title: Prevalence and Correlates of Late Initiation of Smokeless Tobacco in US Firefighters.
abstract: BACKGROUND
  Prevalence rates of smokeless tobacco (SLT) use and late initiation among firefighters (ie, starting use as an adult after joining the fire service) are remarkably high, 10.5% and 26.0%, respectively. The purpose of this study is to examine characteristics associated with late SLT initiation in a sample comprised of male career firefighters from two large cohort studies.
  
  
  METHODS
  We examined correlates of late SLT initiation in a secondary analysis of data combining the baseline evaluations of two published firefighter health studies with 1474 male career firefighters in the United States.
  
  
  RESULTS
  Fourteen percent of participants were current SLT users. Among this group, the unadjusted rate of firefighters who initiated SLT use after joining the fire service was 15.9%, while the age-standardized rate was 38.2%; this is substantially higher than the national adjusted late initiation rate among adult males (0.8%). In addition, firefighters demonstrated higher rates of late SLT initiation (15.9% unadjusted; 18.4% age-standardized) when compared to males in the military overall (13.8%).
  
  
  CONCLUSIONS
  The exceptionally high prevalence of SLT use overall and late initiation in the fire service suggest that joining the fire service in the United States is a risk factor for SLT use. There is a need to develop interventions aimed at reducing SLT use in the fire service that are specifically tailored for this occupational group.
  
  
  CONCLUSIONS
  The high prevalence of late SLT initiation (ie, starting use as an adult after joining the fire service) among firefighters should be addressed by both researchers and fire service organizations given the significant health risks associated with SLT and its impact on occupational readiness. There is a need for developing intervention programs aimed at reducing SLT use in the fire service. Interventions would need to be specifically tailored for this occupational group and their unique culture, given that joining the fire service appears to be a risk factor for SLT initiation among firefighters who did not use tobacco prior to joining the fire service.
authors.affiliation: Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS.
authors.forename: Nattinee
authors.initials: N
authors.lastname: Jitnarin
authors.affiliation: Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS.
authors.forename: Walker S C
authors.initials: WSC
authors.lastname: Poston
authors.affiliation: Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Haddock
authors.affiliation: Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Jahnke
authors.affiliation: School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Rena S
authors.initials: RS
authors.lastname: Day
authors.affiliation: Oregon Research Institute, Eugene, OR.
authors.forename: Herbert H
authors.initials: HH
authors.lastname: Severson
mesh_terms: D000328:Adult; D003071:Cognition; D015331:Cohort Studies; D061388:Firefighters / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016272:Occupational Health; D015995:Prevalence; D064424:Tobacco Use / Q000453:epidemiology*; D014030:Tobacco, Smokeless; D014481:United States / Q000453:epidemiology