Total Worker Health for Wildland Firefighters

The overarching goal is to develop, refine and disseminate a comprehensive, easily accessible and effective Total Worker Health (TWH) program for wildland firefighters (WFF).

The term Total Worker Health® (TWH) (NIOSH) refers to the synergistic combination of 1) health promotion (e.g., healthy nutrition, exercise, restorative sleep), 2) worker safety issues, such as protective equipment and hazard control, merged with 3) work organization change to support and promote TWH.

Study Overview

• Status: Completed
• Conditions: Health Behavior; Occupational Health; Total Worker Health
• Intervention / Treatment: Other: Total Worker Health for Wildland Firefighters

• Study Type: Interventional
• Enrollment (Actual): 150
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Oregon
    • Portland, Oregon, United States, 97239
      • Oregon Health & Science University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• any firefighter attending an OHSU-led informational meeting

Exclusion Criteria:

• Firefighters planning to retire from fire fighting work within 12 months will be excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Needs Assessment and Total Worker Health Program; The initial phase was a needs assessment for wildland firefighters across segments and geographic locations to identify and prioritize program components. During the first phase, we recruited firefighters and collected baseline data in order to assess their needs using surveys for quantitative data and interviews and focus groups for qualitative data. The total worker health program includes 14, 30-minute modules on health topics highlighted during the needs assessment phase. Participants completed the program either individually or as part of a group.

Other: Total Worker Health for Wildland Firefighters; The program is structured as 30-minute modules that can be done individually, with a partner, as a group or in a classroom setting. The six core modules are supplemented with eight elective modules. The program can be accessed on a smartphone, tablet or computer, and if needed can be downloaded as a pdf.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Cardiovascular Risk Knowledge	Change in cardiovascular risk knowledge was assessed using this survey question: "I know my risk factors for cardiovascular disease.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Physical Activity	Change in physical activity was assessed using this survey question: "On average, I get 150 minutes of moderate physical activity per week (including your work).". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Supplement Knowledge	Change in supplement knowledge was assessed using this survey question: "I need supplements to balance the additional nutritional needs of being a wildland firefighter.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Hydration Knowledge	Change in hydration knowledge was assessed using the survey questions: "Camelback systems are more effective for maintaining hydration than canteens." and "Dehydration begins to affect performance when fluid loss equals 2% of body weight.". Both were measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Nutrition Knowledge	Change in nutrition knowledge was assessed using the survey questions: "Carbohydrates are the primary fuel for moderate to intense physical activity." and "Protein is contained in many foods, including bread and rice.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Alcohol Knowledge	Change in alcohol knowledge was assessed using the survey questions: "I know the definition of binge drinking." and " Drinking alcohol increases my cancer risk.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Sleep Knowledge	Change in sleep knowledge was assessed using the survey questions: "Power naps (15 to 30 minutes) will restore alertness and reduce accidents." and "Staying awake for 24 hours is equivalent to having a blood alcohol level greater than 0.08, the legal limit." and "Getting less than 5 hours of sleep lowers testosterone levels equal to someone 10 years older.". Both were measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Mental Health Behavior	Change in mental health behavior was assessed using the survey questions: "I am able to bounce back from stressful events." and "In general, I manage stress in a healthy way.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Blood Pressure Knowledge	Change in blood pressure knowledge was assessed using this survey question: "I know my blood pressure.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change In Nutrition Behavior	Change in nutrition behavior was assessed using this survey question: "I intend to eat every 2 hours while doing arduous wildland firefighting.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Cancer Risk Knowledge	Change in cancer risk knowledge was assessed using this survey question: "I know my risk factors for cancer.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Alcohol Behavior with Sleep	Change in alcohol behavior was assessed using this survey question: "I use alcohol to get to sleep.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Primary Care Behavior	Change in primary care behavior was assessed using this survey question: "It is important for me to have a primary care physician.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Physical Activity Perception	Change in physical activity perception was assessed using this survey question: "I can get in shape two weeks before a wildland fire season.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Mental Health Self Perception	Change in mental health self perception was assessed using the survey questions: "I feel overwhelmed with my work." and "During the last month, I felt significantly depressed.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Alcohol Cancer Risk Knowledge	Change in alcohol cancer risk knowledge was assessed using this survey question: "Drinking alcohol increases my cancer risk.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Alcohol Behavior	Change in alcohol behavior was assessed using this survey question: "I am currently trying to moderate my drinking.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Support Perception	Change in support perception was assessed using this survey question: "I can rely on people at work to support me.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Sleep Hygiene Behavior	Change in sleep hygiene behavior was assessed using this survey question: "Before going to sleep, I wipe soot and ash from my skin.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Cardiovascular Risk Behavior	Change in cardiovascular risk behavior was assessed using this survey question: "I intend to keep track of my risks for cardiovascular disease.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Physical Exam Behavior	Change in physical exam behavior was assessed using this survey question: "I intend to get a physical exam once a year.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Heat Illness Knowledge	Change in heat illness knowledge was assessed using this survey question: "When feeling over heated, the first thing to do is stop working.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Change in Injury Knowledge	Change in injury knowledge was assessed using this survey question: "On steep and rocky terrain, it is best to move quickly to reduce risk of injury.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	0 weeks to 14 weeks
Program Usability and Effectiveness	Program usability and effectiveness was assessed using the survey question: "During the program, the educational modules were valuable for improving my health." and "This program was easy to use." and "This was an efficient way to learn the material." and "I learned ways to improve my health." and "These topics should be part of our training." and "I would recommend this program to my co-workers.". This was measured using a seven-point Likert agreement scale (1 = strongly disagree to 7 = strongly agree).	14 weeks
Technology Used for Program	Technology used for program was assessed using the survey question: "I primarily used this program on:" The options were 1) Phone, 2) Tablet, 3) Computer, 4) Other. For other, space was provided for participants to write in their answer.	14 weeks
How the Program was Completed	How the program was completed was assessed using the survey question: "I primarily used this program on:" The options were 1) By myself, 2) With other firefighters, 3) With my family, 4) Other. For other, space was provided for participants to write in their answer.	14 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Body Mass Index	Change in body mass index was measured in kg/m2.	0 weeks to 14 weeks

