Interactions between home, work, and sleep among firefighters

Lifestyle Dimensions of Public Safety Personnel Families: There's No Life Like It

PURPOSE

The nature and cumulative occupational demands imposed on families of public safety personnel (PSP) are substantial, in many cases non-negotiable, and distinct from the general population accentuating risk factors for family well-being. Despite this reality, the contributions of PSP families are not well understood, and a conceptual framework is needed. The aim of this paper is to summarize contextual factors (lifestyle dimensions) that shape the lives of PSP families; factors supported in the existing, albeit limited, body of research.

METHODS

Grounded in the interpretive/constructivist paradigm, a synthesis was central to understanding the lived experiences of PSP families. An interdisciplinary research team engaged in an iterative process of framework analysis to capture the variability and complexity of PSP family life and distilled the overarching lifestyle dimensions.

RESULTS

Three lifestyle dimensions-logistics, risks, and identities-emerged from contextual factors and represent distinct aspects of PSP family life. PSP families play a crucial role in that their capacity to accommodate the lifestyle dimensions (i.e., logistics, risks, and identities), without which the PSP could not meet the demands of the profession.

CONCLUSION

Promoting awareness of these dimensions and their consequent demands underscores the cumulative demands that put PSP families at risk. Responses from governments, public safety organizations, and communities are required to help PSP families manage non-negotiable elements of the public safety occupation that spill over into family life over which they have no control.

Effect of Peanut Butter Intake on Sleep Health in Firefighters: A Randomized Controlled Trial

Sleep is often impaired in firefighters due to the psychologically and physiologically intense nature of their work and working shift schedules. Peanut butter is affordable and a substantial source of monounsaturated fatty acids, which may aid sleep health. Thus, this study sought to determine if a daily serving of peanut butter consumed before bedtime for seven weeks altered sleep quality and quantity among full-time firefighters. Forty firefighters (peanut butter group = 20; control group = 20) participated in this eight-week randomized controlled trial. All participants completed a subjective questionnaire on mood, focus, and alertness twice daily and wore an Actigraph wristwatch to measure sleep variables, including latency, efficiency, time in bed, time asleep, wake after sleep onset, number of awakenings, and time spent awake. After a baseline week, the peanut butter group consumed two tablespoons of peanut butter two hours prior to bedtime for seven weeks. Compared to the control group, the peanut butter group did not demonstrate significant changes (p > 0.05) in sleep measures or subjective feelings of mood, focus, or alertness after consuming peanut butter for seven weeks. Therefore, peanut butter as a source of peanuts did not alter sleep quality or quantity in this group of firefighters.

Comparing actigraphy and diary to measure daily and average sleep in firefighters: a Bland-Altman analysis

STUDY OBJECTIVES

This study sought to examine the relationship between actigraphy and the Consensus Sleep Diary to contribute information on their concurrent validity in a sample of career firefighters.

METHODS

Sixty firefighters were recruited from a large, urban fire department in the southwest United States that utilizes a fire-based emergency medical services system and a 5/6 shift schedule. A total of 329 differences were recorded during participants' 6-day between-shift recovery period. Data was collected utilizing the two most common forms of sleep analysis in an outpatient setting, wrist actigraphy (Actiwatch-2) and the Consensus Sleep Diary. Nine major sleep indices were computed: wake time after sleep onset, total sleep time, sleep onset latency, sleep offset, in-bed time, lights-off time, out-of-bed time, wake time, and sleep efficiency.

RESULTS

Firefighters overestimated sleep efficiency and underestimated wake after sleep onset by values that were greater than the American Academy of Sleep Medicine a priori clinical significance thresholds. All indices showed very broad limits of agreement. For example, the 95% confidence interval for diary and actigraphic total sleep time estimates fell within a 4.7-hour range.

CONCLUSIONS

Firefighters receiving recovery sleep between tours demonstrated significantly large disagreements between their daily self-reported sleep and measured actigraphic sleep. Sleep findings from actigraphic and Consensus Sleep Diary sleep assessments in this population should be interpreted cautiously until each method is compared against other reliable sleep analysis methods. Currently it is unclear if clinicians are using properly validated tools when diagnosing shift work disorder or other sleep disorders in firefighters.

CITATION

Marmis R, McGoldrick-Ruth L, Kelly MR, Haynes PL. Comparing actigraphy and diary to measure daily and average sleep in firefighters: a Bland-Altman analysis. J Clin Sleep Med. 2024;20(4):497-503.

