Health Disparities Among Racial and Ethnic Minority Firefighters

ABSTRACT Background: Racial/ethnic minorities are substantially underrepresented in the fire service and this situation is unique when compared to similarly mentally and physically demanding and hazardous occupations such as the military and law enforcement. There is little systematic research to provide greater clarity about this significant disparity. The purpose of this study is to examine physical and behavioral health issues of racial/ethnic minority firefighters when compared to their white, non-Hispanic counterparts and potentially identify areas for future research that might assist in improving their substantial underrepresentation. Materials and Methods: We report the results of a secondary analysis of data combining the baseline evaluations of two different firefighter health studies, the Firefighter Injury and Risk Evaluation (FIRE) and Fuel 2 Fight (F2F) studies. Male career firefighters (N=1,404) were from 31 fire departments across the US and its territories. White, non-Hispanic firefighters comprised 72.5% of the sample (n=1,018) and 27.5% classified themselves as a racial/ethnic minority. Firefighters who agreed to participate comprised 94% (F2F) and 97% (FIRE) of those available and all underwent assessments including body composition, fitness, and general/behavioral health, and job satisfaction. Results: We examined differences in health and job status between minority and non-minority firefighters and between firefighters in minority- (MDCs) and white-dominated communities (WDCs). After adjusting for potential confounds, there were significant main effects for the individual minority status vs. non-minority status on both BMI and BF%, indicating that minority firefighters had significantly higher average BMI (28.8±0.3kg/m2) and BF% (24.7± 0.7%) when compared to their white, non-Hispanic colleagues (27.7±0.2kg/m2and 23.1±0.6% for BMI and BF%, respectively). Minority firefighters also were 59% more likely to be obese (adjusted [A]OR=1.59; 95% CI=1.16-2.18). Firefighters serving in MDCs reported significantly more poor health days (Mean±SE; 3.2±0.2 days) than firefighters serving in WDCs (2.8±0.2 days; p=0.038). In addition, minority firefighters reported significantly more poor health days (3.6±0.4 days) than their non-minority colleagues (2.8±0.2 days; p=0.003), while the interaction indicates that minority firefighters in MDCs reported more poor health days than the other groups (p Conclusions: Individual and community minority status (i.e., ethnic density effect) were both significantly associated with a number of important health status indicators, with racial/ethnic minority firefighters demonstrating greater risk for unfavorable body composition and more poor physical health days. In addition, minority firefighters in WDCs reported the highest prevalence of lifetime diagnosis of depression by a physician, while minority firefighters in MDCs had the lowest. Many of these health status indicators have recently been studied within the context of experiences with discrimination, demonstrating that racial discrimination is associated with greater risk for obesity, depression, and poor physical and mental health and could be contributing to health disparities and potentially negatively impacting racial/ethnic minority firefighter health, safety, and retention

High-Intensity Functional Training (HIFT): Definition and Research Implications for Improved Fitness

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 recruitmentthan more traditional exercise. As a relatively new training modality, HIFT is often compared tohigh-intensity interval training (HIIT), yet the two are distinct. HIIT exercise is characterized byrelatively short bursts of repeated vigorous activity, interspersed by periods of rest or low-intensityexercise for recovery, while HIFT utilizes constantly varied functional exercises and various activitydurations that may or may not incorporate rest. Over the last decade, studies evaluating theeffectiveness of HIIT programs have documented improvements in metabolic and cardiorespiratoryadaptations; however, less is known about the effects of HIFT. The purpose of this manuscript is toprovide a working definition of HIFT and review the available literature regarding its use to improvemetabolic and cardiorespiratory adaptations in strength and conditioning programs among variouspopulations. Additionally, we aim to create a definition that is used in future publications to evaluatemore effectively the future impact of this type of training on health and fitness outcomes

Testing the performance of the ENRICHD Social Support Instrument in cardiac patients

