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Hershey MS, Bouziani E, Chen XY(M, Lidoriki I, Hadkhale K, Huang YC, Filippou T, López-Gil JF, Gribble AK, Lan FY, Sotos-Prieto M, Kales SN. Surviving & Thriving; a healthy lifestyle app for new US firefighters: usability and pilot study protocol. Front Endocrinol (Lausanne) 2023; 14:1250041. [PMID: 37908746 PMCID: PMC10614295 DOI: 10.3389/fendo.2023.1250041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
In the United States (US), new firefighters' fitness and health behaviors deteriorate rapidly after fire academy graduation. Over the long-term, this increases their risks for chronic diseases. This study protocol describes the proposed usability testing and pilot study of a newly designed and developed healthy lifestyle smartphone app, "Surviving & Thriving", tailored towards young US firefighters. "Surviving & Thriving" will provide interactive educational content on four lifestyle factors; nutrition, sleep, physical activity, and resilience, and include a personalized journey, habit tracker, and elements of gamification to promote engagement and long-term healthy behavior change. The first phase of the app development entails alpha testing by the research team and pre-beta testing by a fire service expert panel which will help refine the app into a pre-consumer version. Upon completion of the full app prototype, beta 'usability' testing will be conducted among new fire academy graduates from two New England fire academies to collect qualitative and quantitative feedback via focus groups and satisfaction surveys, respectively. A last phase of piloting the app will evaluate the app's efficacy at maintaining/improving healthy lifestyle behaviors, mental health metrics, and physical fitness metrics. We will also evaluate whether firefighters' perceived "health cultures" scores (ratings of each fire station's/fire department's environments as to encouraging/discouraging healthy behaviors) modify the changes in health metrics after utilizing the app for three to six months. This novel user-friendly app seeks to help new firefighters maintain/improve their health and fitness more effectively, reducing their risk of lifestyle-related chronic disease. Firefighters who can establish healthy habits early in their careers are more likely to sustain them throughout their lives.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Eleni Bouziani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xin Yu (Maggie) Chen
- Harvard Faculty of Arts and Sciences, William James Hall, Cambridge, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Irene Lidoriki
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Kishor Hadkhale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Ya-Chin Huang
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - José Francisco López-Gil
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Anne Katherine Gribble
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Illawarra Shoalhaven Local Health District, NSW Health, Warrawong, NSW, Australia
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP) [Consorcio Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health], Madrid, Spain
- Madrid Institute for Advanced Studies (IMDEA)-Food Institute, The Campus of International Excellence (CEI), The Spanish National Research Council (CSIC), The Autonomous University of Madrid (UAM), Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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Burris JC, Werner CM, Woolf K. The Relationship Between Dietary Intake and Dietary-Focused Lifestyle Interventions on Risk Factors Associated with Cardiovascular Disease in Firefighters. Curr Nutr Rep 2022; 11:206-224. [PMID: 35347666 DOI: 10.1007/s13668-022-00406-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of death to on-duty firefighters and is a substantial health concern. Preventative measures, including dietary interventions, may improve CVD in firefighters. The purpose of this review is to examine the literature on the relationship between dietary intake, dietary lifestyle interventions, and risk of CVD in firefighters. RECENT FINDINGS Existing evidence, albeit limited, suggests that firefighters do not meet dietary guidelines. Lifestyle modifications featuring dietary interventions are effective in improving risk factors associated with CVD in firefighters. Unfortunately, no consistent nutrition-related trend was identified across the retrieved studies and only a limited number of randomized controlled trials have examined the efficacy of lifestyle intervention studies on CVD in firefighters. Although this review suggests dietary lifestyle interventions may facilitate decreases in risk factors associated with CVD in firefighters, current evidence is limited, and additional research is needed.
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Affiliation(s)
- Jennifer C Burris
- Department of Nutrition, Saddleback College, 2800 Marguerite Pkwy, Mission Viejo, CA, 92692, USA
| | - Charlotte Marie Werner
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, 411 Lafayette Street, 5th Floor, New York, NY, 10003, USA
| | - Kathleen Woolf
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, 411 Lafayette Street, 5th Floor, New York, NY, 10003, USA.
