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

The validity of self-rated health as a measure of health status among young military personnel: evidence from a cross-sectional survey

Abstract Background Single item questions about self ratings of overall health status are widely used in both military and civilian surveys. Limited information is available to date that examines what relationships exist between self-rated health, health status and health related behaviors among relatively young, healthy individuals. Methods The current study uses the population of active duty United States Air Force recruits (N = 31,108). Participants completed surveys that asked about health behaviors and health states and were rated their health on a continuum from poor to excellent. Results Ratings of health were consistently lower for those who used tobacco (F = 241.7, p < .001), reported binge drinking (F = 69.0, p < .001), reported drinking and driving (F = 19.4, p < .001), reported taking health risks (F = 109.4, p < .001), were depressed (F = 256.1, p < .001) and were overweight (F = 39.5, p < .001). Conclusion Given the consistent relationship between self-rated overall health and factors important to military health and fitness, self-rated health appears to be a valid measure of health status among young military troops.Peer Reviewe

Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Metabolic syndrome, a constellation of metabolic risk factors for type 2 diabetes and cardiovascular disease, is one of the fastest growing disease entities in the world. Weight loss is thought to be a key to improving all aspects of metabolic syndrome. Research studies have suggested benefits from diets rich in vegetables and fruits in helping individuals reach and achieve healthy weights.</p> <p>Objective</p> <p>To evaluate the effects of a ready to serve vegetable juice as part of a calorie-appropriate Dietary Approaches to Stop Hypertension (DASH) diet in an ethnically diverse population of people with Metabolic Syndrome on weight loss and their ability to meet vegetable intake recommendations, and on their clinical characteristics of metabolic syndrome (waist circumference, triglycerides, HDL, fasting blood glucose and blood pressure).</p> <p>A secondary goal was to examine the impact of the vegetable juice on associated parameters, including leptin, vascular adhesion markers, and markers of the oxidative defense system and of oxidative stress.</p> <p>Methods</p> <p>A prospective 12 week, 3 group (0, 8, or 16 fluid ounces of low sodium vegetable juice) parallel arm randomized controlled trial. Participants were requested to limit their calorie intake to 1600 kcals for women and 1800 kcals for men and were educated on the DASH diet. A total of 81 (22 men & 59 women) participants with Metabolic Syndrome were enrolled into the study. Dietary nutrient and vegetable intake, weight, height, leptin, metabolic syndrome clinical characteristics and related markers of endothelial and cardiovascular health were measured at baseline, 6-, and 12-weeks.</p> <p>Results</p> <p>There were significant group by time interactions when aggregating both groups consuming vegetable juice (8 or 16 fluid ounces daily). Those consuming juice lost more weight, consumed more Vitamin C, potassium, and dietary vegetables than individuals who were in the group that only received diet counseling (p < 0.05).</p> <p>Conclusion</p> <p>The incorporation of vegetable juice into the daily diet can be a simple and effective way to increase the number of daily vegetable servings. Data from this study also suggest the potential of using a low sodium vegetable juice in conjunction with a calorie restricted diet to aid in weight loss in overweight individuals with metabolic syndrome.</p

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

Installation Tobacco Control Programs in the U.S. Military.

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 conducted interviews, observations, and focus groups. Installations included Naval Hospital Guam, Tripler Army Medical Center, MacDill Air Force Base, and the Naval Hospital at Marine Corps Air Ground Combat Center Twentynine Palms. The tobacco control managers (TCMs) at the programs studied were all civilian employees, highly motivated and enthusiastic, and had remained in their positions for approximately a decade. Other commonalities included support from command, a "culture" of health, and location in warm climates. Programs varied in their involvement in establishing designated tobacco use areas, and length and requirement of attending cessation classes; however, no evaluation of cessation programs is currently underway. TCMs should be more engaged in policy discussions for the larger installations they serve. A strong policy framework and command support for TCMs will be necessary to achieve the goal of a tobacco-free military

Tobacco Pricing in Military Stores: Views of Military Policy Leaders.

