title: An examination of the benefits of health promotion programs for the national fire service.
abstract: 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 VO2max (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.
authors.affiliation: 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. carlosposton@hopehri.com.
authors.forename: Walker S C
authors.initials: WS
authors.lastname: Poston
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Haddock
authors.forename: Sara A
authors.initials: SA
authors.lastname: Jahnke
authors.forename: Nattinee
authors.initials: N
authors.lastname: Jitnarin
authors.forename: R Sue
authors.initials: RS
authors.lastname: Day
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control; D001008:Anxiety Disorders / Q000517:prevention & control; D003430:Cross-Sectional Studies; D015444:Exercise; D061388:Firefighters; D015438:Health Behavior; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D009784:Occupational Diseases / Q000517:prevention & control*; D016272:Occupational Health; D009786:Occupational Health Services / Q000458:organization & administration; D010809:Physical Fitness / Q000502:physiology; D016730:Program Development; D015397:Program Evaluation; D000074606:Smoking Prevention; D014481:United States; D055815:Young Adult