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Mathias KC, Bode ED, Stewart DF, Smith DL. Changes in Firefighter Weight and Cardiovascular Disease Risk Factors over Five Years. Med Sci Sports Exerc 2021; 52:2476-2482. [PMID: 32366797 PMCID: PMC7556237 DOI: 10.1249/mss.0000000000002398] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose This study aimed to assess changes in cardiovascular disease (CVD) risk factors in firefighters who lost, maintained, or gained weight over 5 yr. Methods Anthropometrics and biomarkers of CVD were measured during two occupational medical exams 4.8 yr apart in 656 career firefighters. Weight change subgroups were loss (decrease of >3% body weight), stable (within ±3% body weight), and gain (increase of >3% body weight). Changes in CVD risk factors in the total sample and within weight change subgroups were tested for statistical significance using paired t-tests. Results After 5 yr, 12% of the sample lost weight, 38% maintained weight, and 50% gained weight. Firefighters on average had significant increases (P < 0.001) in body weight (2.5 ± 0.2 kg), body mass index (0.8 ± 0.1 kg·m−2), total cholesterol (5.5 ± 1.4 mg·dL−1), LDL cholesterol (5.2 ± 1.2 mg·dL−1), and blood glucose (2.1 ± 0.5 mg·dL−1). Firefighters who gained weight (6.6 ± 0.2 kg) had significant increases (P < 0.001) in total cholesterol (12.9 ± 1.8 mg·dL−1), LDL cholesterol (11.1 ± 1.6 mg·dL−1), and blood glucose (2.9 ± 0.7 mg·dL−1) with a significant decrease (P ≤ 0.01) in HDL cholesterol (−1.3 ± 0.4 mg·dL−1). Firefighters who lost weight (−7.2 ± 0.5 kg) had significant decreases (P < 0.05) in total cholesterol (−8.5 ± 3.9 mg·dL−1), LDL cholesterol (−6.7 ± 3.3 mg·dL−1), and blood pressure (systolic: −5.3 ± 1.3 mm Hg; diastolic −4.2 ± 1.0 mm Hg) with a significant increase (P < 0.05) in HDL cholesterol (2.3 ± 1.0 mg·dL−1). Conclusions Although improvements in cardiovascular health among firefighters who lost weight were found, 50% of the sample gained weight with adverse changes in measures of cardiovascular health. Given that sudden cardiac death is the most common cause of duty-related death among firefighters, with increased risk among obese firefighters, the amount of weight gain and the adverse changes in cardiovascular health suggest the need for improvements in health promotion programs for firefighters in the United States.
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Affiliation(s)
- Kevin C Mathias
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY
| | - Emilie D Bode
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY
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Cardiorespiratory Fitness in Spanish Firefighters: Age Differences and Associations Between Fitness-Related Parameters. J Occup Environ Med 2021; 63:e318-e322. [PMID: 33769332 DOI: 10.1097/jom.0000000000002199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the cardiorespiratory fitness and other fitness-related measures, and to analyze the differences among age groups. METHODS This study was conducted on 104 firefighters. Maximal oxygen uptake (VO2 max) was assessed using the Shuttle Test and fitness was evaluated using appropriate physical tests. RESULTS Mean VO2 max was 45.7 mL/kg/min and 60.6% of firefighters were over the minimum accepted standpoint to do effective work, however, the VO2 max decreased with increasing age. 35.6% of the firefighters were overweight. Age, weight, and total body fat were found to be significant predictors of VO2 max level in this population, with total body fat as strongest predictor. CONCLUSIONS Healthy habits-based interventions tailored by age groups should be promoted, to improve cardiorespiratory fitness and body composition for safe work and to improve firefighters' health.
