Walker S C Poston

Firefighters are vulnerable to opioid misuse given the adverse effects their occupation has on mental and physical health. Yet there are limited data on opioid misuse within this population. This study examined the prevalence of illicit prescription opioid use among a nationally representative sample of U.S. firefighters and factors related to opio...

Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of opioid use disorder and overdose due to chronic pain and mental health conditions. The pharmaceutical industry’s role in misrepresenting opioid risks—leading to over USD 50 billion in legal settlements—has included targeted...

Background Firefighters are occupationally exposed to hazardous chemical mixtures. Silicone passive sampling devices capture unique exposures over time with minimal impact to the participant and allow for the analysis of a broad chemical space. Objective Silicone dog tags were worn by firefighters while on- and off-duty to measure individual expos...

Background: Firefighters are faced with a broad range of toxic exposures during their work, including known and suspected carcinogens. The current study is an update to the previously published meta-analysis of cancer risk among firefighters by Soteriades and colleagues, and focuses on studies published from 2008 to 2020. Methods: A comprehensiv...

Firefighting is inherently dangerous, though recently concerns have shifted from traditional fireground injuries (burns and asphyxiation) to a focus on mental and behavioral health. Although firefighters are remarkably resilient, research suggests many suffer negative psychological consequences from repeated exposures to trauma. While the Stress Fi...

The Army Combat Fitness Test (ACFT) is a multi-event assessment battery designed to determine the combat readiness of U.S. Army personnel. However, for Reserve Officers’ Training Corps (ROTC) programs the logistical demands of collegiate life make repeated administration of the ACFT challenging. The present study sought to design and evaluate a sin...

Studies showed that tobacco use and excessive alcohol consumption frequently occur, and both are significant causes of preventable morbidity and mortality. Data were collected as part of a national online study of the health of women in the fire service. Multinomial logistic regression was employed to determine factors associated with smoking and d...

Simple Summary United State (US) military members have increasing obesity rates that threaten human performance optimization. This study focused on a mostly officer population attending graduate school at the US Command and General Staff College and measured obesity, fitness, and self-rated health. Almost 80% of the 136 participants were officers;...

i>Bullying in the fire service has long been overlooked, although efforts to understand the phenomenon have increased over the past few decades. Recent research has highlighted high rates of bullying in the fire service, regardless of gender and race. Despite established issues of bullying, workplace bullying training has yet to be examined in the...

BACKGROUND: Peak performance is dependent on adequate sleep, yet only 37% of Army soldiers report achieving the recommended 7-9 hours of sleep/night. Physical activity (PA) is associated with improved muscle strength and endurance; muscle strength correlates strongly with vigorous PA. PURPOSE: This study aimed to identify if min/week of moderate, v...

Background Problem drinking is a perennial concern in the US fire service. A large literature has documented the importance of addressing alcohol norms in intervention research. The purpose of this study was to explore alcohol norms in a national cohort of firefighters to inform intervention development in this occupational group. Methods Data wer...

This study investigated the prevalence of post-traumatic stress disorder (PTSD) and mental health comorbidities among career firefighters in the U.S. and examined occupational factors related to PTSD. A total of 624 male career firefighters completed questions regarding PTSD and mental health conditions. Nearly 7% met the criteria for being in the...

United States Army soldiers must meet physical fitness test standards. Criticisms of the Army Physical Fitness Test (APFT) include limited testing of only aerobic and muscular endurance activity domains; yet, it is unclear what levels of aerobic and muscle strengthening activity may help predict performance in aspects of the new Army Combat Fitness...

Objectives Firefighter health has received a great deal of increased attention over the past decade, but most work has been specific to men in the fire service due to small numbers of women, likely due to challenges with recruitment and retention of women in the fire service. While findings suggest men in the fire service struggle with high rates o...

Studies suggest that exposure to potential endocrine disrupting chemicals (pEDCs) may contribute to adverse health outcomes, but pEDC exposures among firefighters have not been fully characterized. Previously, we demonstrated the military-style silicone dog tag as a personal passive sampling device for assessing polycyclic aromatic hydrocarbon expo...

Physical activity (PA) classes help college students add weekly PA, which can help improve health and maintain body weight. Traditional weight training (TWT) can improve strength and aerobic capacity. High-intensity functional training such as CrossFit® (CF) provides time-efficient workouts with both muscle strengthening and aerobic exercises. Limi...

While firefighters currently have low smoking rates, rates of smokeless tobacco (SLT) use among this population are remarkably high and substantially greater than similar occupational groups, and the general population. This study explored determinants associated with SLT use, barriers to cessation, and motivators for SLT cessation in the fire serv...

