Evaluation of the Implementation of the NFFF Stress First Aid Intervention in Career Fire Departments: A Cluster Randomized Controlled Trial.

Firefighting is inherently dangerous, though recently concerns have shifted from traditional fireground injuries (burns and asphyxiation) to a focus on mental and behavioral health. Although firefighters are remarkably resilient, research suggests many suffer negative psychological consequences from repeated exposures to trauma. While the Stress First Aid (SFA) model has gained increased attention and adoption among fire departments as a model for behavioral health training, it has not been formally evaluated. This cluster randomized controlled trial used a crossover design comparing the immediate SFA group to delayed SFA control to test the impact of the SFA on firefighters' mental and behavioral health changes after 10-12 months (n = 400; Mage = 37.6, 4.8% women). A convenience sample of 79 firefighters (Mage = 41.4; 8.7% women) provided evaluations on one or more of the training modules. Participants reported satisfaction with all training components (Peer team training 97.6%, Online SFA 94.9%, Curbside Manner 88.4%, After Action Review 89.4%) and reported success in changing personnel's perception of their department's ability to respond to behavioral health issues (SFA M = 3.93, Control 3.50; t = 2.52, p = 0.042). Future work should focus on additional resources and training to augment existing efforts to help departments continue their efforts.

A Single, Multimodal Exercise Tolerance Test Can Assess Combat Readiness in Army-ROTC Cadets: A Brief Report.

The Army Combat Fitness Test (ACFT) is a multi-event assessment battery designed to determine the combat readiness of U.S. Army personnel. However, for Reserve Officers' Training Corps (ROTC) programs the logistical demands of collegiate life make repeated administration of the ACFT challenging. The present study sought to design and evaluate a single, multimodal exercise tolerance test (METT) capable of serving as a time-efficient proxy measure of combat readiness. METHODS: Using a formal instrument design process, we constructed the METT to mimic the demands of the ACFT and assessed its reliability, validity, and responsiveness. RESULTS: The METT demonstrates minimal measurement error (i.e., a 2% coefficient of variation), concurrent validity with the ACFT (R2 = 0.327, F = 10.67, p < 0.001), the ability to classify cadets who may be at-risk for failing the ACFT (X2 = 8.16, p = 0.017, sensitivity = 0.878, specificity = 0.667), and appropriate change following a training intervention (5.69 ± 8.9%). CONCLUSIONS: The METT has the potential to provide a means to monitor progress, identify areas for improvement, and guide informed decision-making regarding individualization of cadet combat training plans.

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.

Obesity prevalence and accuracy of BMI-defined obesity in Russian firefighters.

BACKGROUND: No data exist on obesity or the accuracy of body mass index (BMI) in Russian Federation firefighters. AIMS: To determine the prevalence of obesity and rates of misclassification of BMI-based obesity status. METHODS: Career firefighters in the Moscow region completed anthropometric assessments including height, weight, BMI, body fat per cent (BF%) and waist circumference (WC). Using these three methods, we defined obesity as BMI ≥30, BF% >25 and WC >102, respectively. RESULTS: The study group consisted of 167 male firefighters. Obesity prevalence was 22% for BMI [95% confidence interval (CI) 16.9-28.5], 60% for BF% (95% CI 52.5-67.3) and 28% for WC (95% CI 21.3-34.9). False positive rates for BMI-based obesity status were low, with 3% (95% CI -1.1 to 7.1) and 6% (95% CI 1.6-9.9) of non-obese participants defined by BF% and WC standards misidentified as obese using BMI. However, 65% (95% CI 55.7-77.4) of BF%-defined obese participants and 36% (95% CI 22.5-49.9) of WC-defined obese participants were misclassified as non-obese using BMI (i.e. false negatives). CONCLUSIONS: Rates of BMI-based obesity in Russian male firefighters were similar to that of males in the general Russian adult male population. Compared with BF% or WC standards, BMI-based obesity classi- fication produced low rates of false positives but demonstrated high rates of false negatives.

