An examination of the benefits of health promotion programs for the national fire service

BMC Public Health

R Sue Day¹  Nattinee Jitnarin²  Sara A Jahnke²  Christopher K Haddock²  Walker SC Poston² 

[1]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

[2]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

关键词: Fitness;    Obesity;    Firefighter;    Health promotion;   

Others  :  1161844
DOI  :  10.1186/1471-2458-13-805

 received in 2013-04-24, accepted in 2013-08-30,  发布年份 2013

【 摘 要 】

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 VO_2max (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.

【 授权许可】

   
2013 Poston et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Soteriades ES, Smith DL, Tsesmenakis MA, Baur DM, Kales SN: Cardiovascular disease in US firefighters. A systematic review. Cardiol Rev 2011, 19:202-215.
• [2]Kales SN, Polyhronopoulos GN, Aldrich JM, Leitao EO, Christiani DC: Correlates of body mass index in hazardous materials firefighters. J Occup Environ Med 1999, 41:589-595.
• [3]Poston WSC, Haddock CK, Jahnke SA, Jitnarin N, Tuley BC, Kales SN: The prevalence of overweight, obesity, and substandard fitness in a population-based firefighter cohort. J Occup Environ Med 2011, 53:266-273.
• [4]Flegal KM, Carroll MD, Odgen CL, Curtin LR: Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010, 303:235-241.
• [5]Jitnarin N, Poston WSC, Haddock CK, Jahnke SA, Tuley BC: Accuracy of BMI-defined overweight and normal weight categories in firefighters. Occup Med (Lond) 2013, 63:227-230.
• [6]Soteriades ES, Hauser R, Kawachi I, Liarokapis D, Christiani DC, Kales SN: Obesity and cardiovascular disease risk factors in firefighters: A prospective cohort study. Obes Res 2005, 13:1756-1763.
• [7]Poston WSC, Jitnarin N, Haddock CK, Jahnke SA, Tuley BC: The impact of surveillance on weight change and predictors of change in a population-based firefighter cohort. J Occup Environ Med 2012, 54:961-968.
• [8]Elliot DL, Goldberg L, Kuehl KS, Moe EL, Breger RKR, Pickering MA: The PHLAME (Promoting healthy lifestyles: alternative models’ effects) firefighter study: Outcomes of two models of behavior change. J Occup Environ Med 2007, 49:204-213.
• [9]Soteriades ES, Hauser R, Kawachi I, Christiani DC, Kales SN: Obesity and risk of job disability in male firefighters. Occup Med (Lond) 2008, 58:245-250.
• [10]Poston WSC, Jitnarin N, Haddock CK, Jahnke SA, Tuley BC: Obesity and injury-related absenteeism in a population-based firefighter cohort. Obesity 2011, 19:2076-2081.
• [11]Donovan R, Nelson T, Peel J, Lipsey T, Voyles W, Israel RG: Cardiorespiratory fitness and the metabolic syndrome in firefighters. Occup Med (Lond) 2009, 59:487-492.
• [12]Durand G, Tsismenakis AJ, Jahnke SA, Baur DM, Christophi CA, Kales SN: Firefighters’ physical activity: Relation to fitness and cardiovascular disease risk. Med Sci Sports Exerc 2011, 43:1752-1759.
• [13]Walton SM, Conrad KM, Furner SE, Samo DG: Cause, type, and workers’ compensation costs of injury to fire fighters. Am J Industrial Med 2003, 43:454-458.
• [14]Poplin GS, Harris RB, Pollack KM, Peate WF, Burgess JL: Beyond the fireground: Injuries in the fire service. Inj Prev 2012, 18:228-233.
• [15]Jahnke SA, Poston WSC, Haddock CK, Jitnarin N: Injury among a population based sample of career firefighters in the central United States. Inj Prev 2013. 10.1136/injuryprev-2012-040662
• [16]Jahnke SA, Poston WSC, Haddock CK, Jitnarin N: Obesity and incident injury among career firefighters in the central United States. Obesity 2013. 10.1002/oby.20436
• [17]Clark S, Rene A, Theurer WM, Marshall M: Association of body mass index and health status in firefighters. J Occup Environ Med 2002, 44:940-946.
• [18]Centers for Disease Control and Prevention (CDC): Fatalities among volunteer and career firefighters – United States, 1994–2004. MMWR 2006, 55:453-455.
• [19]Kales SN, Tsismenakis AJ, Zhang C, Soteriades ES: Blood pressure in firefighters, police officers, and other emergency workers. Am J Hypertens 2009, 22:11-20.
• [20]Fahs CA, Smith DL, Horn GP, Agiovlasitis S, Rossow LM, Echols G, Heffernan KS, Fernhall B: Impact of excess body weight on arterial structure, function, and blood pressure in firefighters. Am J Cardiol 2009, 104:1441-1445.
• [21]Geibe JR, Holder J, Peeples L, Kinney AM, Burress JW, Kales SN: Predictors of on-duty coronary events in male firefighters in the United States. Am J Cardiol 2008, 101:585-589.