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Kaipust CM, Jahnke SA, Poston WSC, Jitnarin N, Haddock CK, Day RS. Response to Letter to the Editor on Sleep, Obesity, and Injury Among US Male Career Firefighters. J Occup Environ Med 2020; 62:e290-e291. [PMID: 32510912 DOI: 10.1097/jom.0000000000001865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Rena S Day
- Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, Texas
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Damacena FC, Batista TJ, Ayres LR, Zandonade E, Sampaio KN. Obesity prevalence in Brazilian firefighters and the association of central obesity with personal, occupational and cardiovascular risk factors: a cross-sectional study. BMJ Open 2020; 10:e032933. [PMID: 32169924 PMCID: PMC7069316 DOI: 10.1136/bmjopen-2019-032933] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the obesity prevalence in a population of Brazilian firefighters and the association of central obesity (CO) with sociodemographic, occupational, life habits, fitness and health status variables. DESIGN Cross-sectional study. SETTINGS The data were collected during annual health inspections of firefighters from the Military Fire Service of the State of Espírito Santo, a state in Southeast Brazil. PARTICIPANTS The study encompassed 1018 active military firefighters. After exclusion criteria, 892 male firefighters were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES The collected data included: sociodemographic, occupational, lifestyle, fitness and health status variables. The associations between these factors and CO were calculated by adjusted OR through a hierarchical logistic regression model. RESULTS Obesity estimation by body mass index indicated that 48.65% of the firefighters were overweight and 10.99% were obese. Concerning the body fat percentage, 26.23% of the participants were considered obese, while 18.61% of the firefighters were considered centrally obese or at risk using the waist circumference measure. After adjusted OR analysis, CO was more likely associated with the age range of 50 to 59 years old (OR 2.93; 95% CI 1.05 to 8.14), low self-reported physical activity (OR 1.95; 95% CI 1.14 to 3.34), low cardiorespiratory fitness (OR 5.15; 95% CI 3.22 to 8.23), hyperglycaemia (OR 1.70; 95% CI 1.07 to 2.72) and hypertriglyceridaemia fasting status (OR 3.12; 95% CI 1.75 to 5.55). CONCLUSIONS Our study identified an overall high prevalence of overweight and obese individuals in the examined firefighter population. Age and cardiovascular risk factors were directly associated with CO among the firefighters. Cardiovascular risk factors should be routinely inspected within the Brazilian firefighters' corporations in order to improve the health condition and wellness of these workers. These endeavours will improve the performance of the services provided to the population.
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Affiliation(s)
- Fernanda Camargo Damacena
- Department of Pharmaceutical Sciences, Postgraduate Program in Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Thatiany Jardim Batista
- Department of Pharmaceutical Sciences, Postgraduate Program in Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
- Department of Physiological Sciences, Postgraduate Program in Physiological Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Lorena Rocha Ayres
- Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Eliana Zandonade
- Statistical Department, Public Health Postgraduate Program, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Karla Nívea Sampaio
- Department of Pharmaceutical Sciences, Postgraduate Program in Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
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Bycura DK, Dmitrieva NO, Santos AC, Waugh KL, Ritchey KM. Efficacy of a Goal Setting and Implementation Planning Intervention on Firefighters' Cardiorespiratory Fitness. J Strength Cond Res 2019; 33:3151-3161. [PMID: 31658212 DOI: 10.1519/jsc.0000000000002683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bycura, DK, Dmitrieva, NO, Santos, AC, Waugh, KL, and Ritchey, KM. Efficacy of a Goal Setting and Implementation Planning Intervention on Firefighters' Cardiorespiratory Fitness. J Strength Cond Res 33(11): 3151-3161, 2019-The purpose of this study was to assess the effectiveness of a goal setting and implementation planning (GSIP) intervention on cardiorespiratory fitness among firefighters. Male career firefighters (N = 20) from a large municipal fire department were assigned to an intervention arm (n = 12) or passive control arm (n = 8) of a 14-week study involving cardiorespiratory exercise. The intervention consisted of GSIP coaching at baseline and support throughout the study. Cardiorespiratory fitness was assessed through a standardized physical protocol for firefighters (Candidate Physical Ability Test) at baseline, at 6 weeks, and at 14 weeks time points, using the Cosmed K4b portable metabolic system to measure physiological variables. Using intention-to-treat principles, we employed a 2-level multilevel model to examine the effect of intervention group on intercept and change over time on primary outcomes of interest: oxygen transport and utilization (VO2), heart rate (HR), and respiratory exchange ratio (R). Results demonstrated that the intervention and control groups both exhibited a significant increase in VO2 (B = 0.143, SE = 0.025, p < 0.001) and a decline in R (B = -0.003. SE = 0.001, p < 0.01) over the course of the study. Although both groups exhibited improvements on 2 of the 3 cardiorespiratory outcomes, subjects assigned to the intervention did not exhibit superior outcomes when compared to the control group. Given the improvements we observed in 2 out of 3 outcomes across both conditions, future research may consider testing effectiveness of interventions consisting of functional training exercises that closely translate to firefighting tasks over time periods sufficient to elicit aerobic metabolic adaptations.