BACKGROUND: Previous investigations suggest an important role of social support in the outcomes of patients treated for ischemic heart disease. The ENRICHD Social Support Instrument (ESSI) is a 7-item self-report survey that assesses social support. Validity and reliability of the ESSI, however, has not been formally tested in patients undergoing percutaneous coronary intervention (PCI). METHODS: The ESSI, along with the Short Form-36 (SF-36), was sequentially administered to a cohort of 271 patients undergoing PCI. The test-retest reliability was examined with an intra-class correlation coefficient by comparing scores among 174 patients who completed both instruments 5 and 6 months after their procedure. Internal reliability was assessed using Cronbach's alpha at the time of patients' baseline procedure. The concurrent validity of the ESSI was assessed by comparing scores between depressed (MHI-5 score < 44) vs. non-depressed patients. The correlation between the ESSI and the SF-36 Social Functioning sub-scale, an accepted measure of social functioning, was also examined. RESULTS: Test-retest reliability showed no significant differences in mean scores among ESSI questionnaires administered 1 month apart (27.8+/-1.4 vs 27.8+/-1.5, p = 0.98). The intra-class correlation coefficient was 0.94 and Cronbach's alpha was 0.88. Mean ESSI scores were significantly lower among depressed vs. non-depressed patients (24.6+/-1.7 vs 27+/-1.4, p < 0.018) and a positive albeit modest correlation with social functioning was seen (r = 0.19, p = 0.002). CONCLUSION: The ESSI appears to be a valid and reliable measure of social support in patients undergoing treatment for coronary artery disease. It may prove to be a valuable method of controlling for patient variability in outcomes studies where the outcomes are related to patients' social support

The Effect of Habitual Smoking on VO2max

VO2max is associated with many factors, including age, gender, physical activity, and body composition. It is popularly believed that habitual smoking lowers aerobic fitness. PURPOSE: to determine the effect of habitual smoking on VO2max after controlling for age, gender, activity and BMI. METHODS: 2374 men and 375 women employed at the NASA/Johnson Space Center were measured for VO2max by indirect calorimetry (RER>=1.1), activity by the 11 point (0-10) NASA Physical Activity Status Scale (PASS), BMI and smoking pack-yrs (packs day*y of smoking). Age was recorded in years and gender was coded as M=1, W=0. Pack.y was made a categorical variable consisting of four levels as follows: Never Smoked (0), Light (1-10), Regular (11-20), Heavy (>20). Group differences were verified by ANOVA. A General Linear Models (GLM) was used to develop two models to examine the relationship of smoking behavior on VO2max. GLM #1(without smoking) determined the combined effects of age, gender, PASS and BMI on VO2max. GLM #2 (with smoking) determined the added effects of smoking (pack.y groupings) on VO2max after controlling for age, gender, PASS and BMI. Constant errors (CE) were calculated to compare the accuracy of the two models for estimating the VO2max of the smoking subgroups. RESULTS: ANOVA affirmed the mean VO2max of each pack.y grouping decreased significantly (p<0.01) as the level of smoking exposure increased. GLM #1 showed that age, gender, PASS and BMI were independently related with VO2max (R2 = 0.642, SEE = 4.90, p<0.001). The added pack.y variables in GLM #2 were statistically significant (R2 change = 0.7%, p<0.01). Post hoc analysis showed that compared to Never Smoked, the effects on VO2max from Light and Regular smoking habits were -0.83 and -0.85 ml.kg- 1.min-1 respectively (p<0.05). The effect of Heavy smoking on VO2max was -2.56 ml.kg- 1.min-1 (p<0.001). The CE s of each smoking group in GLM #2 was smaller than the CE s of the smoking group counterparts in GLM #1. CONCLUSIONS: After accounting for the effects of gender, age, PASS and BMI the effect of habitual smoking on reducing VO2max is minimal, about 0.85 ml/kg/min, until the habit exceeds 20 pack.y at which point an additional decrease of 1.71 ml/kg/min is noted. Adding pack.y data improves the accuracy of predicting the VO2max of smokers

The duration of sexual relationship and its effects on adverse pregnancy outcomes

This study aims to determine if a short duration of sexual relationship is more common among women who experience adverse pregnancy outcomes including gestational hypertension (GHT), preeclampsia, small for gestational age (SGA) pregnancies and spontaneous preterm birth (sPTB) with or without abnormal uterine artery Doppler compared to women who have uncomplicated pregnancies. 5591 nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. The risk for pregnancy complications for women who had a duration of sexual relationship of ≤3 months, 4–6 months, 7–9 months, 10–12 months was compared with women who had a duration of sexual relationship of >12 months. Uterine artery Doppler was performed at 20 ± 1 weeks’ gestation. A short duration of sexual relationship (≤3 months) was more common among women with SGA in the presence of abnormal uterine artery Doppler [9.8% vs 3.0%, aOR (95% CI) 3.4 (1.6–7.08] compared to women who had uncomplicated pregnancies. A short duration of sexual relationship (≤3 months) was also more common among women who had abnormal uterine artery Doppler compared to those with normal uterine artery Doppler [6.1% vs 3.1%, aOR (95% CI) = 2.1 (1.4–3.2)]. A short duration of sexual relationship was not associated with preeclampsia after adjusting for confounders. A short duration of sexual relationship is more common among women who deliver SGA infants with features of placental insufficiency as indicated by abnormal uterine artery Doppler.Prabha Andraweera, Claire T. Roberts, Shalem Leemaqz, Lesley McCowan, Jenny Myers, Louise C. Kenny, James Walker, Lucilla Poston, Gus Dekker on behalf of the SCOP