Collaborators and Investigators

• Sponsor: Oregon Health and Science University
• Collaborators: Federal Emergency Management Agency; National Fallen Firefighters Foundation

Publications and helpful links

General Publications

• Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rusch N, Brown JS, Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015 Jan;45(1):11-27. doi: 10.1017/S0033291714000129. Epub 2014 Feb 26.
• Brook RD, Rajagopalan S, Pope CA 3rd, Brook JR, Bhatnagar A, Diez-Roux AV, Holguin F, Hong Y, Luepker RV, Mittleman MA, Peters A, Siscovick D, Smith SC Jr, Whitsel L, Kaufman JD; American Heart Association Council on Epidemiology and Prevention, Council on the Kidney in Cardiovascular Disease, and Council on Nutrition, Physical Activity and Metabolism. Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association. Circulation. 2010 Jun 1;121(21):2331-78. doi: 10.1161/CIR.0b013e3181dbece1. Epub 2010 May 10.
• Elliot DL, Goldberg L, Kuehl KS, Moe EL, Breger RK, Pickering MA. The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) firefighter study: outcomes of two models of behavior change. J Occup Environ Med. 2007 Feb;49(2):204-13. doi: 10.1097/JOM.0b013e3180329a8d.
• Kuehl KS, Elliot DL, Goldberg L, MacKinnon DP, Vila BJ, Smith J, Miocevic M, O'Rourke HP, Valente MJ, DeFrancesco C, Sleigh A, McGinnis W. The safety and health improvement: enhancing law enforcement departments study: feasibility and findings. Front Public Health. 2014 May 8;2:38. doi: 10.3389/fpubh.2014.00038. eCollection 2014.
• MacKinnon DP, Elliot DL, Thoemmes F, Kuehl KS, Moe EL, Goldberg L, Burrell GL, Ranby KW. Long-term effects of a worksite health promotion program for firefighters. Am J Health Behav. 2010 Nov-Dec;34(6):695-706. doi: 10.5993/ajhb.34.6.6.
• Robertson M, Henning R, Warren N, Nobrega S, Dove-Steinkamp M, Tibirica L, Bizarro A; CPH-NEW Research Team. The Intervention Design and Analysis Scorecard: a planning tool for participatory design of integrated health and safety interventions in the workplace. J Occup Environ Med. 2013 Dec;55(12 Suppl):S86-8. doi: 10.1097/JOM.0000000000000036.
• von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007 Oct 16;4(10):e296. doi: 10.1371/journal.pmed.0040296.
• Kales SN, Soteriades ES, Christophi CA, Christiani DC. Emergency duties and deaths from heart disease among firefighters in the United States. N Engl J Med. 2007 Mar 22;356(12):1207-15. doi: 10.1056/NEJMoa060357.
• Fritschi L, Glass DC. Firefighters and cancer: where are we and where to now? Occup Environ Med. 2014 Aug;71(8):525-6. doi: 10.1136/oemed-2014-102230. Epub 2014 Jul 4. No abstract available.
• Walton SM, Conrad KM, Furner SE, Samo DG. Cause, type, and workers' compensation costs of injury to fire fighters. Am J Ind Med. 2003 Apr;43(4):454-8. doi: 10.1002/ajim.10200.