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Affiliation(s)
- Dierdra K Bycura
- Department of Health Sciences-Fitness Wellness, Northern Arizona University, Flagstaff, Arizona
| | | | - Anthony C Santos
- Department of Health Sciences-Fitness Wellness, Northern Arizona University, Flagstaff, Arizona
| | - Kelsey L Waugh
- Department of Health Sciences-Fitness Wellness, Northern Arizona University, Flagstaff, Arizona
| | - Kamiko M Ritchey
- Department of Health Sciences-Fitness Wellness, Northern Arizona University, Flagstaff, Arizona
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Occupationally Tailored, Web-Based, Nutrition and Physical Activity Program for Firefighters: Cluster Randomized Trial and Weight Outcome. J Occup Environ Med 2019; 61:841-848. [PMID: 31348415 DOI: 10.1097/jom.0000000000001685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the efficacy of an occupationally tailored, web-based health and wellness program, The First Twenty® (TF20), for weight change among volunteer firefighters. METHODS The impact of TF20 on firefighters' 6-month weight change was tested in a cluster, randomized controlled trial, using a crossover design of firefighters in 10 departments. TF20 has web-based nutrition, physical activity, and behavioral health components. RESULTS An adjusted treatment-induced weight loss from 1.7 to 2.8 lb was observed for all participants and 2.3 to 3.1 lb among overweight and obese participants. An average weight gain was observed among firefighters in the control condition and weight loss for those in the treatment condition. CONCLUSIONS TF20 supports firefighters' weight loss. Firefighters need wellness interventions to improve nutrition and physical activity given their high prevalence of obesity.
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Petruzzello SJ, Poh PYS, Greenlee TA, Goldstein E, Horn GP, Smith DL. Physiological, Perceptual and Psychological Responses of Career versus Volunteer Firefighters to Live-fire Training Drills. Stress Health 2016; 32:328-336. [PMID: 25393336 DOI: 10.1002/smi.2620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/10/2014] [Accepted: 10/20/2014] [Indexed: 11/10/2022]
Abstract
A primary objective of the present study was to examine the effect of short-term live-fire firefighting activities on key physiological, perceptual and psychological variables and whether occupational status influenced these responses. It was also of interest to examine whether individual difference factors differentiated the occupational status groups and if so, whether such individual difference factors influenced perceptual and psychological responses to firefighting activities. Male firefighters (n = 52 career, n = 53 volunteer firefighters) participated in 18 min of simulated firefighting activity in a training structure that contained live fires. Measures of heart rate (HR) and Tcore were obtained before and after firefighting activities along with perceptions of thermal sensations, exertion, respiratory distress and affect. Firefighting activities resulted in significant elevations in HR and Tcore , whereas thermal sensations, respiratory distress, exertion and affect all showed significant and sizable changes reflecting greater distress and dysphoria. Occupational status and individual difference factors accounted for some of this negative change. The findings replicate and extend previous work by demonstrating the influence of occupational status and individual difference factors in the psychological responses to firefighting activity. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Steven J Petruzzello
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA. .,University of Illinois Fire Service Institute, Champaign, IL, USA.