Expanding Research on Firefighter Trainee Fitness, Reasons for Academy Release, and the Predictive Capabilities of Fitness Tests

ABSTRACT

Lockie, RG, Orr, RM, Montes, F, and Dawes, JJ. Expanding research on firefighter trainee fitness, reasons for academy release, and the predictive capabilities of fitness tests. J Strength Cond Res 38(4): 724-733, 2024-Firefighter trainees need a level of fitness to be admitted to and complete a training academy. Fitness could indicate a trainee's likelihood of graduation, in addition to their reasons for release. This study determined fitness differences between firefighter trainees who graduated (GRAD) from academy or were released because of injury (RELI), performance test failures (RELP), or resignation (RELR), and whether fitness predicted graduation. Occupational physical ability test (OPAT) data for 686 trainees were analyzed, including: Illinois agility test; push-ups; pull-ups; leg tucks; maximal aerobic capacity (V̇O2max); backward overhead medicine ball throw; 10-repetition maximum deadlift; and farmer's carry. Raw and scaled (based on internal scoring) scores were recorded. Trainees were split into GRAD (n = 576), RELI (n = 33), RELP (n = 66), and RELR (n = 11) groups. A 1-way ANOVA with Bonferroni post hoc calculated between-group differences. Stepwise linear regression determined whether fitness predicted group inclusion. Receiver operating curves and area under the curve (AUC) derived test accuracy for predicting academy release. The GRAD group was superior (p ≤ 0.04) to the RELI group in all tests except push-ups, pull-ups, and farmer's carry; RELP group in all tests except the farmer's carry; and RELR group in V̇O2max, deadlift, and total OPAT score. Select fitness tests could predict inclusion in each group, although the explained variances were low (∼1-11%). Raw V̇O2max (AUC = 0.71) and total OPAT score (AUC = 0.74) had acceptable prediction accuracy. Fitness influenced academy graduation and reasons for release. Scaled scores could predict group inclusion in this department; V̇O2max and total OPAT score provided the most accurate predictors for release.

Sleep Quality and Associated Factors Among Firefighters in Bangkok, Thailand: A Cross-sectional Study

OBJECTIVES

Professional firefighters face various health hazards and are required to maintain both physical and mental fitness to effectively mitigate crises and respond to emergencies. Moreover, the long working hours and shift work of this profession impact sleep quality. This study investigated the quality of sleep and its associated factors among firefighters in Bangkok, Thailand.

METHODS

This was a cross-sectional study of firefighters affiliated with the Bangkok Fire and Rescue Department, Bangkok Metropolitan Administration, Thailand between January 2023 and March 2023. A cluster random sampling technique was utilized to distribute 600 questionnaires to firefighters in 15 fire stations. The questionnaire addressed demographic, work-related, and environmental factors. Sleep quality was assessed using the Thai version of the Pittsburgh Sleep Quality Index (PSQI). Data analysis involved both descriptive and inferential statistics. Bivariate and multiple logistic regressions were performed.

RESULTS

The response rate was 78.7% (n=472), and 44.1% of the firefighters reported poor sleep quality (PSQI score >5). Sleep quality was statistically associated with conflicting family relationships (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1 to 2.9), additional part-time jobs (daytime, OR, 2.4; 95% CI, 1.3 to 4.4; or nighttime, OR, 4.3; 95% CI, 1.1 to 16.7), noisy sleeping areas (OR, 1.7; 95% CI, 1.1 to 2.8), and the availability of adequate bedding (OR, 3.0; 95% CI, 1.8 to 4.9).

CONCLUSIONS

Poor sleep quality among firefighters was associated with various personal, work-related, and environmental factors. Organizations should promote policies that improve sleep quality through good sleep hygiene practices and facilities.

Marital status and living apart affect sleep quality in male military personnel: a study of the China's Navy during COVID-19

Background

Marital status is a robust sociodemographic predictor of sleep. Having to live apart from spouse may have different implications than those of cohabitants or singles, especially in military personnel. Further research on this group will help provide knowledge in advance and facilitate early targeted interventions.

Methods

An online questionnaire study was conducted from July to November 2021. A total of 1,832 male military personnel completed the questionnaire. The marital status was measured by a self-reported single choice question. Pittsburgh sleep quality index (PSQI), Epworth Sleepiness Scale (ESS) and The Dysfunctional Beliefs and Attitudes about sleep scale (DBAS-16) were used to measure sleep-related outcomes. Inverse probability weighting (IPW) was applied to reduce the effects of confounding. Logistic regression was used to analyze the relationship between marital status and sleep and explore the impact of living together or not.