• [22]Haddock CK, Jitnarin N, Poston WSC, Tuley BC, Jahnke SA: Tobacco use among firefighters in the central United States. Am J Ind Med 2011, 54:697-706.
• [23]Jitnarin N, Haddock CK, Poston WSC, Jahnke S: Smokeless tobacco and dual use among firefighters in the Central United States. J Environ Public Health 2013. doi:10.1155/2013/675426.
• [24]Haddock CK, Jahnke SA, Poston WS, Jitnarin N, Kaipust CM, Tuley B, Hyder ML: Alcohol use among firefighters in the central United States. Occup Med (Lond) 2012, 62:661-664.
• [25]International Association of Fire Fighters (IAFF), International Association of Fire Chiefs (IAFC): The fire service joint labor management wellness-fitness initiative. 3rd edition. Washington, DC: International Association of Fire Fighters; 2008.
• [26]Kuehl KS, Elliot DL, Goldberg L, Moe EL, Perrier E, Smith J: Economic benefit of the PHLAME wellness program on firefighter injury. Occup Med (Lond) 2013, 63:203-209.
• [27]Leffer M, Grizzell T: Implementation of a physician-organized wellness regime (POWR) enforcing the 2007 NFPA standard 1582: injury rate reduction and associated cost savings. J Occup Environ Med 2010, 52:336-339.
• [28]Winick C, Rothacker DQ, Norman RL: Four worksite weight loss programs with high-stress occupations using a meal replacement product. Occup Med (Lond) 2002, 52:25-30.
• [29]Carey MG, Al-Zaiti SS, Liao LM, Martin HN, Butler RA: A low-glycemic nutritional fitness program to reverse metabolic syndrome in professional firefighters. Results of a pilot study. J Cardiovascular Nurs 2011, 26:298-304.
• [30]Shadish WR, Cook TD, Campbell DT: Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston, MA: Houghton-Mifflin; 2002.
• [31]National Fire Protection Association: NFPA 1582, Standards on comprehensive occupational medicine programs for fire departments. Quincy, MA: NFPA; 2006.
• [32]Rubiano F, Nunez C, Heymsfield SB: A comparison of body composition techniques. Ann NY Acad Sci 2000, 904:335-338.
• [33]NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults (US): Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda, MD: National Heart, Lung, and Blood Institute; 1998.
• [34]Chang VW, Christakis NA: Self-perception of weight appropriateness in the United States. Am J Prev Med 2003, 24:332-339.
• [35]Jackson A, Ross RM: Understanding exercise for health and fitness. 3rd edition. Dubuque, IA: Kendall/Hunt; 1997.
• [36]Jackson AS, Blair SN, Mahar MT, Wier L, Ross RM, Stuteville JE: Prediction of functional aerobic capacity without exercise testing. Med Sci Sports Exerc 1990, 22:863-870.
• [37]Jackson AS, Beard EF, Wier LT, Ross RM, Stuteville JE, Blair SN: Changes in aerobic power of men ages 25–70 yr. Med Sci Sports Exerc 1995, 27:113-120.
• [38]Jackson AS, Wier LT, Ayers GW, Beard EF, Stuteville JE, Blaire SN: Changes in aerobic power of women, ages 20–64 yr. Med Sci Sports Exerc 1996, 28:884-891.
• [39]Jurca R, Jackson AS, LaMonte MJ, Morrow JR Jr, Blair SN, Wareham NJ, Haskell WL, van Mechelen W, Church TS, Jakicic JM, Laukkanen R: Assessing cardiorespiratory fitness without performing exercise testing. Am J Prev Med 2005, 29:185-193.
• [40]Wier LT, Jackson AS, Ayers GW, Arenare B: Nonexercise models for estimating VO2max with waist girth, percent fat, or BMI. Med Sci Sports Exerc 2006, 38:555-561.
• [41]Haddock CK, Poston WSC, Pyle SA, Klesges RC, Vander Weg MW, Peterson A, Debon M: The validity of self-rated health as a measure of health status among young military personnel: Evidence from a cross-sectional survey. Health Qual Life Outcomes 2006, 4:57.
• [42]NIH/NHLBI: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). 2004. Available at: http://www.nhlbi.nih.gov/guidelines/hypertension/ webcite. Accessed January 10, 2013
• [43]Centers for Disease Control and Prevention (CDC): Behavioral Risk Factor Surveillance System Questionnaire (2010). 2010. http://www.cdc.gov/brfss/questionnaires/pdf-ques/2010brfss.pdf webcite
• [44]National Institutes of Standards and Technology (NIST): The Economic Consequences of Firefighter Injuries and Their Prevention. Final report (NIST GCR 05–874). Gaithersberg, MD: US Department of Commerce and National Institute of Standards and Technology; 2005.
