title: A national qualitative study of tobacco use among career firefighters and department health personnel.
abstract: BACKGROUND
  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.
authors.affiliation: Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS 66224, USA. poston@ndri.org
authors.forename: Walker S C
authors.initials: WS
authors.lastname: Poston
authors.forename: C K
authors.initials: CK
authors.lastname: Haddock
authors.forename: Nattinee
authors.initials: N
authors.lastname: Jitnarin
authors.forename: Sara A
authors.initials: SA
authors.lastname: Janhke
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D061388:Firefighters / Q000523:psychology*; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D036301:Qualitative Research; D012907:Smoking / Q000523:psychology; D000074606:Smoking Prevention; D020340:Tobacco Use Cessation / Q000523:psychology; D014030:Tobacco, Smokeless