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Developing a Firefighter Occupational Health Questionnaire Using Focus Groups: the FORWARD study

BongKyoo Choi, Marnie Dobson, Peter Schnall, Leslie Israel, Javier Garcia, Erin Wigger, Paul Landsbergis, Dean Baker

The 139th APHA Conference, Washington DC, October 31, 2011

FORWARD (Firefighter Obesity Research: Workplace Assessment to Reduce Disease) study: This study is funded by the CDC/NIOSH (2010-2012, Grant Award #: 1R21OH009911) and supported by the Orange County Fire Authority (OCFA) and International Association of Fire Fighter (IAFF) Local 3631.

The main aim of this study is to explore occupational and behavioral risk factors for obesity in firefighters.

Developing a firefighter work and health questionnaire to be used for exploring occupational and behavioral risk factors for obesity and heart disease in OCFA firefighters

Why?• Sources of Occupational Stress (SOOS) (Beaton et al., 1993) – developed on firefighters/paramedics in WA. But it does not measure shift-work related job demands of firefighters in the questionnaire (e.g., # of calls per shift, overtime, and consecutive shifts) and includes only a few items on diet and exercise. • Standard questionnaires – developed for use in general working populations. Their relevance to firefighters should be reviewed by firefighters.

Objective

• 2 focus groups with firefighters/engineers (n=11) at a local station and UCI-COEH • 1 focus group with captains (n=4) at OCFA headquarters• 1 focus group with battalion chiefs (n= 5) at a local station

Measures of Job Control , Job Demands, and Job Strain at both T1 and T2 • Job control*: (skill discretion + decision authority) – 5 items (e.g., How often do you learn new things at work?).• Job demands* - 3 items (e.g., How often do you have too many demands made on you?).• Creating 9 groups for cumulative exposure profiles of job control and job demands: (e.g., job control) - Continuous job control scores both at T1 and at T2 were first divided into three groups (low, middle, and high) and they were used for creating 9 (=3x3) exposure combinations of job control between T1 and T2.

LowLow (low control at T1 and low control at T2); LowHigh; HighLow; HighHigh; and Middle (LowMiddle, MiddleLow, MiddleMiddle, MiddleHigh, and HighMiddle – these 5 middle groups were combined into one group for a simpler analysis).

• Job Strain: A combination of job control and job demands (Karasek, 1979): high strain (low control and high demand) vs. low strain (the other three combinations).

Background – FORWARD study

4 Focus Groups of Firefighters (N=20)

Conclusions and Implications

The focus groups pointed to the possibility of significant differences in the interpretation of questionnaire items by rank of firefighters. Focus groups proved to be a very effective method for developing a firefighter occupational health questionnaire.

It will be used for the 15-month survey starting May 23, 2011 at UCI-COEH. It will be further validated through the survey and sub-study (starting July 2011). The current version is available to other researchers. Contact: Dr. BongKyoo Choi (b.choi@uci.edu)

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Adverse Working Conditions:

Slow/Too busy HousesFrequent 24-hrs shift work

(overtime)Poor social relationship at work

Poor health climateHigh job strain

High effort/reward imbalanceHigh emotional demands

ObesityLow work

and non-workPhysical inactivity

(watching TV, games)

Overeating/Unhealthy diet

(high fat/sugar)

Hypothalamus Dysfunction

(autonomic, endocrine,

and circadian)

Job title/Gender & Other Individual Factors (age, race, marital status, self-efficacy, self-esteem, coping, etc)

Significant reductionof structural fires:

Reduction of energy expenditure

Increased emergencyresponse calls:

Historical changesin tasks of firefighters

(since 1978)

+ causal moderating

Firefighter Wellness and Fitness Programs

Health Behaviors

CNS

interaction

Chronic Strain

Focus Group (90 minutes) Procedure

1. Introduce the purposes of the FORWARD study and Focus group (IRB Study Information Sheet)

2. A brief free-talk about the causes of obesity in firefighters3. Review working-conditions in the questionnaire and identify

missing areas (domains)4. Review questions in the questionnaire and discuss alternative

questions and wordings5. Discuss firefighter health behaviors