IntroductionHigher 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 Walmarts.MethodsTo gain insight into policy leaders' ideas and positions on military tobacco pricing, we interviewed members of the Department of Defense (DoD) Addictive Substances Misuse Advisory Committee and the Advisory Committee on Tobacco about tobacco pricing policies (n = 12).ResultsParticipants frequently lacked specific knowledge of details of military pricing policy, and the impact higher prices might have on military tobacco use. Most participants thought tobacco should not be sold at military stores, but many also felt that this policy change was unlikely due to tobacco industry pressure, and DoD reliance on tobacco profits to support Morale, Welfare, and Recreation funds.ConclusionsAchieving a tobacco-free military will require changing pricing policy, but this study suggests that for effective implementation, military leadership must also understand and articulate more clearly the rationale for doing so.ImplicationsPrevious work has found that adherence to military tobacco pricing policy is inconsistent at best. This study suggests that lack of knowledge about the policy and conflicting pressures resulting from the funding stream tobacco sales represent extend to high level military policy leaders. Without clearer information and direction, these leaders are unlikely to be able to establish and implement better tobacco pricing policy

Cigarette prices and community price comparisons in US military retail stores.

BackgroundTobacco 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 prices.MethodsData on cigarette prices were obtained directly from military retailers (exchanges) from January 2013 to March 2014. Complete pricing data were obtained from exchanges on 114 military installations.ResultsThe average price for a pack of Marlboro cigarettes in military exchanges was US$5.51, which was similar to the average lowest community price (US$5.45; mean difference=-0.06; p=0.104) and almost a US$1.00 lower than the average highest price (US$6.44). Military retail prices were 2.1%, 6.2% and 13.7% higher than the lowest, average and highest community comparisons, respectively, and 18.2% of exchange prices violated pricing instructions. There was a negative correlation (r=-0.21, p=0.02) between the number of community stores surveyed and exchange cigarette prices.ConclusionsThere was no significant difference between prices for cigarettes on military installations and the lowest average community comparison, and in some locations, the prices violated Department of Defense (DoD) policy. US Marine Corps exchanges had the lowest prices, which is of concern given that the Marines also have the highest rates of tobacco use in the DoD. Given the relationship between tobacco product prices and demand, a common minimum (or floor) shelf price for tobacco products should be set for all exchanges and discount coupon redemptions should be prohibited

Perspectives of US military commanders on tobacco use and tobacco control policy.

BackgroundTobacco 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 line commanders' perspectives about current tobacco control policies and the impact of tobacco on readiness.MethodsWe conducted key-informant interviews with 20 officers at the US Army's Command and General Staff College about military tobacco use and tobacco control policy.ResultsParticipants identified the long-term impact of tobacco use on military members, but were unaware of proximal effects on health and readiness other than lost productivity due to smoke breaks. Officers also discussed nicotine addiction and the logistics of ensuring that an addicted population had access to tobacco. Regarding policy, most knew about regulations governing smoke-free areas and were open to stronger restrictions, but were unaware of current policies governing prevention, intervention and product sales.ConclusionsFindings suggest that strong policy that takes advantage of the hierarchical and disciplined nature of the military, supported by senior line and civilian leadership up to and including the secretaries of the services and the Secretary of Defense, will be critical to substantially diminishing tobacco use by military personnel

Is it time for a tobacco-free military?

Achieving a tobacco-free military requires rethinking current perceptions of service members' tobacco use and unmasking the forces perpetuating those perceptions. Prohibiting tobacco use would be entirely consistent with other military requirements regarding health

Is it time for a tobacco-free military?

Achieving a tobacco-free military requires rethinking current perceptions of service members' tobacco use and unmasking the forces perpetuating those perceptions. Prohibiting tobacco use would be entirely consistent with other military requirements regarding health