| | - Paula Y S Poh
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Tina A Greenlee
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Eric Goldstein
- University of Illinois Fire Service Institute, Champaign, IL, USA
| | - Gavin P Horn
- University of Illinois Fire Service Institute, Champaign, IL, USA
| | - Denise L Smith
- University of Illinois Fire Service Institute, Champaign, IL, USA.,Department of Health and Exercise Science, Skidmore College, Saratoga Springs, NY, USA
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Brown AL, Poston WSC, Jahnke SA, Keith Haddock C, Luo S, Delclos GL, Sue Day R. Weight loss advice and prospective weight change among overweight firefighters. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:233-239. [PMID: 27467464 DOI: 10.1080/10773525.2016.1207045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obesity compromises firefighter safety, yet more than 70% of firefighters are overweight. Though healthcare professionals are encouraged to counsel overweight patients, the effectiveness of weight counseling is not consistent across studies. OBJECTIVE Examine longitudinal changes in cardiovascular risk factors and determine the role of healthcare professional weight loss advice on six-month weight changes among a national sample of male, overweight and obese firefighters. METHODS This study included baseline and six-month assessments of 757 firefighters. Medical and demographic data were collected using questionnaires. Investigators collected height, weight, percent body fat, waist circumference, blood pressure, and fasting serum samples (total cholesterol, high-density lipoprotein, low-density lipoprotein, glucose). Multilevel linear regression assessed the association between weight advice and outcomes. RESULTS Participants lost an average of 0.55 kg (95%CI: 0.17-0.93), and experienced significant improvements in systolic blood pressure (mean: 3.75 mm Hg; 95% CI: 2.35-5.14) and non-significant improvements in other clinical outcomes. Healthcare professional weight advice was not significantly associated with weight loss or other outcomes. CONCLUSION Similar to other studies, results show little benefit of low intensity weight loss counseling. Additional research is needed to identify effective and feasible weight management strategies to address firefighter obesity.
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Affiliation(s)
- Austin L Brown
- a Department of Pediatrics - Section of Hematology Oncology , Baylor College of Medicine , Houston , TX , USA.,b Division of Epidemiology, Human Genetics and Environmental Sciences , School of Public Health, The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Walker S C Poston
- c Center for Fire, Rescue, and EMS Health Research , National Development and Research Institutes, Institute for Biobehavioral Health Research , Leawood , KS , USA
| | - Sara A Jahnke
- c Center for Fire, Rescue, and EMS Health Research , National Development and Research Institutes, Institute for Biobehavioral Health Research , Leawood , KS , USA
| | - C Keith Haddock
- c Center for Fire, Rescue, and EMS Health Research , National Development and Research Institutes, Institute for Biobehavioral Health Research , Leawood , KS , USA
| | - Sheng Luo
- d Division of Biostatistics , School of Public Health, The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - George L Delclos
- b Division of Epidemiology, Human Genetics and Environmental Sciences , School of Public Health, The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - R Sue Day
- e Division of Epidemiology, Human Genetics and Environmental Sciences , School of Public Health, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston , Houston , TX , USA
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Hostler D, McEntire SJ, Rittenberger JC. Emergency Incident Rehabilitation: Resource Document to the Position Statement of the National Association of EMS Physicians. PREHOSP EMERG CARE 2016; 20:300-6. [PMID: 26847801 DOI: 10.3109/10903127.2015.1111481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Position Statement: Emergency Incident Rehabilitation The National Association of EMS Physicians® believes that: Emergency operations and training conducted while wearing protective clothing and respirators is physiologically and cognitively demanding. The heat stress and fatigue created by working in protective clothing and respirators creates additional risk of illness/injury for the public safety provider. Emergency incident rehabilitation provides a structured rest period for rehydration and correction of abnormal body core temperature following work in protective clothing and respirators. Emergency incident rehab should be conducted at incidents (e.g. fireground, hazardous materials, and heavy rescue emergencies) and trainings involving activities that may lead to exceeding safe levels of physical and mental exertion. Emergency incident rehabilitation is incident care, not fitness for duty, and meant to reduce physiologic strain and prepare the responder to return to duty at the current incident and for the remainder of the shift. EMS should play a role in emergency incident rehabilitation with providers trained to understand the physiologic response of healthy individuals to environmental, exertional, and cognitive stress and implement appropriate mitigation strategies. An appropriately qualified physician should have oversight over the creation and implementation of emergency incident rehabilitation protocols and may be separate from the roles and responsibilities of the occupational medicine physician. There are no peer-reviewed data related to cold weather rehabilitation. Future studies should address this limitation to the literature.
