Intra-Tour Variation of Firefighter Sleep Duration and Sleep-Wake Cycle within the 24/48 and 48/96 Shift Schedules.

OBJECTIVE: The purpose of this paper is to investigate intra-tour variation in total sleep time (TST) and sleep-wake cycle among US firefighters working the 24 hours on and 48 hours off shift schedule (24/48) and the 48 hours on and 96 hours off shift schedule (48/96). METHODS: Twenty-four firefighters were recruited for this sleep study and were evaluated over 18 days during a 24/48 shift schedule and again 6 months after firefighters transitioned to a 48/96 shift schedule. The primary outcome variables included TST, measured by actigraphy, and sleep-wake cycle (in-bed time and sleep offset) using the Emergency Services Sleep Diary. RESULTS: Firefighters experienced intra-tour variations in TST and sleep offset. The least TST occurred at home prior to starting shift on the 24/48 and 48/96 schedules (5.80 hours and 5.66 hours, respectively). The second least TST occurred the night preceding shift end (5.84 hours and 5.81 hours, respectively). In contrast to in-bed time, sleep offset varied throughout the schedule and was found to correlate with TST. In addition, shift start/end time appears to be responsible for advanced sleep offset. CONCLUSION: Results indicate that firefighters' sleep is complex and should not be reduced to singular averages. In both schedules, firefighters arrived at work with insufficient sleep, received insufficient sleep while on shift, and would commute home with insufficient sleep. These findings can inform future firefighter sleep research by accounting for intra-tour variations.

Occupationally Tailored, Web-Based, Nutrition and Physical Activity Program for Firefighters: Cluster Randomized Trial and Weight Outcome.

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.

Veterans' views on military tobacco use and tobacco control policy.

National military and veteran service organizations (MVSOs) have the potential to be advocates for stronger military tobacco control. This study consisted of qualitative analysis of interviews with 5 MVSO leaders (or their designees) and 6 focus groups conducted with veterans, to explore the opinions of MVSO leaders and veterans about military tobacco use and tobacco control policy, and to assess their current knowledge, attitudes, and likelihood of engaging with civilian tobacco control. Themes discussed include the impact of tobacco use on the military mission and on veterans; the possibility of stronger military tobacco control policies; and the idea that such policies would affect the rights of military personnel. Participants considered whether tobacco use impacts the military mission in the most literal sense (e.g., giving away patrol locations), ignoring larger scale effects on long term health and costs. While familiar with tobacco's impacts on veterans' health, MVSO leaders did not endorse stronger policies, although some veterans did. Participants were largely unaware of the impact of tobacco use on military readiness. Establishment of better alliances among MVSOs and civilian public health groups for mutual education about tobacco's many negative effects on the military's mission may be necessary to achieve a tobacco-free military.

Current Female Firefighters' Perceptions, Attitudes, and Experiences with Injury.

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.

Weight loss advice and prospective weight change among overweight firefighters.

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.

Weight Advice Associated With Male Firefighter Weight Perception and Behavior.

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.

A slow neutron polarimeter for the measurement of parity-odd neutron rotary power.

We present the design, description, calibration procedure, and an analysis of systematic effects for an apparatus designed to measure the rotation of the plane of polarization of a transversely polarized slow neutron beam as it passes through unpolarized matter. This device is the neutron optical equivalent of a crossed polarizer/analyzer pair familiar from light optics. This apparatus has been used to search for parity violation in the interaction of polarized slow neutrons in matter. Given the brightness of existing slow neutron sources, this apparatus is capable of measuring a neutron rotary power of dϕ/dz = 1 × 10(-7) rad/m.

Accuracy of self-reported weight, height and BMI in US firefighters.

BACKGROUND: Obesity is of increasing concern especially among firefighters. Bias in self-reported body weight, height and body mass index (BMI) has received a great deal of attention given its importance in epidemiological field research on obesity. AIMS: To determine the validity of self-reported weight, height and BMI and identify potential sources of bias in a national sample of US firefighters. METHODS: Self-reported and measured weight and height (and BMI derived from them) were assessed in a national sample of 1001 career male firefighters in the USA and errors in self-reported data were determined. RESULTS: There were 1001 participants. Self-reported weight, height and BMI were significantly correlated with their respective measured counterparts, i.e. measured weight (r = 0.990; P < 0.001), height (r = 0.961; P < 0.001) and BMI (r = 0.976; P < 0.001). The overall mean difference and standard deviation between self-reported weight, height and BMI were 1.3±2.0kg, 0.94±1.9cm and 0.09±0.9kg/m(2), respectively, for male firefighters. BMI-based weight status (P < 0.001) was the most consistent factor associated with bias in self-reported BMI, weight and height, with heavier firefighters more likely to underestimate their weight and overestimate their height, resulting in underestimated BMIs. Therefore, using self-reported BMI would have resulted in overestimating the prevalence of obesity (BMI ≥ 30.0) by 1.8%, but underestimating the prevalence of more serious levels of obesity (Class II and III) by 1.2%. CONCLUSIONS: Self-reported weight and height (and the resulting BMI) were highly correlated with measured values. A primary and consistent source of error in self-reported weight, height and BMI based on those indices was BMI-based weight status.