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.

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.

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.

Military tobacco policies: the good, the bad, and the ugly.

The United States military has the legacy of a pro-tobacco culture and still has prevalence rates of tobacco use that are higher than their civilian counterparts. One tactic for decreasing use and the subsequent health problems is through effective tobacco control policies. We collected available tobacco control policies from all four branches of the military and, through qualitative analysis, identified policies that were unique either as providing more or less detail and restriction than peer group policies. Best and worst practice policies in the areas of enforcement, smoking cessation, smokeless tobacco use, environmental tobacco smoke, framing tobacco as non-normative, designated tobacco use areas, and monitoring of tobacco use are presented. Because policy making can be an effective tool for improving the health of military members, understanding what policy components are comparatively positive or negative is an important tool for health advocates both in the military and civilian settings.

Prevalence of overweight and obesity in Thai population: results of the National Thai Food Consumption Survey.

Overweight and obesity are considered a serious health problem in Thailand. This study examined the prevalence of overweight and obesity in a nationally representative sample of Thai children and adults based on international standards. A cross-sectional population survey of 16,596 Thais aged 3 years and over was conducted. Heights and weights were obtained using standardized methods. Estimates of the overweight and obesity prevalence in children, adolescents, and adults were computed. The prevalence of overweight and obesity among children and adolescents aged 3 to 18 years was 7.6% and 9.0%, respectively, and was higher among boys than girls. Among adults, using the the Regional Office for the Western Pacific (WPRO) standard, 17.1% of adults were classified as overweight [body mass index (BMI) 23.0-24.9 kg/m²], 19.0% as class I obesity (BMI 25.0-29.9 kg/m²), and 4.8% as class II obesity (BMI ≥ 30.0 kg/m²). Using the World Health Organization (WHO) definition, 19.0% were overweight (BMI 25-29.9 kg/m²), 4.0% class I obesity (BMI 30.0-34.9 kg/m²), 0.8% class II obesity (BMI 35.0-39.9 kg/m²), and 0.1% class III obesity (BMI ≥ 40.0 kg/m²). There was a vast difference in obesity prevalence between the WHO and the WPRO criteria. Obesity prevalence when using the WPRO definition (23.8%) was almost five times greater than when defined with the WHO standard (4.9%). The present study found a high prevalence of overweight and obesity in nationally representative sample of the Thai population. Higher rates of overweight and obesity prevalence were computed using the WPRO standard when compared to the WHO standard.

The Census of Social Institutions (CSI): a public health direct observation measure of local land use.

This manuscript describes the development of the Census of Social Institutions (CSI), a reliable direct observation parcel-level built environment measure. The CSI was used to measure all non-residential parcels (n = 10,842) in 21 one-mile-radius neighborhoods centered around census block groups of varying income and ethnicity in a large metropolitan area. One year test-retest and inter-rater intra-class correlations showed high reliability for major use type and detail code observations. The CSI accurately captured the presence of about 9,500 uses, including 828 multiple major use and 431 mixed major use parcels that would have been missed in standard commercial databases. CSI data can be utilized to determine the health impacts of environmental settings.

Effectiveness of Medifast supplements combined with obesity pharmacotherapy: a clinical program evaluation.

