11.53]), Hispanic/Latinx ethnicity (2.39 [1.45 to 3.921), with some college education (2.06 [1.29 to 3.27]), married (1.65 [1.03 to 2.65]), of current rank firefighter/EMS (2.21 [1.60 to 3.08]). Conclusions: Over half of US firefighters and EMS workers were uncertain or reported low acceptability of the COVID-19 vaccine when it becomes available. [ABSTRACT FROM AUTHOR]

• Silicone dog tags are a new configuration of personalized passive sampling device. • Silicone dog tags detected 18 PAHs not previously reported as firefighter exposures. • Firefighters have higher chemical exposures on– compared to off-duty. • Concentrations were more correlated to fire attack numbers than firefighter rank. • Silicone dog tags can provide quantitative exposure data on chemical mixtures. Occupational chemical hazards in the fire service are hypothesized to play a role in increased cancer risk, and reliable sampling technologies are necessary for conducting firefighter chemical exposure assessments. This study presents the military-style dog tag as a new configuration of silicone passive sampling device to sample individual firefighters' exposures at one high and one low fire call volume department in the Kansas City, Missouri metropolitan area. The recruited firefighters (n = 56) wore separate dog tags to assess on– and off-duty exposures (n dogtags = 110), for a total of 30 24 h shifts. Using a 63 PAH method (GC–MS/MS), the tags detected 45 unique PAHs, of which 18 have not been previously reported as firefighting exposures. PAH concentrations were higher for on– compared to off-duty tags (0.25 < Cohen's d ≤ 0.80) and for the high compared to the low fire call volume department (0.25 ≤ d < 0.70). Using a 1530 analyte screening method (GC–MS), di-n-butyl phthalate, diisobutyl phthalate, guaiacol, and DEET were commonly detected analytes. The number of fire attacks a firefighter participated in was more strongly correlated with PAH concentrations than firefighter rank or years in the fire service. This suggested that quantitative data should be employed for firefighter exposure assessments, rather than surrogate measures. Because several detected analytes are listed as possible carcinogens, future firefighter exposure studies should consider evaluating complex mixtures to assess individual health risks. [ABSTRACT FROM AUTHOR]

Objectives: To establish the extent of steady state hypohydration among firefighters and examine factors associated with their hydration status. Methods: Data on 450 career firefighters from 11 randomly selected fire departments had their body composition, total body water (TBW), and hypohydration status assessed using bioelectrical impedance. Measured height and weight were used to determine body mass index (BMI) and weight classification. Results: The hypohydration rate was 17% and 94% of hypohydrated firefighters were obese. A one-unit increase in BMI was associated with an 83% greater likelihood of being hypohydrated. Conclusions: This study indicates that steady state hypohydration is a significant issue among obese firefighters. Current hydration policies based on previous reports that most (more than 90%) firefighters are hypohydrated in the steady state should be revisited and additional, confirmatory research in this area should be conducted. [ABSTRACT FROM AUTHOR]

Objective: Both media reports and preliminary research suggest that problem drinking is a concern in the U.S. fire service. However, no national epidemiological research has been conducted. This study presents the first national data on alcohol consumption patterns among firefighters. Method: Data are from 954 male firefighters at 20 career fire departments. The departments covered 14 U.S. states, commonwealths, and/or territories and each of the four major U.S. Census Bureau Regions. Alcohol use was assessed through both surveys and, in a subsample, 24-hour dietary recall interviews from an off-duty day. Results: More than 85% of participants consumed alcohol, nearly half reported excessive drinking, and approximately one third reported episodic heavy use when off duty. Firefighters (in comparison with officers or chiefs) and those with fewer years of service had particularly high levels of alcohol intake. Among firefighters who drank, the energy derived from alcohol averaged 539 kcals, or nearly 18% of total energy. Twenty-five percent of firefighters consumed more than 770 kcals from alcohol in a single day. Conclusions: Given the high prevalence of excessive and episodic heavy drinking and the impact of alcohol on energy intake in this population, national surveillance programs and targeted prevention interventions for problem drinking in the U.S. fire service are critically needed. [ABSTRACT FROM AUTHOR]

Objective: Quantify the association between adiposity and frequency of self-reported poor health days among male firefighters. Methods: Measures were taken for body mass index, waist circumference, and percentage of body fat. Firefighters self-reported the outcome of the number of poor health days in the past 30 days. Zero-inflated negative binomial models and fractional polynomial plots were used to determine the impact of adiposity on the frequency of self-reported poor health days. Results: Body mass index (rate ratio [RR]: 1.037; 95% confidence interval [CI]: 1.003 to 1.073), waist circtjmference (RR: 1.012; 95% CI: 0.999 to 1.030), and percentage of body fat (RR: 1.021 ; 95% CI: 0.999 to 1.041 ) were associated with self-reported poor health days. Conclusions: Adiposity is positively associated with frequency of self-reported poor health days among male firefighters. Future efforts to improve health among firefighters should emphasize reductions in adiposity. [ABSTRACT FROM AUTHOR]

The article discusses a study to evaluate the prevalence of excessive daytime sleepiness (EDS) during working hours among a sample of firefighters. The study was conducted by using the Epworth Sleepiness Scale on the given sample of male career firefighters. The results of the study conducted revealed that firefighters did not show high rates of EDS despite their extended work schedule.

The article discusses a study to document weight changes in a population-based cohort of male career firefighters as well as evaluate the impact of health surveillance on subsequent participant behavior and body composition. The study concluded that regular health surveillance may motivate some firefighters to make health behavior changes. The need for fire departments to provide firefighters with annual health assessments including body composition and fitness measurements is highlighted.

[Display omitted] Studies suggest that exposure to potential endocrine disrupting chemicals (pEDCs) may contribute to adverse health outcomes, but pEDC exposures among firefighters have not been fully characterized. Previously, we demonstrated the military-style silicone dog tag as a personal passive sampling device for assessing polycyclic aromatic hydrocarbon exposures among structural firefighters. This follow-up analysis examined the pEDC exposures based on department call volume, duty shift, and questionnaire variables. Structural firefighters (n = 56) were from one high and one low fire call volume department (Kansas City, MO metropolitan area) and wore separate dog tags while on- and off-duty (n dogtags = 110). The targeted 1530 analyte semi-quantitative screening method was conducted using gas chromatography mass spectrometry (n pEDCs = 433). A total of 47 pEDCs were detected, and several less-frequently-detected pEDCs (<75%) were more commonly detected in off- compared to on-duty dog tags (conditional logistic regression). Of the 11 phthalates and fragrances detected most frequently (>75%), off-duty pEDC concentrations were strongly correlated (r = 0.31–0.82, p < 0.05), suggesting co-applications of phthalates and fragrances in consumer products. Questionnaire variables of "regular use of conventional cleaning products" and "fireplace in the home" were associated with select elevated pEDC concentrations by duty shift (paired t -test). This suggested researchers should include detailed questions about consumer product use and home environment when examining personal pEDC exposures. [ABSTRACT FROM AUTHOR]