Exploring Occupational and Behavioral Risk Factors for Obesity in Firefighters

Abstract submitted to the 2011 APA NIOSH Meeting

BongKyoo Choi (1), Peter Schnall (1), Marnie Dobson (1), Leslie Israel (1), Paul Landsbergis (2), Pietro Galassetti (3), Andria Pontello (4), Stacey Kojaku (1), Dean Baker (1)

(1) Center for Occupational and Environmental Health, University of California Irvine, USA.
(2) Department of Environmental and Occupational Health Science, State University of New York Downstate Medical Center, USA.
(3) Department of Pediatrics and Department of Pharmacology, University of California Irvine, USA.
(4) Institute for Clinical and Translational Science, University of California Irvine, USA.


Background: Obesity has been a serious public health issue in the general population and among workers in the United States (US) since at least the 1980s. Among 41 male-dominated occupations, firefighters have the third highest prevalence rate of obesity. Despite the high obesity prevalence rate among firefighters, epidemiological studies on firefighters and obesity have focused on the correlations between obesity (defined by body mass index (BMI)) and physiological covariates (e.g., blood pressures and lipid profiles). Few studies have examined the roles of working conditions and health behaviors of firefighters in obesity. The working
conditions of firefighters are generally characterized by high mental and physical job demands, unpredictable fire fighting, relatively long calm periods of time between alarms, shift work (i.e., 24-hr shift), and frequent overtime work. These factors may increase the risk of obesity in firefighters directly or indirectly through promoting unhealthy behaviors (e.g., overeating and
physical inactivity both at work and during leisure time). In addition, few validated instruments – a methodological prerequisite for obesity studies in firefighters – are available that specifically assess the unique working conditions and health behaviors of firefighters who work on a 24 hrshift system. Many firefighter wellness fitness (WEFIT) programs have focused on fitness training and periodic medical examinations. The WEFIT programs have never been intended to examine occupational or behavioral determinants of obesity and biological CVD risk factors.Furthermore, no study has explored differential relationships between BMI and skinfoldbased % fat by age and ethnicity (e.g., Latinos vs. Whites) and differential relationships of BMI and skinfold-based body fat % with other CVD risk factors (e.g., hypertension and blood lipid profiles) in firefighters.

Objectives: The main aims of this study are a) to develop and validate a firefighter-relevant work and health questionnaire using qualitative and quantitative methods in firefighters, b) to use this questionnaire in an epidemiological study to explore whether adverse working conditions and health behaviors are risk factors for obesity in firefighters, and c) to explore the interrelations between working conditions and health behaviors as they relate to obesity. A supplementary objective is to evaluate the strengths and weaknesses of BMI as a measurement (commonly used as a surveillance measure of obesity in many (WEFIT) programs for
firefighters) in comparison with skinfold-based body fat %.

Methods: This study will be conducted in collaboration with a fire authority covering a county of Southern California. In order to facilitate and oversight the study, a research advisory committee will be created with members from the fire authority management, International Association of Fire Fighters (IAFF) local union, WEFIT coordinators, and researchers at a university. This study involves the following steps in chronological order: a) focus groups of firefighters by rank (captains vs. firefighters/engineers) will review and revise the domains and items in a questionnaire about working conditions and heath behaviors (dietary quality, eating behaviors, and physical activity) of firefighters; b) a final version of the questionnaire will be introduced to firefighters (n ≥ 357) who will visit an occupational health clinic as part of a firefighter WEFIT program on a regular basis. For analyses, the questionnaire information will be linked to the records of the WEFIT medical and fitness exams (BMI, body fat %, VO2 max, blood pressures, and blood lipid profiles) of the survey participants; c) a sub-sample (n ≥ 80) of the survey participants will be recruited to test the validity of the self-reported questionnaire information on working conditions and health behaviors. They will be asked to wear a waist physical activity monitor for 72 hrs (24 hrs at a work day and 48 hrs at non-work days), to complete a 3-day food
diary, and to fill out the questionnaire again in one week after completing the survey for a 1-week test-retest reliability, and d) focus groups of firefighters will assess and evaluate study findings in order to develop recommendations for reducing weight and obesity in firefighters.

Results: This study is a 2-year project, funded by the Center for Disease Control and Prevention (CDC)/National Institute for Occupational and Environmental Health (NIOSH) from 2010 to 2012 (Grant #: 1R21OH009911-01). From a study design perspective, the overall study plan will be presented at the APA/NIOSH 2011 conference. In addition, the findings from the
focus groups of firefighters for developing a firefighter-relevant work and health questionnaire (to be completed before the conference) will be presented in detail with focus on firefighters’ insights and contributions.

Brief Summary: Identify occupational and behavioral risk factors for obesity in firefighters is an essential first step for establishing effective intervention programs for obesity in almost 1.1 million professional and voluntary firefighters in the US.

For correspondence: BongKyoo Choi, Center for Occupational and Environmental Health,
University of California Irvine, 5210 California Avenue, Suite 100, Irvine, CA, 92617. Tel. 1-949-
824-8641, Fax 1-949-824-2345, E-mail: b.choi@uci.edu

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