Results

After inverse probability weighting, the prevalence of poor sleep quality, sleepiness and dysfunctional beliefs were 16.1, 20.1 and 7.1%, respectively. One-way ANOVA results for the means of both groups were statistically significantly different, except for the sleep latency and sleep disturbance dimensions of PSQI. Participants who were married were more likely to have poor sleep quality (OR: 1.408, 95% CI: [1.10, 1.80]), to have daytime sleepiness (OR: 1.560, 95% CI: [1.27, 1.92]) and to develop dysfunctional beliefs and attitudes (OR: 2.497, 95% CI: [1.65, 3.80]) than those who were unmarried. Further analysis showed that the odds of developing poor sleep quality and DBAS in participants who married but living apart were significantly bigger than those unmarried (OR: 1.548 and 3.991, respectively.), while there were no significant differences in the odds of daytime sleepiness (OR: 0.738, p = 0.050). Age was a protective factor for the development of bad sleep outcomes, while family economic was an independent risk factor.

Conclusion

Marital status appear important for sleep quality, daytime sleepiness and sleep beliefs. The effect of living apart or not should be considered separately as an important predictor of sleep.

Fatigue as a Cause of Professional Dissatisfaction Among Chinese Nurses in Intensive Care Unit During COVID-19 Pandemic

Aim

To clarify the mediating role of burnout and the moderating role of turnover intention in the association between fatigue and job satisfaction among Chinese nurses in intensive care units (ICU) during the COVID-19 pandemic.

Methods

A cross-sectional survey of fifteen provinces in China was conducted, using an online questionnaire, from December 2020 to January 2021, during the COVID-19 pandemic. A total of 374 ICU nurses (effective response rate: 71.37%) provided sufficient responses. Sociodemographic factors, job demographic factors, fatigue, burnout, job satisfaction, and turnover intention were assessed using questionnaires. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive modeling (GAM) were performed to examine all the considered research hypotheses.

Results

Fatigue was found to be negatively and significantly associated with job satisfaction. Moreover, burnout played a partial mediating role and turnover intention played a moderating role in the relationship between fatigue and job satisfaction.

Conclusion

Over time, a state of physical and mental exhaustion and work weariness among Chinese ICU nurses potentially results in job burnout and consequently promotes the level of job dissatisfaction. The results also found that turnover intention played a moderating role in the relationship between burnout and job satisfaction. Specific policies could be considered to eliminate nurses' fatigue and negative attitudes during times of public health emergencies.

Mobile app for personalized sleep–wake management for shift workers: A user testing trial

Objective

Development of personalized sleep–wake management tools is critical to improving sleep and functional outcomes for shift workers. The objective of the current study was to test the performance, engagement and usability of a mobile app ( SleepSync) for personalized sleep–wake management in shift workers that aid behavioural change and provide practical advice by providing personalized sleep scheduling recommendations and education.

Methods

Shift workers ( n = 27; 20 healthcare and 7 from other industries) trialled the mobile app for two weeks to determine performance, engagement and usability. Primary outcomes were self-reported total sleep time, ability to fall asleep, sleep quality and perception of overall recovery on days off. Secondary performance outcomes included sleep disturbances (insomnia and sleep hygiene symptoms, and sleep-related impairments) and mood (anxiety, stress and depression) pre- and post-app use. Satisfaction with schedule management, integration into daily routine and influence on behaviour were used to determine engagement, while the usability was assessed for functionality and ease of use of features.

Results

Total sleep time ( P = .04), ability to fall asleep ( P < .001), quality of sleep ( P = .001), insomnia ( P = .02), sleep hygiene ( P = .01), sleep-related impairments ( P = .001), anxiety ( P = .001), and stress ( P = .006) were all improved, with non-significant improvements in recovery on days off ( P = .19) and depression ( P = .07). All measures of engagement and usability were scored positively by the majority of users.

Conclusions

This pilot trial provides preliminary evidence of the positive impact of the SleepSync app in improving sleep and mood outcomes in shift workers, and warrants confirmation in a larger controlled trial.

Effects of fitness on self-reported physical and mental quality of life in professional firefighters: An exploratory study

BACKGROUND

The work-related stress experienced by firefighters is associated with numerous health issues. In the general population, improving physical fitness is associated with improvements in both mental and physical quality of life.

OBJECTIVE

The purpose of the study was to examine whether fitter professional firefighters report greater physical and mental quality of life.

METHODS

Twenty-three professional firefighters (males = 21, females = 2; age: 36.78±7.12yrs; height: 176.96±5.67 cm; weight: 88.20±16.02 kg; years of service: 8.70±6.62years) volunteered for the study. Participants completed a fitness protocol that included the wall sit and reach, Y-balance test, vertical jump, 1 repetition maximum bench press, pull-ups to failure, push-ups to failure, a plank hold and 1-mile run. The short form 36 questionnaire was used to assess overall quality of life. Firefighters were divided into "high" and "low" groups for physical and mental quality of life. Group differences in fitness parameters were assessed using a multivariate analysis of covariance with gender, age, years of service, height, and body mass as co-variates.