Introduction: The prevalence of smokeless tobacco (SLT) use among firefighters is substantially higher than the general population and similar occupational groups. Despite the significant health risks associated with SLT and its impact on occupational readiness, there are no occupationally-tailored SLT education or treatment programs for the fire...

This study investigated differences in the body composition of police officers from different occupational groups and the moderation effects of leisure time physical activity (LTPA). A sample of 237 police officers (special anti-terrorist unit, gendarmerie, firefighters, and general duties) participated in the study. Body mass index (BMI), percent...

Occupational chemical hazards in the fire service are hypothesized to play a role in increased cancer risk, and reliable sampling technologies are necessary for conducting firefighter chemical exposure assessments. This study presents the military-style dog tag as a new configuration of silicone passive sampling device to sample individual firefigh...

Objective: To examine occupational injuries among career women firefighters (FFs). Methods: A national cross-sectional survey assessing injury prevalence, types, frequencies, and predictors. Results: A total of 3,012 women career FFs were enrolled in the study. Almost a third (31.7%) reported at least one occupational injury in the past 12 mon...

Background Prevalence rates of smokeless tobacco (SLT) use among firefighters are remarkably high and substantially higher than similar occupational groups and the general U.S. population. The purpose of this study was to explore the perspectives of fire service personnel regarding cancer and its associations with tobacco and SLT use. Methods This...

Background Despite efforts by the U.S. Department of Defense to train behavioral health (BH) providers in evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), numerous barriers limit EBP implementation. A context-tailored implementation approach called TACTICS (Targeted Assessment and Context-Tailored Implementation of Ch...

In some countries, obesity rates among police officers are higher than the general public, despite physically demanding jobs. Obesity rates based on body mass index (BMI) may lack accuracy as BMI does not directly address body composition. Since data are lacking for obesity rates among Russian police officers, this study documented and compared off...

Objective: To determine the efficacy of an occupationally tailored, web-based health and wellness program, The First Twenty® (TF20), for weight change among volunteer firefighters. Methods: The impact of TF20 on firefighters' 6-month weight change was tested in a cluster, randomized controlled trial, using a crossover design of firefighters in 1...

Abstract BACKGROUND: Data suggest that sedentary behavior is an independent risk factor for obesity; however, the extent to which physical activity (PA) and sex alter this relationship remains unclear. To address this gap, the current study examined the association between television (TV) viewing time and percent body fat (%BF) as a function of PA...

Objectives: Firefighters play a crucial role in protecting the lives and property of the communities they serve. Health and readiness for duty among women firefighters is of great concern because they are a significantly understudied group in this critical occupation. A tobacco-free fire service has been strongly promoted, but there are no publish...

Background Firefighting is a dangerous occupation with high rates of injuries and fatalities, with the majority of line of duty fatalities due to cardiovascular events. Additionally, firefighters struggle with poor health/low levels of fitness, including high (> 80%) rates of overweight and obesity. Limited resources exist for fire departments that...

Intro: Both discrimination and harassment directly impact mental and physical health. Further, workplace discrimination degrades workplace culture and negatively impacts health behaviors, job-related outcomes, and family dynamics. Women represent a small proportion of the fire service and are often the targets of discrimination/harassment, yet lit...

Objective: The aim of this study was to determine the role of obesity on the association between sleep and on-duty injury among male career firefighters. Methods: Data on 1,419 male career firefighters for this cross-sectional study came from two firefighter cohorts from 2008-2013. On-duty injury within the past 6-12 months was the dependent var...

Objectives: To establish the extent of steady state hypohydration among firefighters and examine factors associated with their hydration status. Methods: Data on 450 career firefighters from 11 randomly selected fire departments had their body composition, total body water (TBW), and hypohydration status assessed using bioelectrical impedance. M...

High-intensity functional training (HIFT) is an exercise modality that emphasizes functional, multi-joint movements that can be modified to any fitness level and elicit greater muscle recruitment than more traditional exercise. As a relatively new training modality, HIFT is often compared to high-intensity interval training (HIIT), yet the two are...

Objectives Despite increasing attention to the occupational impact of firefighting, little is known specific to the health of women firefighters. In particular, quantitative data is lacking on the impact firefighting has on maternal and child health for women who become pregnant while working as firefighters. Methods A total of 1821 women firefight...

