A Qualitative Study Exploring Barriers to Colorectal Cancer Screening Among Firefighters.

OBJECTIVE: Firefighters are at increased risk of colorectal cancer (CRC), yet rates of CRC screening are low among this occupational group. This study examines perceived risks, barriers, and facilitators to CRC screening. METHODS: Three semistructured focus group discussions were conducted by investigators in Tucson, AZ. Thematic analysis was used to identify patterns and themes in the data. RESULTS: Three groups of firefighters (8 male (57%); 6 female (43%) mean age 50.4 ( SD = 12.2) years) voluntarily participated in the CRC discussions. Four major themes were examined: (1) perceptions of risk for CRC, (2) barriers to cancer screening, (3) facilitators to getting cancer screening, and (4) misinformation about CRC and screening. CONCLUSIONS: Findings indicate unique perceptions, attitudes, and beliefs among firefighters. Results from this study will inform the adaptation of a tailored CRC screening intervention for firefighters.

Cardiometabolic health among United States firefighters by age.

Firefighting is strenuous work that results in considerable cardiovascular strain. Sudden cardiac events are the leading cause of duty-related death in the fire service. This cross-sectional study examined cardiometabolic measures and prevalence of risk factors in firefighters by age and sex and compare these data to the general population. Data obtained at medical exams (2015-2018) from 4279 male and 234 female career firefighters at four occupational health clinics in the United States were analyzed. Estimates for the general population were obtained using the 2015-16 National Health and Nutrition Examination Survey fasting subsample. Linear regression models stratified by sex with age modelled as a continuous variable were used to examine general trends. Point estimates across age groups (20-29, 30-39, 40-49, and 50-59 year olds) for cardiometabolic measures were reported. Among the total sample, 36% were obese and 25% had low HDL cholesterol. Females had significantly lower body mass index (BMI), LDL cholesterol, triglycerides and blood glucose than males. A significant quadratic relationship of age with BMI, total cholesterol, LDL cholesterol, and triglycerides was found in males with increasing values peaking between 45 and 50 years. Total cholesterol and LDL cholesterol increased with age among females. Blood glucose increased with age in both sexes. Firefighters had similar or better cardiometabolic health profiles than the US general population; however, both samples had a concerning prevalence of cardiometabolic risk factors among individuals ≥ 40 years of age. Health professionals and fire service members alike should consider prevention efforts among young firefighters and better treatment among older firefighters.

Cardiovascular Disease Risk Factors by BMI and Age in United States Firefighters.

OBJECTIVE: This study examined cardiovascular disease risk factors by BMI category in firefighters, the association of BMI and age with risk factor prevalence, and the prevalence of risk factors by BMI category within age groups. METHODS: Cardiovascular measures from the medical evaluations of 4,453 firefighters, performed between 2015 and 2018 at four occupational health clinics in the United States (South-West Cohort, Mid-Atlantic Cohort, South-East Cohort, and Mid-West Cohort), were analyzed cross-sectionally by BMI and age categories. RESULTS: Among female firefighters with normal weight, 25% had high blood pressure, 8% had low high-density lipoprotein cholesterol, and 0% had high glucose, whereas the prevalence in female firefighters with obesity was 57%, 45%, and 11%, respectively. Among male firefighters, there were independent and significant associations of BMI and age for the prevalence of high blood pressure, high cholesterol, high triglycerides, and high glucose. Higher BMI category was associated with a higher prevalence of high blood pressure, high triglycerides, and low high-density lipoprotein cholesterol within all age groups and with a higher prevalence of high glucose and high cholesterol within ages 40 to 49 and 50 to 59 years. CONCLUSIONS: An increasing prevalence of risk factors with older age and higher BMI suggests that preventive strategies should be initiated in younger firefighters and aggressively promoted or mandated throughout firefighters' careers.

Hypertension in the United States Fire Service.

Hypertension is a major risk factor for atherosclerotic cardiovascular disease and cardiac remodeling and is associated with an increased risk of sudden cardiac events, the leading cause of duty-related death in the fire service. We assessed systemic blood pressures and prevalence of hypertension among US firefighters by decade of life. Medical records of career firefighters (5063 males and 274 females) from four geographically diverse occupational health clinics were assessed. Hypertension was defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg, or taking antihypertensive medication. Results from the firefighter sample were compared to the US general population (2015-2016 and 2017-2018 National Health and Nutrition Examination Surveys). Among the total sample, 69% of firefighters met the criteria for hypertension and 17% were taking antihypertensive medications. Percentages of hypertensive male and female firefighters were 45% and 11% among 20-29 years old, respectively, and increased to 78% and 79% among 50-59 years old, respectively. Compared to the general population, male firefighters had a higher prevalence of hypertension (p < 0.05) across all age groups (11-16% higher). In order to improve firefighter health and protect against sudden incapacitation in this public safety occupational group, increased efforts are necessary to screen for and manage high blood pressure.

Barriers to Weight Management Among Overweight and Obese Firefighters.

OBJECTIVE: To examine barriers to weight management among firefighters. METHODS: Health risk data collected on 2373 overweight firefighters were used for this cross-sectional study. Barriers to weight management were the dependent variables and demographic characteristics, readiness for change, and health risk factors were the correlates in the multivariate-adjusted logistic models. RESULTS: Overweight firefighters who were ready to begin a weight management program were more likely to identify "lack of knowledge about weight management," "lack of access to exercise opportunities," and "eating helps me cope with stress" and report a greater number of barriers toward weight management. Older firefighters were less likely to identify or report one or more barriers to weight management. CONCLUSION: Understanding barriers, readiness for change, and age may be useful in planning interventions to help firefighters better manage their weight.

Excess mortality among Indiana firefighters, 1985-2013.

BACKGROUND: Firefighters are exposed to toxic agents increasing their risk for cancer and cardiovascular disease. We examined the odds of cancer and cardiovascular mortality of firefighters relative to a matched group of non-firefighters from the general population. METHODS: Firefighter death records were matched to four non-firefighter death records on age at time of death, sex, race, ethnicity, and year of death. Exact odds ratios, 95% confidence intervals, and P-values were calculated using conditional logistic regression to compare groups. RESULTS: The odds of death due to malignant cancers was significantly higher for firefighters than non-firefighters (OR: 1.19; 95%CI 1.08, 1.30). There was no difference in the odds of death for cardiovascular diseases, including ischemic heart disease, between the two groups. CONCLUSIONS: The study suggests the importance of early and effective cancer prevention strategies among firefighters including worksite health promotion programs and incumbent physical activity evaluation.