• [45]Irwin M, Artin KH, Oxman MN: Screening for depression in the older adult: criterion validity of the 10-item center for epidemiological studies depression scale (CES-D). Arch Intern Med 1999, 159:1701-1704.
• [46]Stein RJ, Pyle SA, Haddock CK, Poston WSC, Bray R, Williams J: Reported stress and its relationship to tobacco use among U.S. military personnel. Mil Med 2008, 173:271-277.
• [47]Alfonso VC: Measures of quality of life, subjective well-being, and satisfaction with life. In Handbook of Assessment Methods for Eating Behaviors and Weight-Related Problems: Measures, Theory, Research. Edited by Allison DB. Thousand Oak, CA: SAGE Publications; 1995:23-80.
• [48]Hulett DM, Bendick M, Thomas SY, Moccio F: A National Report Card on Women in Firefighting. Madison, WI: International Association of Women in Fire & Emergency Services; 2008.
• [49]IAFC. (2012): Metropolitan Chiefs Association of the International Association of Fire Chiefs and The National Fire Protection Association Bylaws. Fairfax, VA; 2012. http://www.nfpa.org/assets/files/PDF/Member%20Sections/Metrobylaws.pdf webcite
• [50]Jahnke SA, Poston WSC, Jitnarin N, Haddock CK: Health concerns of the U.S. fire service: perspectives from the firehouse. Am J Health Promotion 2012, 27:111-118.
• [51]Poston WSC, Haddock CK, Jitnarin N, Jahnke SA: A national qualitative study of tobacco use among career firefighters. Nicotine Tob Res 2012, 14:734-741.
• [52]Bender R, Grouven U: Ordinal logistic regression in medical research. J R Coll Physicians Lond 1997, 31:546-551.
• [53]Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, Franch HA, Jacobs DR Jr, Kraus WE, Kris-Etherton PM, Krummel DA, Popkin BM, Whitsel LP, Zakai NA: Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American heart association. Circulation 2012, 126:1514-1563.
• [54]Osilla KC, Van Busum K, Schnyer C, Larkin JW, Eibner C, Mattke S: Systematic review of the impact of worksite wellness programs. Am J Manag Care 2012, 18:e68-e81.
• [55]Conn VS, Hafdahl AR, Cooper PS, Brown LM, Lusk SL: Meta-analysis of workplace physical activity interventions. Am J Prev Med 2009, 37:330-339.
• [56]Kay BF, Lund MM, Taylor PN, Herbold NH: Assessment of firefighters’ cardiovascular disease-related knowledge and behaviors. J Am Diet Assoc 2001, 100:807-809.
• [57]Baur DM, Christophi CA, Tsismenakis AJ, Jahnke SA, Kales SN: Weight-perception in male career firefighters and its association with cardiovascular risk factors. BMC Publ Health 2012, 12:480.
• [58]Moore-Merrell L, Zhou A: McDonald-Valentine S, Goldstein R, Slocum C: Contributing factors to firefighter line-of-duty injury in metropolitan fire departments in the United States. Washington, DC: International Association of Firefighters; 2008.
• [59]Moylan S, Jacka FN, Pasco JA, Berk M: Cigarette smoking, nicotine dependence, and anxiety disorders: A systematic review of population-based, epidemiological studies. BMC Med 2012, 10:123.
• [60]Petry NM, Barry D, Pietrzak RH, Wagner JA: Overweight and obesity are associated with psychiatric disorders: Results from the national epidemiologic survey of alcohol and related conditions. Psychosomatic Med 2008, 70:288-297.
• [61]Strine TW, Mokdad AH, Dube SR, Balluz SL, Gonzalez O, Berry JT, Manderscheid R, Kroenke K: The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry 2008, 30:127-137.
• [62]Dietz NA, Lee DJ, Fleming LE, Leblanc WG, McCollister KE, Arheart KL, Davila EP, Caban-Martinez AJ: Trends in smokeless tobacco use in the US workforce: 1987–2005. Tob Induc Dis 2011, 9:6.
• [63]Carey MG, Al-Zaiti SS, Dean GE, Sessannna L, Finnell DS: Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters. J Occup Environ Med 2011, 53:928-933.
• [64]Centers for Disease Control and Prevention (CDC): Vital signs: Binge drinking prevalence, frequency, and intensity among adults – United States, 2010. MMWR 2012, 61:14-19.
• [65]International Association of Fire Chiefs (IAFC): Policy Statement: Zero Tolerance for Alcohol and Drinking in the Fire and Emergency Services. Fairfax, VA: IAFC; 2003.
• [66]Carnethon M, Whitsel LP, Franklin BA, Kris-Etherton P, Milani R, Pratt CA, Wagner GR: Worksite wellness programs for cardiovascular disease prevention: A policy statement from the American heart association. Circulation 2009, 120:1725-1741.
• [67]Finkelstein EA, DiBonaventura MD, Burgess SM, Hale BC: The costs of obesity in the workplace. J Occup Environ Med 2010, 52:971-976.