Socio-economic status influences the relationship between obesity and antenatal depression: Data from a prospective cohort study

Background Obesity has been associated with increased risk of antenatal depression, but little is known about this relationship. This study tested whether socio-economic status (SES) influences the relationship between obesity and antenatal depression. Methods Data were taken from the Screening for Pregnancy Endpoints (SCOPE) cohort. BMI was calculated from measured height and weight at 15±1 weeks' gestation. Underweight women were excluded. SES was indicated by self-reported household income (dichotomised around the median: low SES ≤£45,000; high SES >£45,000). Antenatal depression was defined as scoring ≥13 on the Edinburgh Postnatal Depression Scale at both 15±1 and 20±1 weeks' gestation, to identify persistently elevated symptoms of depression. Results Five thousand five hundred and twenty two women were included in these analyses and 5.5% had persistently elevated antenatal depression symptoms. There was a significant interaction between SES and BMI on the risk of antenatal depression (p=0.042). Among high SES women, obese women had approximately double the odds of antenatal depression than normal weight controls (AOR 2.11, 95%CI 1.16–3.83, p=0.014, adjusted for confounders). Among low SES women there was no association between obesity and antenatal depression. The interaction effect was robust to alternative indicators of SES in sensitivity analyses. Limitations 1) Antenatal depression was assessed with a self-reported screening measure; and 2) potential mediators such as stigma and poor body-image could not be examined. Conclusions Obesity was only associated with increased risk of antenatal depression among high SES women in this sample. Healthcare professionals should be aware that antenatal depression is more common among low SES women, regardless of BMI category

Exploration and confirmation of factors associated with uncomplicated pregnancy in nulliparous women: prospective cohort study

Objective: To identify factors at 15 and 20 weeks’ gestation associated with a subsequent uncomplicated pregnancy. Design: Prospective international multicentre observational cohort study. Setting: Auckland, New Zealand and Adelaide, Australia (exploration and local replication dataset) and Manchester, Leeds, and London, United Kingdom, and Cork, Republic of Ireland (external confirmation dataset). Participants: 5628 healthy nulliparous women with a singleton pregnancy. Main outcome measure: Uncomplicated pregnancy, defined as a normotensive pregnancy delivered at >37 weeks’ gestation, resulting in a liveborn baby not small for gestational age, and the absence of any other significant pregnancy complications. In a stepwise logistic regression the comparison group was women with a complicated pregnancy. Results: Of the 5628 women, 3452 (61.3%) had an uncomplicated pregnancy. Factors that reduced the likelihood of an uncomplicated pregnancy included increased body mass index (relative risk 0.74, 95% confidence intervals 0.65 to 0.84), misuse of drugs in the first trimester (0.90, 0.84 to 0.97), mean diastolic blood pressure (for each 5 mm Hg increase 0.92, 0.91 to 0.94), and mean systolic blood pressure (for each 5 mm Hg increase 0.95, 0.94 to 0.96). Beneficial factors were prepregnancy fruit intake at least three times daily (1.09, 1.01 to 1.18) and being in paid employment (per eight hours’ increase 1.02, 1.01 to 1.04). Detrimental factors not amenable to alteration were a history of hypertension while using oral contraception, socioeconomic index, family history of any hypertensive complications in pregnancy, vaginal bleeding during pregnancy, and increasing uterine artery resistance index. Smoking in pregnancy was noted to be a detrimental factor in the initial two datasets but did not remain in the final model. Conclusions: This study identified factors associated with normal pregnancy through adoption of a novel hypothesis generating approach, which has shifted the emphasis away from adverse outcomes towards uncomplicated pregnancies. Although confirmation in other cohorts is necessary, this study implies that individually targeted lifestyle interventions (normalising maternal weight, increasing prepregnancy fruit intake, reducing blood pressure, stopping misuse of drugs) may increase the likelihood of normal pregnancy outcomes.Lucy C Chappell, Paul T Seed, Jenny Myers, Rennae S Taylor, Louise C Kenny, Gustaaf A Dekker, James J Walker, Lesley M E McCowan, Robyn A North, Lucilla Posto