PURPOSE: To evaluate the long-term impact of Medifast meal-replacement supplements (MMRS) combined with appetite suppressant medication (ASM) among participants who received 52 weeks of treatment. METHODS: We conducted a systematic program evaluation of weight loss data from a medically-supervised weight control program combining the use of MMRS and ASM. Data were obtained and analyzed from 1,351 patient (BMI> or =25) medical charts who had participated for at least 12 weeks of treatment. Outcomes included weight loss (kg) and percent weight loss from baseline and at 12, 24, and 52 weeks. Both completers and intention-to-treat analyses were conducted. Completers' (i.e., those with complete data for 52 weeks) outcomes were evaluated after stratification for reported adherence to the MMRS and ASM. RESULTS: Participants who completed 52 weeks of treatment experienced substantial weight losses at 12 (-9.4+/-5.7 kg), 24 (-12.0+/-8.1 kg), and 52 weeks (-12.4+/-9.2 kg) and all measures were significantly different from baseline weight (p<0.001 for all contrasts) for both true completers (n=324) and for ITT analysis (n=1,351). Fifty percent of patients remained in the program at 24 weeks and nearly 25% were still participating at one year. CONCLUSIONS: This weight loss program using a combination of MMRS and ASM produced significant and sustained weight losses at 52 weeks. Results were better than those typically reported for obesity pharmacotherapy in both short- and long-term studies and also better than those reported for partial meal replacement programs. Program retention at one year was similar to that reported in many controlled drug trials and better than most commercial programs reported in the literature.

Reported stress and its relationship to tobacco use among U.S. military personnel.

In addition to common stressors, members of the U.S. Armed Forces experience a high level of stress unique to their status as service members. In an effort to combat stress, many military personnel report high levels of nicotine use. This study investigated the relationship between tobacco use and perceived stress among military members in all four armed services. Results indicate that those who use tobacco products specifically to reduce stress report significantly higher stress levels than those who do not use tobacco. Moreover, current users and those who both smoked and used smokeless tobacco were far more likely to report experiencing "a lot" of stress from a variety of sources than former or never users. Tobacco users also engaged more frequently in negative coping behaviors and relied less on the positive coping strategies used more often by former or never smokers. These findings are consistent with the larger body of literature suggesting that tobacco is not only an ineffective stress-reducing strategy, it also likely perpetuates a stress response in users. It is, therefore, critical that the military improve effective means of coping among nicotine-using troops.

Relationship between patterns of alcohol use and negative alcohol-related outcomes among U.S. Air Force recruits.

The negative impact of alcohol use on workplace performance is of significant concern to the U.S. military, given the costs associated with recruiting, hiring, and training personnel. However, little is known about the extent of potential alcohol use problems of recruits. We examined the history of alcohol-related problems among recruits entering the Air Force (N=37858). Although the average age of recruits was <21 years, 78% reported consuming alcohol and 49% reported binging before basic military training. Recruits who drank reported having negative alcohol-related outcomes (NAROs). In fact, >95% reported that they or someone else had been injured as a result of their drinking and that a relative, friend, doctor, or other health care worker has been concerned about their drinking. The remaining NAROs were reported by approximately one-quarter of those who drank. However, recruits who reported binge drinking were substantially more likely to report more NAROs, such as morning drinking, inability to stop drinking, having others be concerned about their drinking, having blackouts, fighting, having injured or been injured, feeling guilty about their drinking, and wanting to reduce the amount they drink. Results suggest that alcohol-related problems are common among recruits before basic military training and screening for future problems may be beneficial.

Cigarette use among two cohorts of U.S. Air Force recruits, compared with secular trends.

This study provides a comparison of cigarette smoking among two cohorts of U.S. Air Force recruits. The first cohort, Air Force 1, entered the military between August 1995 and August 1996. The second cohort, Air Force 2, entered between October 1999 and September 2000. Cigarette use significantly increased among both men (7.0-percentage point increase) and women (7.3-percentage point increase) between the two cohorts. This difference remained statistically significant in models adjusted for demographic differences between the two groups of recruits. Direct standardization methods were then used to compare rates in both Air Force surveys with rates of current smoking reported for a national sample from the Behavioral Risk Factor Surveillance System surveys from the same years. Although the average number of cigarettes smoked and years of smoking decreased between the two cohorts, troops from Air Force 2 reported being less motivated to quit. This study suggests that efforts to reduce smoking among junior enlisted troops in the Air Force should be bolstered.

Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat.

