Total Worker Health on Occupational Injury among Male and Female, Career and Volunteer Firefighters

There are more than 1 million firefighters in the US, of which 70% are career, 30% are volunteer, and 5% of the entire fire service is female. Physical characteristics, health behaviors, and psychosocial factors have been explored in association with on-duty injury among male career firefighters, but never in volunteer firefighters or female firefighters. The aim of this study was to explore the role of obesity on the association between on-duty injury and physical characteristics, health behaviors, and psychosocial factors in male and female, career and volunteer firefighters. ^ Data for this cross-sectional study came from the Firefighter Injury and Risk Evaluation Study (2008-2010), the Fuel 2 Fight study (2010-2013), The First Twenty for Volunteer Firefighters study (2014-2017), and The Health of Women Firefighters study (2013-2014). Male career (n=1,419), male volunteer (n=533), and female career (n=1,817) firefighters were examined separately. On-duty injury was the dependent variable, obesity was the effect modifier among the male firefighters, and the following factors were explored as independent variables: sleep, total work hours, physical activity, depression, job stress, job satisfaction, anxiety, rank, and age. Mixed effect multivariable logistic regression models stratified by obesity with a group level factor of department were conducted among male career and volunteer firefighters. A multivariable logistic regression model was conducted among female career firefighters since there was no department selection factor to consider. Potential confounders were evaluated using backward elimination approach and the change in estimate of 10% applied to determine model efficiency. The odds ratios, stratified odds ratio, 95% CI, and p-value (p\u3c0.05) were used to evaluate results for significance and model fit was explored for models in each of the analyses. ^ Female career firefighters had the highest prevalence of on-duty injury, followed by male career firefighters, and male volunteer firefighters. Male volunteer firefighters had the highest prevalence of obesity compared to male career firefighters and female career firefighters. Obesity modified the association between on-duty injury and sleep, physical activity, depression, and job stress among male career firefighters. Among male volunteer firefighters, obesity modified the association between on-duty injury and total work hours, sleep, and depression. Depression and job stress were found to be significantly associated with on-duty injury among female firefighters. The results of the study as a whole suggest the risk profile for on-duty injury is different among non-obese and obese male firefighters, and different from the risk profile for female firefighters likely due to the lower prevalence of obesity among females. ^ Body composition should be examined as an effect modifier between on-duty injury and its predictors among male firefighters. Findings from this study highlight the need to address obesity, depression, job stress, sleep, and fitness to reduce the disproportionate burden of on-duty injuries in the fire service.