The Determinants of Firefighter Physical Fitness: an Inductive Inquiry Into Firefighter Culture and Coronary Risk Salience
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The Determinants of Firefighter Physical Fitness: An Inductive Inquiry into Firefighter Culture and Coronary Risk Salience John Alexander Staley III A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Policy and Administration, School of Public Health. Chapel Hill 2008 Approved By: James Porto, Ph.D., MPA (Chair) Bryan Weiner, Ph.D. Laura Linnan, Sc.D., CHES Bonnie Rogers, DrPH COHN FAAN Felicia Mebane, Ph.D., MSPH © 2008 John Alexander Staley III ALL RIGHTS RESERVED ii ABSTRACT John Alexander Staley III: The Determinants of Firefighter Physical Fitness: An Inductive Inquiry into Firefighter Culture and Coronary Risk Salience (Under the direction of Dr. James V. Porto) Objective: An extensive body of research demonstrates firefighters are at risk of sudden cardiac death, with physical fitness a significant contributor to coronary outcomes. Emergency response events place considerable physiological demands on firefighters that require high levels of fitness and cardiovascular endurance many firefighters do not possess. Additionally, interventions demonstrate little effectiveness improving firefighter long term fitness level. Yet previous research demonstrates that unique socio-cultural and normative factors may influence firefighter health behaviors, but little is understood regarding the presence of overall fitness culture. It is uncertain if fitness and readiness expectations translate into practice, i.e., whether physical fitness is a core value in firefighter culture. Therefore it may be inappropriate to implement behavioral change without first considering the part physical fitness plays in firefighting. This research informed these critical knowledge gaps by: 1) Determining the cultural meaning of physical fitness, worksite program adherence, and coronary health from the firefighter’s perspective, 2) Identifying if fitness norms exist in the absence of mandatory programs, and 3) Ascertaining factors that facilitate overall firefighter physical fitness. Study Design: Full time firefighters were recruited from four urban North Carolina fire departments. The study was guided by a social ecological framework in which data was gathered via a three phase, mixed methods design. Ethnographic key informant interviews provided intrapersonal perspectives into the cultural meaning of fitness, iii worksite program adherence, and coronary health. Focus groups identified structural components of fitness norms and socio-cultural factors influencing fitness within fire service culture. The results of the focus groups were then used to guide development of a survey administered to approximately 1,000 firefighters to test emergent hypotheses regarding socio-cultural factors influencing fitness, including any correlation between fitness level and normative structural characteristics of fitness and smoking behaviors in the work environment. Principal Findings: Key insights into socio-cultural and normative factors affecting firefighter fitness has provided significant insights to assist fire departments to improve the effectiveness of workplace fitness programs, and change the culture of fitness and low coronary risk salience. iv To my “Life Beat” Amy, Abby Nub, and Noah v ACKNOWLEDGEMENTS Though many people might say the dissertation journey is but a hurdle in the marathon of completing the Ph.D., I can say that it was an arduous, yet joyful and life- changing experience. During the course of my research I learned that firefighters are much more than we expect and admire in our public servants; they truly are heroes in the purest and greatest sense. They put their lives on the line every day, and suffer from the same human frailties that plague us all. Yet still, as one firefighter reminded me, “we run into the fire when others are running out”. I found through the course of two years of close work with firefighters that they are wonderfully passionate about their work and care deeply for the needs of the public health. My thanks go to the Cary, Chapel Hill, Durham, and Raleigh Fire Departments, and I can only hope that my research will someday help improve and save your lives, to in some small part return the favor for those of us whom you save everyday. Additionally, I learned that I have considerably more physical and mental strength than I previously thought possible. To work through chronic back pain (at times lying on an ice pack with my laptop on my chest), my wife’s own work and graduate education schedule, and the birth of two precious children that bring me joy and wonder daily that only a parent can understand, I realize that throughout this phase of the journey of my life, how gracious and merciful our Heavenly Father is. Beyond a doubt, His mercies are renewed daily and He has given me unlimited strength when I needed it; for as “those who hope in the LORD will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.” vi (Isa 40:31 (NIV)) Thank you Heavenly Father for saving my life and giving me the second chance to glorify you at the university I love, through the gift to all of your Son and my savior Jesus Christ. And now, to thank those who have been so integral to my life, I would first like to thank my beautiful “Life Beat” Amy, my wife and partner in life, for her patience, love, and sweet reassurance when I felt overwhelmed during those sleepless nights when I though I might never complete my research. She always reminds me to turn to the Lord for renewed peace and focus, as He ALWAYS comes through. I must also thank my two year old daughter Abigail Grace, for when I come home from work mentally exhausted and back aching, she always yells “Daddy!”, and runs up, hugs me and invites me to join her for “marker markers”, which is drawing in her coloring book on our kitchen floor. Simple pleasures such as these are the best treasures in life. Additionally, though only two months old at the time of completion of my Ph.D., my son Noah James’s smile will always be a snapshot for my joyful mental scrapbook. I would also like to thank my mom and dad, Coble and John Staley, who during all my life crises and despite foolish life choices you were always (and still are) there for me. I have always known your love, and I too love you so very much. Mom, you are so very smart and gifted with helping me and others through life’s obstacles, and Dad, you have always supported me unconditionally in my life decisions, despite knowing many were doomed for failure. I am overjoyed that we can share the excitement of completing my Ph.D. together, as your love, help, and reassurance were critical to the mental health of Amy and me! Additionally, we can share in the joy of the daily wonders of your grandchildren. How abundantly blessed we are Poppa and Gigi! vii To my chair, mentor, “psycho-therapist”, and friend, Dr. Jim Porto, you have been integral to my growth as a researcher and scholar. Your open door mantra and ability to answer any question, calm any fear, and save my family’s financial stability, despite being involved with a dozen other research projects, students, and putting out “fires” will never be forgotten. Thank you so very much Jim! You will always be the person I look up to as the model of a faculty member who personifies the “Carolina Way”. To my committee members, I would like to thank Dr. Bryan Weiner, as your unwavering support and guidance as my second mentor throughout my research and doctoral career were vital to the success of my research and scholarly growth. To Dr. Laura Linnan, your direction through the health behavior, education, and promotion jungle was invaluable; to Dr. Felicia Mebane, your guidance from the earliest days of my program and our monthly political science dinners was both fun and greatly supportive; and to Dr. Bonnie Rogers, your faith in my ability to be a member of a top doctoral program, and fighting for my right to be in a program among high caliber candidates recruited by several tier one doctoral programs will not be forgotten. I would also like to acknowledge the research expertise and assistance of Dr. Jennifer Griffith in the development and facilitation of my focus group discussions, as well as Doug Melton for his coding proficiency and more importantly, his friendship. Lastly, I would like to thank ex-officio committee members for their insights and support during my doctoral program tenure. My thanks and gratitude goes to Dr. Tom Griggs, Dr. Kerry Kilpatrick, and Susan Randolph. Additionally, I wish to thank Drs. Ned Brooks, Bill Zelman, Sue Havala-Hobbs, and John Paul of the Department of Health viii Policy and Administration, UNC School of Public Health, for their mentoring and support of me as a colleague and “one of them”. ix TABLE OF CONTENTS LIST OF TABLES........................................................................................................... xvi LIST OF FIGURES ........................................................................................................ xvii Chapter I. Introduction 1. 1. Overview of the Problem...........................................................................1 1. 2. Background and Significance ....................................................................3 1. 2.1. Physical Activity Reduces Coronary Heart Disease Risk.................................................................................................3