Findings from an online behavioural weight management programme provided with or without a fortified diet beverage.

The present multi-centre randomised weight-loss trial evaluated the efficacy of a low-intensity 12-week online behavioural modification programme, with or without a fortified diet beverage using a 2 × 2 factorial design. A total of 572 participants were randomised to: (1) an online basic lifestyle information (OBLI) intervention, consisting of one online informational class about tips for weight management; (2) an online behavioural weight management (OBWM) intervention, entailing 12 weekly online classes focused on weight-loss behaviour modification; (3) an OBLI intervention plus a fortified diet cola beverage (BEV) containing green tea extract (total catechin 167 mg), soluble fibre dextrin (10 g) and caffeine (100 mg) (OBLI+BEV); (4) OBWM+BEV. Assessments included height, weight, dual-energy X-ray absorptiometry-derived body composition, and waist circumference (WC). Attrition was 15·7 %. Intention-to-treat (ITT) models demonstrated a main effect for type of Internet programme, with those assigned to the OBWM condition losing significantly more weight (F= 7·174; P= 0·008) and fat mass (F= 4·491; P= 0·035) than those assigned to the OBLI condition. However, there was no significant main effect for the OBWM condition on body fat percentage (F= 2·906; P= 0·089) or WC (F= 3·351; P= 0·068), and no significant main effect for beverage use or significant interactions between factors in ITT models. A 12-week, low-intensity behaviourally based online programme produced a greater weight loss than a basic information website. The addition of a fortified diet beverage had no additional impact.

Excessive daytime sleepiness in firefighters in the central United States.

OBJECTIVE: To determine the prevalence and severity of excessive daytime sleepiness (EDS) in a population-based sample of firefighters. METHODS: Sleepiness was assessed using the Epworth Sleepiness Scale in a sample of male career firefighters (n = 458) from 11 randomly selected fire departments in the Midwestern United States. RESULTS: Unadjusted EDS rates (13.7% and 14.0% for on- and off-duty, respectively) were similar to the general US population and comparable occupational groups. Factors associated with EDS included 48-hour work shifts, non-private department sleep areas, and working a second job outside the fire service (P < 0.05). CONCLUSION: Given firefighters' important role in public safety, concerns have been raised about whether firefighters' work schedules result in high rates of excessive sleepiness. Nevertheless, firefighters in this study did not have high rates of EDS despite their extended work schedule.

Obesity and incident injury among career firefighters in the central United States.

OBJECTIVE: Firefighting is a dangerous profession with high injury rates, particularly musculoskeletal (MS), but limited longitudinal data is available to examine predictors of MS injuries in this population. DESIGN AND METHODS: The relationship between personal individual, nonoccupational factors (e.g., demographic characteristics, body composition, fitness, and health behaviors) and incident injury and incident MS injury in a prospective cohort of 347 firefighters from the central United States was examined. RESULTS: Baseline weight status was a significant predictor of incident MS injury, with obese (BMI ≥ 30 kg m(-2)) firefighters 5.2 times more likely (95% CI = 1.1-23.4) to experience a MS injury than their normal weight (BMI = 18.5-24.9 kg m(-2)) colleagues over the course of the study. Similarly, firefighters who were obese based on WC (>102.0 cm) were almost three times as likely (OR = 2.8, 95% CI = 1.2-6.4) to have a MS injury at follow-up. CONCLUSIONS: Findings highlight the importance of focusing on firefighters' body composition, nutrition and fitness as a means of decreasing risk for injury.

Accuracy of body mass index-defined overweight in fire fighters.

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.

Health concerns of the U.S. fire service: perspectives from the firehouse.