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Brown AL, Poston WSC, Jahnke SA, Haddock CK, Luo S, Delclos GL, Day RS. Weight Advice Associated With Male Firefighter Weight Perception and Behavior. Am J Prev Med 2015; 49:589-93. [PMID: 26141913 PMCID: PMC5059839 DOI: 10.1016/j.amepre.2015.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Austin L Brown
- Division of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Walker S C Poston
- Center for Fire, Rescue, and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, Kansas
| | - Sara A Jahnke
- Center for Fire, Rescue, and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, Kansas
| | - C Keith Haddock
- Center for Fire, Rescue, and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, Kansas
| | - Sheng Luo
- Division of Biostatistics, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - George L Delclos
- Division of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - R Sue Day
- Division of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, Texas.
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Wilkinson ML, Brown AL, Poston WSC, Haddock CK, Jahnke SA, Day RS. Physician weight recommendations for overweight and obese firefighters, United States, 2011-2012. Prev Chronic Dis 2014; 11:E116. [PMID: 25010998 PMCID: PMC4093977 DOI: 10.5888/pcd11.140091] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION National guidelines state that health care professionals (HCPs) should advise patients on the importance of maintaining a healthy weight. Firefighters have high rates of obesity, and cardiovascular events are the leading cause of line-of-duty deaths in firefighters. This study assessed the association of age and body mass index (BMI) with HCP weight recommendations among male firefighters. METHODS We used data on self-reported HCP weight recommendations and measured BMI from a 2011-2012 national sample of male firefighters (N = 1,002). HCP recommendations were recorded as no advice, maintain, gain, or lose weight, and BMI was categorized as normal (<25.0 kg/m(2)), overweight (25.0-29.9 kg/m(2)), class I obese (30.0-34.9 kg/m(2)), and class II or III obese (≥35.0 kg/m(2)). We used multinomial logistic regression to estimate the odds of receiving weight advice by age and BMI categories. RESULTS Most firefighters (96%) reported visiting an HCP in the past year. Most (69%) firefighters and 48% of class I to III obese firefighters reported receiving no weight advice. Higher BMI predicted HCP advice to lose weight (odds ratio class I obese vs normal weight: 12.98; 95% confidence interval: 5.38-31.34). Younger firefighters were less likely to receive weight loss advice than older firefighters, except among those who were class II or III obese. CONCLUSIONS HCPs are important sources of health information for firefighters. Overweight and obese firefighters, particularly those who are younger, do not consistently receive HCP advice to lose weight. This marks a missed opportunity to prevent further weight gain and reduce obesity-related health outcomes.
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Affiliation(s)
- Michelle Lynn Wilkinson
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
| | - Austin Lane Brown
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
| | | | | | | | - Rena Sue Day
- The University of Texas Health Science Center at Houston, School of Public Health, Division of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, 1200 Pressler Dr, RAS E1027, Houston, TX 77030. E-mail:
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Poston WSC, Haddock CK, Jahnke SA, Jitnarin N, Day RS. An examination of the benefits of health promotion programs for the national fire service. BMC Public Health 2013; 13:805. [PMID: 24007391 PMCID: PMC3846399 DOI: 10.1186/1471-2458-13-805] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/30/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Firefighters suffer from high prevalence of obesity, substandard fitness, and cardiovascular-related deaths. There have been a limited number of firefighter health promotion programs that have been developed and empirically-tested for this important occupational group. We evaluated the health of firefighters from departments with well-developed health promotion programs and compared them with those from departments not having such programs using a large national sample of career fire departments that varied in size and mission. We measured a broad array of important individual firefighter health outcomes (e.g., body composition, physical activity, and general and behavioral health) consistent with national fire service goals and addressed significant statistical limitations unaccounted for in previous studies. METHODS Using the approach of purposive sampling of heterogeneous instances, we selected and conducted a national