A Theory-Guided Qualitative Exploration of Occupational Influences on Firefighters' Dietary Behaviors

Firefighters face many inherent occupational health hazards and increased risk for several cancers, making peak health essential. However, cardiac events and stroke continue as leading causes of on-duty deaths. Healthy diets promote prevention of cardiovascular disease and cancers. While some dietary interventions have been undertaken, sustained improvements have not been observed. Understanding firefighters' occupational influences on dietary behavior is vital for implementation of effective interventions to improve nutrition.

The Theoretical Domains Framework (TDF) guided this qualitative study. Nine focus groups of firefighters who work 24-hour shifts and one interview with a fire administrator (N = 34) were conducted in 2018 across South Carolina, United States.

Predominant TDF domains of influence for workplace dietary behaviors included social/professional role and identity; social influences; environmental context and resources; knowledge; beliefs about consequences; memory, attention, and decision processes; and emotion. Four emergent themes mapped to TDF domains: "We are family": Firefighters feel a strong identity in their work and with peers; "If you are a firefighter, you've got a second job": Firefighters experience many limitations in personal and workplace resources; "That kills us": Firefighters were knowledgeable about most all occupational health and safety risks except dietary risks; and "You're tired, wore out": Occupational stress influenced nutritional choice making.

Firefighters experience many barriers to healthy eating while at work due to unique occupational influences. The findings from this study highlighted specific behavioral domains and barriers to be intervened upon that may increase the likelihood of long-term adoption of healthier dietary practices by firefighters.