There has been little research conducted on the reproductive health of female firefighters. The purpose of this study was to determine whether female reproductive health is a concern among firefighters and to identify key associated issues. Eighty-seven United States (US) firefighters participated in focus groups or interviews. Themes were created...

Background Although few United States adults meet physical activity recommendations, those that do are more likely to access to physical activity facilities. Additionally, vigorous exercisers may be more likely to utilize a nearby physical activity facility, while light-to-moderate exercisers are less likely to do so. However, it is unclear what ch...

National military and veteran service organizations (MVSOs) have the potential to be advocates for stronger military tobacco control. This study consisted of qualitative analysis of interviews with 5 MVSO leaders (or their designees) and 6 focus groups conducted with veterans, to explore the opinions of MVSO leaders and veterans about military toba...

Objectives: Given high levels of occupational stress and toxic exposures, firefighters have a relatively high prevalence of occupationally related medical and mental health disorders compared with the general public. Previous research found high rates of heavy and binge drinking among male firefighters. This study is the first to examine alcohol u...

Objectives: Although the United States Air Force (USAF) has been a leader in efforts to reduce tobacco use among service members, tobacco continues to be a problem and initiatives to decrease tobacco use further require buy-in from leadership. We explored line leaderships' perspectives on tobacco. Methods: A diverse group of 10 senior commission...

Background No data exist on obesity or the accuracy of body mass index (BMI) in Russian Federation firefighters. Aims To determine the prevalence of obesity and rates of misclassification of BMI-based obesity status. Methods Career firefighters in the Moscow region completed anthropometric assessments including height, weight, BMI, body fat per c...

Research presented here examines how the demands of fire fighting uniquely affect women. A national sample of 73 female firefighters and fire-service leaders participated in focus groups and key informant interviews. Participants were asked about perceived threats to safety and standard operating procedures (SOPs) that lead to injury regarding gend...

Introduction: Prevalence rates of smokeless tobacco (SLT) use and late initiation among firefighters (i.e., 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 fir...

Introduction: High intensity functional training (HIFT) programs are designed to address multiple fitness domains, potentially providing improved physical and mental readiness in a changing operational environment. Programs consistent with HIFT principals such as CrossFit, SEALFIT and the US Marine Corps' High Intensity Tactical Training (HITT) ar...

Background: Tobacco pricing impacts use, yet military retailers sell discounted cigarettes. No systematic research has examined how military retail stores use internal community comparisons to set prices. We analysed data obtained through a Freedom of Information Act request on community price comparisons used by military retail to set cigarette p...

Background: Obesity compromises firefighter safety, yet more than 70% of firefighters are overweight. Though healthcare professionals are encouraged to counsel overweight patients, the effectiveness of weight counseling is not consistent across studies. Objective: Examine longitudinal changes in cardiovascular risk factors and determine the role of...

High-intensity functional training (HIFT) is a promising fitness paradigm that gained popularity among military populations. Rather than biasing workouts toward maximizing fitness domains such as aerobic endurance, HIFT workouts are designed to promote general physical preparedness. HIFT programs have proliferated as a result of concerns about the...

Tobacco use prevalence is unacceptably high in the U.S. military, and the Department of Defense and service branches have implemented tobacco control policies and cessation programs. To explore aspects of programs regarded as exemplary by their services, we visited four installations, nominated by their service's health promotion leaders, and condu...

Introduction: Higher tobacco taxes reduce tobacco use. On military installations, cigarettes and other tobacco products are sold tax-free, keeping prices artificially low. Pricing regulations in the military specify that tobacco should be within 5% of the local most competitive price, but prices still average almost 13% lower than those at local Wa...

Background: Tobacco use among members of the US military service is unacceptably high, resulting in substantial healthcare and personnel costs. Support of military command is critical to the success of tobacco control policies because line commanders are responsible for implementation and enforcement. This study is the first to examine US military...

Background: Firefighters must be ready to respond to a broad range of emergencies every duty day. In the course of many of these emergencies, firefighters witness events which have the potential to induce emotional trauma, such as badly injured people, deceased children, and individuals who are highly distraught. Previous research suggests that re...

The high prevalence of overweight and obesity threatens the health and safety of the fire service. Healthcare professionals may play an important role in helping firefighters achieve a healthy weight by providing weight loss counseling to at-risk firefighters. This study characterizes the impact of healthcare professional weight loss advice on fire...

Military installation newspapers are a primary means used by military commanders to communicate information about topics important to military personnel including leadership, training issues, installation events, safety concerns, and vital health issues. We conducted a content analysis of military commanders' messages about health issues that were...