evaluation of 10 departments already implementing wellness and fitness programs (Wellness Approach; WA) with 10 departments that did not (Standard). Participants were 1,002 male firefighters (WA n = 522; Standard n = 480) who underwent assessments including body composition, fitness, and general/behavioral health (e.g., injury, depressive symptoms). RESULTS Firefighters in WA departments were healthier than their Standard department counterparts. For example, they were less likely to be obese (adjusted [A]OR = 0.58; 95% CI = 0.41-0.82), more likely to meet endurance capacity standards for firefighting (AOR = 5.19; 95% CI = 2.49-10.83) and have higher estimated VO2max (40.7 ± 0.6 vs. 37.5 ± 1.3 for firefighters in Standard departments; p = 0.001). In addition, WA firefighter were substantially less likely to smoke (AOR = 0.30; 95% CI = 0.17-0.54) or ever have been diagnosed with an anxiety disorder (AOR = 0.27; 95% CI = 0.14-0.52) and they expressed higher job satisfaction across several domains. However, WA firefighters were somewhat more likely to have reported an injury to Workers' Compensation (AOR = 1.74; 95% CI = 1.05-2.90). It was notable that both groups evidenced high prevalence of smokeless tobacco use and binge drinking. CONCLUSIONS Firefighters in departments selected based on having strong wellness programs (WA) were healthier along a number of dimensions important to firefighter wellness and operational readiness. However, several health areas require greater attention including problematic alcohol consumption and smokeless tobacco use, suggesting that more emphasis on these behavioral health issues is needed in the fire service.
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Affiliation(s)
- Walker SC Poston
- Center for Fire, Rescue and EMS Health Research, Institute for Biobehavioral Health Research, NDRI-MA, NDRI: National Development and Research Institutes, Inc, 1920 West 143rd Street Suite 120, Leawood, KS 66224, USA
| | - Christopher K Haddock
- Center for Fire, Rescue and EMS Health Research, Institute for Biobehavioral Health Research, NDRI-MA, NDRI: National Development and Research Institutes, Inc, 1920 West 143rd Street Suite 120, Leawood, KS 66224, USA
| | - Sara A Jahnke
- Center for Fire, Rescue and EMS Health Research, Institute for Biobehavioral Health Research, NDRI-MA, NDRI: National Development and Research Institutes, Inc, 1920 West 143rd Street Suite 120, Leawood, KS 66224, USA
| | - Nattinee Jitnarin
- Center for Fire, Rescue and EMS Health Research, Institute for Biobehavioral Health Research, NDRI-MA, NDRI: National Development and Research Institutes, Inc, 1920 West 143rd Street Suite 120, Leawood, KS 66224, USA
| | - R Sue Day
- Division of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Houston Health Sciences Center, 1200 Herman Pressler, RAS Building, E1027, Houston TX 77030, USA
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Jitnarin N, Poston WSC, Haddock CK, Jahnke S, Tuley BC. Accuracy of body mass index-defined overweight in fire fighters. Occup Med (Lond) 2012; 63:227-30. [PMID: 23266431 DOI: 10.1093/occmed/kqs213] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Overweight, obesity and weight gain are significant problems in the U.S. fire service. While classification of obesity using body mass index (BMI) has demonstrated accuracy and low rates of false positives when compared with body fat percentage (BF%)-based standards, no studies have examined the accuracy of BMI-based overweight and normal weight status with other comparable body composition indices. AIMS To compare overweight and normal weight BMI categories with BF% standards from the American Council on Exercise and analogous waist circumference (WC) categories and to examine rates and types of misclassification in fire fighters. METHODS Data were collected from 11 randomly selected career fire departments in the International Association of Fire Chief's Missouri Valley Region. Demographics, occupational history, and body composition indices (weight, BF% and WC) were obtained from male career fire fighters who were categorized as normal weight or overweight based on BMI. RESULTS There were 293 participants of whom 92 had normal BMI. There were low rates of false positives (12%) and moderate rates of false negatives (22%) when comparing BMI categories to the compar able BF% categories. However, using WC as the standard resulted in very high rates of false positives (63%) and very low rates of false negatives (5%). CONCLUSIONS BMI-based overweight status was associated with significant errors in classification depending on the standard to which it was compared.
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Affiliation(s)
- N Jitnarin
- Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS 66224, USA.
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