Health Disparities Among Racial and Ethnic Minority Firefighters

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. 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 nonminority 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/m) and BF% (24.7± 0.7%) when compared to their white, non-Hispanic 106 Health Disparities Among Racial and Ethnic Minority Firefighters Poston et al. Journal of Health Disparities Research and Practice Volume 7, Issue 5 2014 colleagues (27.7±0.2kg/m and 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=1.162.18). 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<0.001). Firefighters serving MDCs also had 48% (AOR=0.52; 95%CI=0.30-0.91) less risk for lifetime depression than firefighters working in WDCs, but minority firefighters in MDCs were the least likely to have a history of physician diagnosed depression while minorities in WDCs had the highest rate of lifetime history of depression. 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