PURPOSE: Firefighters are expected to respond to any domestic emergency at a moment's notice, and therefore their health and readiness are key to the public safety net. Although emerging research is focusing on understanding firefighters' increased risk for disease and injury, the perspectives of fire service personnel is lacking. DESIGN: This study uses the cross-sectional qualitative data collection techniques of key informant interviews and focus groups. SETTING: Data collection occurred with a national sample of firefighters from 28 (municipal and federal) career fire departments. PARTICIPANTS: Participants were 332 career firefighters (57.2%), company officers (23.4%), fire chiefs (15.4%), and other fire service personnel (3.9%). METHOD: Focus groups and informant interviews were conducted with firefighters, fire chiefs, health promotion personnel, and medical directors to assess attitudes, opinions, and perceptions about firefighter health. RESULTS: Major themes that developed among fire service personnel included concerns about cancer, risk of cardiovascular disease, the importance of and barriers to physical fitness, the food culture of the firehouse, psychological stress resulting from repeated exposure to trauma, sleep disruptions, injuries, and risk for infectious disease. Health concerns identified by firefighters are juxtaposed with current efforts and trends within the national fire service. CONCLUSIONS: The health concerns of firefighters parallel both available epidemiological research and the health priorities of national fire service organizations. Unfortunately, these concerns often are in contrast with efforts by local governments to limit their financial liability for illnesses presumed to be caused by occupational exposures and long-held traditions in the fire service. This study highlights the need for epidemiological surveillance of firefighters and innovative health and organizational policy in the fire service. Future directions for the fire service, the public health community, and researchers are discussed.

The health of women in the US fire service.

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.

Alcohol use among firefighters in the Central United States.

BACKGROUND: Although the US National Fire Service is concerned about alcohol use among firefighters, little research has been conducted on the topic. AIMS: To survey alcohol use patterns among career and volunteer firefighters. METHODS: Data were from a population-based cohort study of male firefighters conducted in randomly selected career and volunteer departments. Data were collected from 2008 to 2010. RESULTS: There were 656 participants from 11 career and volunteer 13 departments included in the study with a response rate of 97%. Career firefighters drank approximately 10 days per month (just about half of their off duty days) and drank relatively heavily on those days. Fifty-eight per cent of career and 40% of volunteer firefighters averaged three or more drinks and similar percentages reported binge drinking on the days they consumed alcohol. In general, firefighters who drank but did not binge drink tended to have the best health outcomes, while those who binge drank typically were at highest risk of negative health outcomes. Nine per cent of career and 10% of volunteer firefighters who drank self-reported driving while intoxicated in the previous 30 days. CONCLUSIONS: Given the high rates of heavy and binge drinking, local and nationally coordinated efforts to increase the surveillance of drinking behaviour among firefighters and the development of targeted prevention interventions are critically needed.

The impact of surveillance on weight change and predictors of change in a population-based firefighter cohort.

OBJECTIVE: To document weight changes in a population-based cohort of male career firefighters and evaluate the impact of health surveillance on subsequent participant behavior and body composition. METHODS: Body mass index, waist circumference, and body fat percentage were assessed longitudinally in 311 male firefighters. RESULTS: Firefighters who reported making no changes after the baseline assessment (42.1%) experienced a 0.64 ± 3.1 kg average weight gain, whereas firefighters who reported making one or more health behavior change (ie, changing their diet, increasing their physical activity, or both; 52.1%) lost an average of -1.3 kg. CONCLUSIONS: Regular health surveillance may motivate some firefighters to make health behavior changes. Although it is not currently the norm, fire departments should provide firefighters with annual health assessments including body composition and fitness measures, consistent with those recommended by the fire service's Wellness and Fitness Initiative.

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

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

Obesity and injury-related absenteeism in a population-based firefighter cohort.

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.

Tobacco use among firefighters in the central United States.

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 Smoking 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.

The prevalence of overweight, obesity, and substandard fitness in a population-based firefighter cohort.

OBJECTIVE: To examine the prevalence of overweight and obesity in firefighters. METHODS: Body mass index (BMI), waist circumference, and body fat percentage (BF%) were assessed in 478 career and 199 volunteer male firefighters from randomly selected departments. RESULTS: High prevalence rates of overweight + obesity (BMI ≥ 25 kg/m) and obesity (BMI ≥ 30 kg/m) were found in career (79.5%; 33.5%) and volunteer firefighters (78.4%; 43.2%). False-positive obesity misclassification based on BMI, compared to waist circumference and BF%, was low (9.8% and 2.9%, respectively). False negatives were much higher: 32.9% and 13.0%. Obese firefighters demonstrated unfavorable cardiovascular disease (CVD) profiles. CONCLUSIONS: The prevalence of overweight and obesity exceeded that of the US general population. Contrary to common wisdom, obesity was even more prevalent when assessed by BF% than by BMI, and misclassifying muscular firefighters as obese by using BMI occurred infrequently.