Occupational and Health Behavioral Causes of Obesity in Firefighters: A Qualitative Study

Details

• Personal Author:
  Baker, Dean B. ; Choi B ; Dobson M ; Garcia J ; Israel L ; Schnall P ; Wigger E
• Description:
  Background: Obesity is a national health crisis in the United States (U.S.) [1] and is a significant risk factor for first responders such as firefighters where sudden cardiac death is consistently the number one cause of line-of-duty deaths [2-4]. Firefighters rank third in obesity prevalence among 41 U.S. male occupations [5, 6]. A handful of studies have examined firefighter health behaviors related to obesity [7-11]. Missing from these studies, however, is a growing research literature which shows a relationship between obesity and working conditions including sedentary work [12-14], shift work [15-17], long work hours [18, 19], and psychosocial stressors [12, 20-24]. The FORWARD study (Firefighter Obesity Research: Workplace Assessment to Reduce Disease) is guided by a theoretical model that links adverse working conditions to obesity in firefighters both directly and indirectly through health behaviors [6]. This presentation highlights findings from qualitative research with firefighters in the ongoing FORWARD study.* Methods: Qualitative research methods provide rich, descriptive data and tend to ask "what" or "why" questions whereas quantitative methods ask questions related to "how often" or "how many." Qualitative research is being used increasingly in occupational health and is often part of participatory research approaches [25-31]. The FORWARD project incorporated a mixed-methods approach including qualitative methods in conjunction with a cross-sectional epidemiological survey and field study. The qualitative methods included 1) focus group discussions of firefighter perspectives on causes of obesity within the fire service (Phase I), 2) focus group workshops to develop a firefighter-specific work and health questionnaire (Phase I), 3) open-ended questions within the survey about firefighter working conditions (Phase II), 4) after completion of the survey (in November 2012) focus groups will be reconvened and study results will be presented for dialogue with firefighters and their organizations over the design and implementation of future programs for reducing obesity (Phase III). The fire authority in this study includes 62 fire stations covering 22 cities and unincorporated parts of a diverse, suburban county in Southern California. Structural fires are rare; 1.6% of calls in 2010. Firefighters work a required ten or eleven 24 hour shifts but most work an additional 2 to 3 shifts per month. We conducted four focus groups (90-120 minutes) in Jan-Feb 2011(Phase I) with 20 firefighters of every rank. Focus group discussions were transcribed and analyzed for common "themes" using grounded theory methodology. During focus group workshops, firefighters also reviewed 13 psychosocial work stressor domains and their items in terms of relevance to their work experiences, clarity of wording, and missing domains or items. In Phase II, we also analyzed, using Nvivo, open-ended questions from the survey (n=279) about the "best" and "most difficult" aspects of the firefighter's job. Analyses and results: Analysis of the discussion with firefighters about causes of obesity revealed five main "themes" of central importance to firefighters: 1) the culture of eating in the fire station, 2) sleep interruption, 3) leadership and physical fitness, 4) sedentary work, and 5) aging and generational differences. These will be discussed using representative quotes. The workshops to refine a firefighter-specific work and health questionnaire revealed that the most relevant psychosocial work stressor domains to firefighters (out of 13) were: workload (e.g., # of shifts), job demands, quality of leadership, sleep problems, and eating culture at work and two domains appeared to be least relevant: reward and discrimination/harassment. Focus group members and subsequent field testing of the survey led to the addition of several questions about eating behaviors at work (e.g. family style vs. eating out) and alternative wording for items that were unclear (e.g., substitute "company" for "group"). Preliminary findings from the survey open-ended questions revealed that most firefighters stated the best parts of their jobs were the social support of coworkers, and helping others. The most often described "difficult" aspects of the job were witnessing traumatic events, lack of sleep, and being away from family. Practical/theoretical implications and conclusions: These qualitative research findings suggest that obesity and typical "individual health behaviors" such as eating behaviors and exercise patterns may not be just a product of individual "choice" but may also be influenced by working conditions. These findings confirm that firefighters are exposed to significant work stressors and that along with their work organization, may contribute to poor eating habits and lower physical activity. Integrating these findings along with the survey results will enhance the understanding of the effects of firefighter-specific psychosocial work stressors such as sleep quality, job demands, work-family spillover, and experiencing trauma, on health behaviors linked to weight gain and obesity. Focus groups will then be reconvened to encourage firefighter participation in interpreting these findings and in fostering ongoing dialogue about feasible programs that will target both occupational factors and health behaviors related to obesity. [Description provided by NIOSH]
• Subjects:
  Behavior Firefighters Occupational Health Risk Assessment Risk Factors Safety
• Keywords:
  Behavior Patterns Fire Fighters Obesity Qualitative Analysis Risk Factors
• Publisher:
  American Psychological Association
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Abstract or Summary
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-2
• NIOSHTIC Number:
  nn:20056216
• Citation:
  Work, Stress, and Health 2013: Protecting and Promoting Total Worker Health(TM), The 10th International Conference on Occupational Stress and Health, May 16-19, 2013, Los Angeles, California. Washington, DC: American Psychological Association, 2013 May; :1-2
• Federal Fiscal Year:
  2013
• NORA Priority Area:
  Public Safety
• Performing Organization:
  University of California - Irvine
• Peer Reviewed:
  False
• Start Date:
  20100901
• Source Full Name:
  Work, Stress, and Health 2013: Protecting and Promoting Total Worker Health(TM), The 10th International Conference on Occupational Stress and Health, May 16-19, 2013, Los Angeles, California
• End Date:
  20130831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:5f2506e1a498d140d3435c8edb65e12970e8ad180d65ab4807f25e9b6036ec35326cc0f1f33afba50576da6a772290e49966e2743c6cc415f5cb064e9b4176e5
• Download URL:
  https://stacks.cdc.gov/view/cdc/213868/cdc_213868_DS1.pdf
• File Type:
  [PDF - 141.16 KB ]