The purpose of this study was to conduct a content analysis of Veterans and Military Service Organizations (VMSOs) magazines to determine what health-related topics VMSOs target and how they inform their constituencies about health issues. Health-related topics in 288 VMSOs' magazines from 21 VMSOs published in 2011 and 2012 were coded by trained r...

Both media reports and preliminary research suggest that problem drinking is a concern in the U.S. fire service. However, no national epidemiological research has been conducted. This study presents the first national data on alcohol consumption patterns among firefighters. Data are from 954 male firefighters at 20 career fire departments. The depa...

It is a common belief in the fire service that the divorce rate for firefighters is higher than that in the general population. However, no data exists to substantiate this concern. We conducted surveys in 31 U.S. fire departments to assess relationship status, history of divorce, and key health outcomes. Prevalence of divorce among male firefighte...

Neighborhood characteristics are important correlates for a variety of health outcomes. Among several health risk behaviors, smoking and alcohol use have significant consequences. Perceptions of neighborhood problems are associated with depressive symptoms, lower physical activity, and lower quality of life. However, it is unclear which perceived a...

Obesity and fitness have been identified as key health concerns among United States (US) firefighters yet little is known about the current habits related to exercise and diet. In particular, high intensity training (HIT) has gained increasing popularity among this population but limited quantitative data is available about how often it is used and...

Military and Veterans Service Organizations (MVSOs) have a unique opportunity to influence legislation and advocate for the interests of their members. However, little is known about what legislative priorities MVSOs see as important. Understanding the legislative priorities of MVSOs can inform efforts by health scientists to promote policy and law...

Obesity is a significant problem affecting United States (US) firefighters. While body mass index (BMI) is widely used to diagnose obesity, its use for this occupational group has raised concerns about validity. We examined rates and types of misclassification of BMI-based obesity status compared to body fat percentage (BF%) and waist circumference...

Background The military has had a long pro-tobacco tradition. Despite official policy discouraging smoking, tobacco still is widely seen as part of military culture. While active smoking has presented a particular challenge for the military, in recent years there also has been increasing concern with secondhand smoke. This is especially true in clo...

Introduction: To date, there have been no large-scale, national epidemiological studies of tobacco use patterns among firefighters, particularly with a focus on smokeless tobacco (SLT) and dual use with cigarettes. While rates of firefighters’ smoking are relatively low compared to the general population, SLT use typically is substantially higher t...

Introduction National guidelines state that health care professionals (HCPs) should advise patients on the importance of maintaining a healthy weight. Firefighters have high rates of obesity, and cardiovascular events are the leading cause of line-of-duty deaths in firefighters. This study assessed the association of age and body mass index (BMI) w...

Secretary of the Navy Ray Mabus recently announced that he wanted to end tobacco sales on all Navy installations. Secretary of Defense Chuck Hagel, citing both financial costs and tobacco's harmful effects on readiness, added that military tobacco policy in general should be reviewed, including the possibility of ending tobacco sales and establishi...

Objective: Quantify the association between adiposity and frequency of self-reported poor health days among male firefighters. Methods: Measures were taken for body mass index, waist circumference, and percentage of body fat. Firefighters self-reported the outcome of the number of poor health days in the past 30 days. Zero-inflated negative bino...

Firefighters face a number of occupational risks including the impact of being exposed to traumatic experiences. Critical incident stress debriefing (CISD) was previously introduced as a viable option for intervention postincident; however, concern has been raised about the efficacy of such debriefings. This study uses focus groups and key informan...

Background Obesity is of increasing concern especially among firefighters. Bias in self-reported body weight, height and body mass index (BMI) has received a great deal of attention given its importance in epidemiological field research on obesity.AimsTo determine the validity of self-reported weight, height and BMI and identify potential sources o...

Introduction: We evaluated correlates of seeking treatment among ACS patients in a rural, medically underserved community. This study is unique because patient data came from medical records and physician-administered structured interviews and it is the first to evaluate correlates of treatment delay in a rural and medically underserved patients. M...

Objectives: We conducted a longitudinal assessment of tobacco pricing in military retail outlets, including trends within each service branch. Methods: We determined the price of a single pack of Marlboro Red cigarettes at military retail stores located in the continental United States, Alaska, and Hawaii and at their nearest Walmarts in spring...

Capturing portion size estimates is a constant challenge. Our objective was to characterize reported portion size during face-to-face and telephone 24-hour diet recalls among career fire fighters in the Fuel 2 Fight study. Trained nutritionists reviewed recalls and categorized reported portion size into weights, household measures, servings & items...