• Semmens EO, Domitrovich J, Conway K, Noonan CW. A cross-sectional survey of occupational history as a wildland firefighter and health. Am J Ind Med. 2016 Apr;59(4):330-5. doi: 10.1002/ajim.22566. Epub 2016 Jan 21.
• Britton C, Lynch CF, Ramirez M, Torner J, Buresh C, Peek-Asa C. Epidemiology of injuries to wildland firefighters. Am J Emerg Med. 2013 Feb;31(2):339-45. doi: 10.1016/j.ajem.2012.08.032. Epub 2012 Nov 15.
• Vincent GE, Aisbett B, Hall SJ, Ferguson SA. Fighting fire and fatigue: sleep quantity and quality during multi-day wildfire suppression. Ergonomics. 2016 Jul;59(7):932-40. doi: 10.1080/00140139.2015.1105389. Epub 2015 Dec 18.
• Kuehl KS, Elliot DL, MacKinnon DP, O'Rourke HP, DeFrancesco C, Miocevic M, Valente M, Sleigh A, Garg B, McGinnis W, Kuehl H. The SHIELD (Safety & Health Improvement: Enhancing Law Enforcement Departments) Study: Mixed Methods Longitudinal Findings. J Occup Environ Med. 2016 May;58(5):492-8. doi: 10.1097/JOM.0000000000000716.
• Elliot DL, Goldberg L, Duncan TE, Kuehl KS, Moe EL, Breger RK, DeFrancesco CL, Ernst DB, Stevens VJ. The PHLAME firefighters' study: feasibility and findings. Am J Health Behav. 2004 Jan-Feb;28(1):13-23. doi: 10.5993/ajhb.28.1.2.
• Andajani-Sutjahjo S, Liew TCH, Smith JF, Esekielu I, Mason G, Tariu I. Engaging community volunteers in participatory action research in Tamaki community of Auckland, New Zealand. Health Promot Int. 2018 Apr 1;33(2):219-228. doi: 10.1093/heapro/daw057.
• Elliot DL, Goldberg L, MacKinnon DP, Ranby KW, Kuehl KS, Moe EL. Empiric validation of a process for behavior change. Transl Behav Med. 2016 Sep;6(3):449-56. doi: 10.1007/s13142-015-0343-y.
• Mabry L, Elliot DL, Mackinnon DP, Thoemmes F, Kuehl KS. Understanding the durability of a fire department wellness program. Am J Health Behav. 2013 Sep;37(5):693-702. doi: 10.5993/AJHB.37.5.13.
• Chen SY, Feng Z, Yi X. A general introduction to adjustment for multiple comparisons. J Thorac Dis. 2017 Jun;9(6):1725-1729. doi: 10.21037/jtd.2017.05.34.

Helpful Links

• an open source, cloud-based, software that allows researchers to sort "cards" into different categories.
• an open source, cloud-based, qualitative software
• subscription platform for e-learning course development

Study record dates

Study Major Dates

• Study Start (Actual): February 24, 2020
• Primary Completion (Actual): April 14, 2022
• Study Completion (Actual): April 14, 2022

Study Registration Dates

• First Submitted: February 10, 2023
• First Submitted That Met QC Criteria: February 21, 2023
• First Posted (Actual): March 3, 2023

Study Record Updates

• Last Update Posted (Actual): March 3, 2023
• Last Update Submitted That Met QC Criteria: February 21, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Keywords: Cardiovascular Disease; health promotion; Sleep Hygiene; Firefighter; Wildland; Occupational Hazards; Occupational Safety
• Other Study ID Numbers: EMW-2018-FP-00284

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No