Offering weight management support to pregnant women with high body mass index: A qualitative study with midwives

Objective: The prevalence of pregnant women with high body mass index is increasing worldwide. High body mass index is associated with health risks for mother and baby and supporting healthy gestational weight gain is important. Midwives play an important role in supporting women to engage in behaviours such as healthy eating and physical activity. The aim of this study was to explore how midwives’ support pregnant women with high body mass index to establish a healthy lifestyle with emphasis on nutrition and physical activity in order to minimise gestational weight gain. Methods: Semi-structured interviews were conducted with 16 midwives working in antenatal health care in Sweden. Interviews were conducted shortly after new guidelines on care for pregnant women with high body mass index had been introduced. The interviews were recorded, transcribed and analysed by thematic analysis. Results: Three main themes were identified; use a conscious approach, invite to participate and have a long-term health perspective. Midwives built a relationship with a woman through identifying her concerns and circumstances, before sensitively discussing weight. Some midwives used Motivational Interviewing to help women identify their own resources. To reach long-term health benefits, midwives set achievable goals with the women. Conclusion: These study findings provide practical examples of how midwives can support women with weight management during pregnancy. Through being sensitive when developing a relationship, midwives enabled the women to identify their own resources and achievable goals. Support after the baby is born is needed subsequently to help women maintain their healthy behaviour changes

Prevalence and predictors of alcohol use during pregnancy: findings from international multicentre cohort studies

Objectives To compare the prevalence and predictors of alcohol use in multiple cohorts. Design Cross-cohort comparison of retrospective and prospective studies. Setting Population-based studies in Ireland, the UK, Australia and New Zealand. Participants 17 244 women of predominantly Caucasian origin from two Irish retrospective studies (Growing up in Ireland (GUI) and Pregnancy Risk Assessment Monitoring System Ireland (PRAMS Ireland)), and one multicentre prospective international cohort, Screening for Pregnancy Endpoints (SCOPE) study. Primary and secondary outcome measures Prevalence of alcohol use pre-pregnancy and during pregnancy across cohorts. Sociodemographic factors associated with alcohol consumption in each cohort. Results Alcohol consumption during pregnancy in Ireland ranged from 20% in GUI to 80% in SCOPE, and from 40% to 80% in Australia, New Zealand and the UK. Levels of exposure also varied substantially among drinkers in each cohort ranging from 70% consuming more than 1–2 units/week in the first trimester in SCOPE Ireland, to 46% and 15% in the retrospective studies. Smoking during pregnancy was the most consistent predictor of gestational alcohol use in all three cohorts, and smokers were 17% more likely to drink during pregnancy in SCOPE, relative risk (RR)=1.17 (95% CI 1.12 to 1.22), 50% more likely to drink during pregnancy in GUI, RR=1.50 (95% CI 1.36 to 1.65), and 42% more likely to drink in PRAMS, RR=1.42 (95% CI 1.18 to 1.70). Conclusions Our data suggest that alcohol use during pregnancy is prevalent and socially pervasive in the UK, Ireland, New Zealand and Australia. New policy and interventions are required to reduce alcohol prevalence both prior to and during pregnancy. Further research on biological markers and conventions for measuring alcohol use in pregnancy is required to improve the validity and reliability of prevalence estimates

Associations between the built environment and physical activity in public housing residents

Background: Environmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments. Methods: Physical activity data from 452 adult residents residing in 12 low-income housing developments were combined with measured environmental data that examined the neighborhood (800 m radius buffer) around each housing development. Aggregated ecological and multilevel regression models were used for analysis. Results: Participants were predominately female (72.8%), African American (79.6%) and had a high school education or more (59.0%). Overall, physical activity rates were low, with only 21% of participants meeting moderate physical activity guidelines. Ecological models showed that fewer incivilities and greater street connectivity predicted 83% of the variance in days walked per week, p < 0.001, with both gender and connectivity predicting days walked per week in the multi-level analysis, p < 0.05. Greater connectivity and fewer physical activity resources predicted 90% of the variance in meeting moderate physical activity guidelines, p < 0.001, and gender and connectivity were the multi-level predictors, p < 0.05 and 0.01, respectively. Greater resource accessibility predicted 34% of the variance in days per week of vigorous physical activity in the ecological model, p < 0.05, but the multi-level analysis found no significant predictors. Conclusion: These results indicate that the physical activity of low-income residents of public housing is related to modifiable aspects of the built environment. Individuals with greater access to more physical activity resources with few incivilities, as well as, greater street connectivity, are more likely to be physically active