Purpose Little is known about veterans service organizations (VSOs) and their perspectives on veterans smoking or military tobacco control. Veterans have high smoking rates and many started smoking in the military, where a culture promoting use exists. Design A qualitative content analysis of VSO Web sites was conducted to classify health topics a...

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 hea...

The present multi-centre randomised weight-loss trial evaluated the efficacy of a low-intensity 12-week online behavioural modification programme, with or without a fortified diet beverage using a 2 × 2 factorial design. A total of 572 participants were randomised to: (1) an online basic lifestyle information (OBLI) intervention, consisting of one...

Objective: Firefighting is a dangerous profession with high injury rates, particularly musculoskeletal (MS), but limited longitudinal data is available to examine predictors of MS injuries in this population. Design and methods: The relationship between personal individual, nonoccupational factors (e.g., demographic characteristics, body composi...

Tobacco use is the leading cause of preventable death in the United States and has been shown to significantly harm the combat readiness of military personnel. Unfortunately, recent research showed that cigarettes are sold at substantial discounts in military retail outlets. In fact, the military is the only retailer that consistently loses money o...

Objective: To determine the prevalence and severity of excessive daytime sleepiness (EDS) in a population-based sample of firefighters. Methods: Sleepiness was assessed using the Epworth Sleepiness Scale in a sample of male career firefighters (n = 458) from 11 randomly selected fire departments in the Midwestern United States. Results: Unadju...

Background: Rates of occupational injuries among firefighters are high because of the physically demanding and variable tasks required by their job. While descriptive data about injuries exist, few studies have explored individual risk factors and their relationship to occupational injury. Methods: The current study presents data from a populati...

Little is known about smokeless tobacco (SLT) use in the fire service, whose personnel need to maintain high levels of health and fitness given the rigorous physical and mental job requirements. We examined the relationships among variables associated with SLT use and dual tobacco use (SLT and smoking) among 353 male career firefighters. Around 13%...

Background Overweight, obesity and weight gain are significant problems in the US fire service. While classification of obesity using body mass index (BMI) has demonstrated accuracy and low rates of false positives when compared with body fat percentage (BF%)-based standards, no studies have examined the accuracy of BMI-based overweight and normal...

Purpose Firefighters are expected to respond to any domestic emergency at a moment's notice, and therefore their health and readiness are key to the public safety net. Although emerging research is focusing on understanding firefighters' increased risk for disease and injury, the perspectives of fire service personnel is lacking. Design This study...

Background Despite statements from national fire service organizations, including the International Association of Fire Fighters (IAFF) and the International Association of Fire Chiefs (IAFC), promoting a diverse work force related to gender within the fire service, rates of women firefighters remain very low. Thus, research into why this extensive...

Background Although the US National Fire Service is concerned about alcohol use among firefighters, little research has been conducted on the topic.AimsTo survey alcohol use patterns among career and volunteer firefighters.Methods Data were from a population-based cohort study of male firefighters conducted in randomly selected career and volunteer...

Appropriate and effective physical fitness training is imperative for soldier survival and mission success. The purpose of this study was to determine the effects of Mission Essential Fitness (MEF) circuit-style training program compared to standard Army Physical Readiness Training (APRT) on fitness, physiological, and body composition changes. Act...

Background Cigarette prices at military exchanges historically have been discounted. DoD Instruction 1330.9 has mandated that prices be within 5% of the price offered in the local community since 2001. Because minorities are highly represented in the military, we determined whether menthol cigarette prices, the leading choice of African Americans,...

To document weight changes in a population-based cohort of male career firefighters and evaluate the impact of health surveillance on subsequent participant behavior and body composition. Body mass index, waist circumference, and body fat percentage were assessed longitudinally in 311 male firefighters. Firefighters who reported making no changes a...

Obesity is a significant public health concern that affects a growing number of people in the United States and throughout the world. While substantial advances have been made in the development of new pharmacotherapies and in understanding the biological underpinnings (e.g., genetics and physiology) of obesity, lifestyle modification, which involv...

An important research area is the relationship among income status, health, and the environment. This study examined the relationships among income levels, features of the environment and friendliness toward physical activity. We investigated whether low-, middle-, and high-income neighborhoods differ in terms of four environmental characteristics...

This study examined the relationship between dietary intake, body weight, and body mass index (BMI) in adult Thais as a function of smoking status. A cross-sectional, nationally representative survey using health and dietary questionnaires and anthropometric measurements were used. Participants were 7858 Thai adults aged 18 years and older recruite...

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. Key informant inte...