RESULTS

Firefighters with lower mental quality of life had lower body fat percentages (p = 0.003), fat mass (p = 0.036), greater fat free mass (p = 0.015), vertical jump height (p = 0.024) and performed more pull-ups (p = 0.003). There were no significant differences in any of the fitness measures between high and low physical quality of life groups.

CONCLUSION

The findings indicate that physical fitness of firefighters is not indicative of overall health. Firefighters might use exercise to cope for psychological stress and a holistic approach to improve firefighter quality of life is recommended.

What matters most? Network analysis of mental health, recovery experiences, sleep, and fatigue among career firefighters

Firefighters exhibit a higher prevalence of mental health issues than other occupations because they often directly or indirectly experience potentially traumatic events. Previous research has suggested that recovery experiences, sleep, and fatigue may be protective or risk factors for firefighters' mental health. This study conducted regularised partial correlation network analysis to investigate and visualise the complex relationships between these variables. We collected data through an online survey, and 3144 career firefighters from a large east-coast city in China, were included in the analyses. The results of the network analysis showed that: (1) only relaxation and mastery experiences directly correlated with one dimension of the mental health scale, namely, life/social functioning; (2) sleep quality had stronger correlations with mental health issues than sleep quantity; and (3) mental health issues were central nodes of the network. These results indicated that firefighters' mental health was close to other variables in the network and acted as a bridge linking other variables. Therefore, more attention should be paid to the mental health of firefighters to prevent comorbidities. The study's results also indicated that recovery experiences and sleep may be protective factors for firefighters' mental health.

Lifestyle and environmental factors may induce airway and systemic inflammation in firefighters

Health status depends on multiple genetic and non-genetic factors. Nonheritable factors (such as lifestyle and environmental factors) have stronger impact on immune responses than genetic factors. Firefighters work is associated with exposure to air pollution and heat stress, as well as: extreme physical effort, mental stress, or a changed circadian rhythm, among others. All these factors can contribute to both, short-term and long-term impairment of the physical and mental health of firefighters. Increased levels of some inflammatory markers, such as pro-inflammatory cytokines or C-reactive protein (CRP) have been observed in firefighters, which can lead to local, acute inflammation that promotes a systemic inflammatory response. It is worth emphasizing that inflammation is one of the main hallmarks of cancer and also plays a key role in the development of cardiovascular and respiratory diseases. This article presents possible causes of the development of an inflammatory reaction in firefighters, with particular emphasis on airway inflammation caused by smoke exposure.

The mental health and wellbeing of spouses, partners and children of emergency responders: A systematic review

Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners’ mental health problem on the couples’ communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER’s operational effectiveness.

Public Safety Personnel Family Resilience: A Narrative Review

The families of public safety personnel (PSP) face demands that are unique to these occupations. Nonstandard work, trauma exposure, and dangerous work environments affect both workers and the families who support them. This narrative review aims to identify the stressors that PSP families experience and the support and resources needed to enhance family resilience. Due to a lack of research on PSP families, this review is a necessary first step to summarizing and interpreting a diverse body of research. The studies included addressed structural and emotional work-family conflict with reference to PSP sectors. A framework from the military family resiliency literature interprets the findings. Factors influencing family functioning and the availability and accessibility of resources provide clues about the type of skills and supports that PSP families rely on. Meaning-making, collaboration, a sense of coherence, and communication were identified as themes associated with intrafamilial processes. Extrafamilial themes included public perceptions, a lack of recognition for the roles families fulfill, and the need for information and education. The results suggest that the vulnerability of PSP families is variable and extrafamilial resources in the form of formal and informal supports are necessary to enhance family resiliency.

Helping others not always helps ourselves: the relationship between victim incivility and emergency workers' burnout through work-to-family conflict

Purpose

This study aims to analyse whether and when victim incivility may be related to work-to-family conflict and then burnout among emergency workers.

Design/methodology/approach

A total of 304 Italian emergency workers from five firehouses and six emergency rooms completed questionnaires, examining: victim incivility, work-to-family conflict, social support seeking and burnout symptoms. Descriptive analyses, confirmatory factor analyses and structural equation models were conducted.

Findings

Victim incivility was positively associated with burnout symptoms, both directly and indirectly, as mediated by work-to-family conflict. Additionally, social support seeking exacerbated (rather than mitigated) the impact of work-to-family conflict on burnout symptoms.

Practical implications

Organisations can greatly benefit from implementing family-friendly practices and providing their workers with training programmes on how to deal with difficult victims.

Originality/value

This study contributes to the existing literature on workplace incivility and work–life interface by supporting for the first time the notion that victim incivility can spill over into emergency workers' family domain and by clarifying how and when victim incivility is related to burnout symptoms.