OBJECTIVE: There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counselling intervention alone, in combination with orlistat, and drug-alone in a 12-month randomized-clinical trial at a medical school obesity centre. METHODS: Participants (N = 250) with body mass index (BMI) >or=27 were randomized. Changes in body weight, lipids, blood pressure and serum glucose were examined. Drug adherence and attendance were also evaluated. RESULTS: Completers analysis was conducted on 136 participants with data at baseline, 6 and 12 months and intention-to-treat analyses (ITT) for the total sample. Amongst completers, participants in the drug only (P = 0.012) and drug + brief counselling (P = 0.001) groups lost more weight (mean +/- SD: -3.8 +/- 5.8 kg and -4.8 +/- 4.4 kg, respectively) than participants in the brief counselling only group at 6 months (-1.7 +/- 3.3 kg), but there were no significant group differences at 12 months. ITT model results were similar to completers at 6 months and remained significant at 12 months, but the weight losses were more modest (<3 kg) for both groups receiving orlistat. For brief counselling alone, participants gained weight (1.7 +/- 4.2 kg). Cardiovascular disease (CVD) parameter changes were negligible. CONCLUSIONS: Pharmacotherapy alone or combined with brief counselling resulted in modest weight losses that had minimal impact on cardiovascular parameters, but were greater than brief counselling alone. Whilst brief interventions and primary pharmacotherapy have been suggested as viable treatments for implementation in primary care settings, our study suggests that such minimal interventions provide minimal benefits.

Does metabolic syndrome mitigate weight loss in overweight Mexican American women treated for 1-year with orlistat and lifestyle modification?

AIMS: To investigate the effects of a pharmacotherapy (orlistat) plus lifestyle management (OLM) intervention on weight loss in Mexican American women with and without metabolic syndrome (MS). METHODS: One hundred and seven female participants aged 21-65 years and of Mexican origin were randomized to either OLM or a wait-list control group (WLC) for one year. The lifestyle interventions were tailored to exhibit features of the Mexican culture. Within each group, subjects with MS were compared to those without MS to assess whether its presence mitigates weight loss. Risk factors for MS also were assessed. RESULTS: Participants with MS in the OLM group experienced significant decreases in weight and body mass index (BMI) as compared to participants without MS. Participants with MS in the OLM group and who completed the study lost 9.3+/-7.5 kg (20.5+/-16.5 lb) as compared to participants with MS in the WLC group, who only lost 0.2+/-3.1 kg (0.4+/-6.8 lb). Further, participants with MS in the OLM group who completed the study experienced a 3.1+/-3.9 kg/m2 decrease in BMI whereas participants with MS in the WLC group only experienced a 0.1+/-1.2 kg/m2 decrease in BMI. No changes in other MS risk factors were significant. CONCLUSIONS: Patients with MS experienced significant weight loss and decreases in BMI as a result of a lifestyle and pharmacotherapy intervention.

Tobacco use among medical professionals in Kerala, India: the need for enhanced tobacco cessation and control efforts.

In developing nations where reductions in tobacco use have not been realized, it is critical that health professionals be encouraged to abstain from tobacco use. Data on tobacco use among health professionals in India are limited. We conducted cross-sectional surveys among 110 male medical school faculty (MSF), 229 physicians (67% male), 1130 medical students (46% male), and 73 female nursing students. Information on tobacco use and quit attempts was collected using structured questionnaires. Among the male respondents, current smokers were 15.1% of MSF, 13.1% of physicians, and 14.1% of medical students. Among current smokers, 42% of MSF and physicians and 51% of medical students had not attempted quitting in the last year. However, one third of MSF and physicians and 16% of medical students had attempted to quit at least 4 times. This is one of the first studies among health care professionals in India. Our findings show that a substantial proportion of physicians and medical students in Kerala continue to smoke. Smoking cessation programs are warranted in medical schools in Kerala. An initiative is presently underway by the authors to incorporate tobacco education into the medical school curriculum.