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Firefighters and cigarettes: What the numbers say

Peer pressure and policy have drastically altered firefighters’ smoking habits more dramatically that what’s seen in the general population


There remains no real debate about cigarettes — everyone from your grandmother to your 5-year-old is well versed on how they increase risk for cancer, heart disease and pretty much every other illness possible.

For smokers, quitting smoking is the single best thing they can do to reduce those risks — even above changes in diet and exercise.

There are no studies from the past few decades that look specifically at the rates of cigarette use by firefighters. But there are a few studies that report smoking as a co-variate or as part of the demographics.

What we find is alarming: around 40 to 50 percent of firefighters smoked in the 1990s. The rate was more than males in the general population at the time, which was around 30 percent.

The rates in the literature is consistent with stories from older firefighters who describe day rooms and kitchens with smoke weighing heavy in the air, rookies being tasked with carrying their captains’ packs, and celebrating a good fire with a smoke on the tailboard.

As there has been an increased understanding of the dangers of smoking, the rates of cigarette use in the general population have dropped. They are typically around a quarter of the population for males.

Getting it right
The rates for the fire service, however, are different. While not true of every department and every area, research shows a range between only 7 to 13 percent of firefighters smoking.

By contrast the military has smoking rates among males as high as 30 percent. And that is despite considerable efforts being spent on anti-tobacco messaging and access to free smoking cessation for military members.

So what did the fire service do so right?

In our qualitative work, many firefighters have said they believe the rates of smoking are reflective of the general population and increased awareness of the dangers of smoking. If that was the only reason for the decrease, rates would still be about 10 percent higher than they are.

Rather, the fire service has made smoking something that is seen as not consistent with being a firefighter. There has been a shift of the social norm among firefighters to an environment where smoking is not accepted.

Under peer pressure
In our focus groups across the country, the shift in peer pressure was obvious. Anytime the topic of smoking came up, if one of the firefighters in the group smoked, everyone else made a point of letting us know. It usually came with a lot of mocking and a few friendly insults.

The fire service was able to use the brotherhood/sisterhood and use the peer pressure to encourage a positive health change. In our research, firefighters and fire officers discussed the shift from a pro- to an anti-cigarette environment and the reasons behind the change.

A major motivator has been the presumptive laws and the need to eliminate smoking as it is so consistently related to the diseases that are the focus of presumptive legislation. This has spawned several tobacco-free policies and no-smoking contracts in some areas and departments.

Smoke-free workplace policies also curtailed much of the smoking in the firehouse. There also has been an increased focus on the negative health effects of occupational exposures for firefighters.

It’s clear that choosing to add to that risk through voluntarily inhaling additional carcinogens in a cigarette is inconsistent with the mission of firefighters.

Area of concern
Some have argued for a more libertarian approach to smoking among firefighters. The argument goes that firefighters are adults, cigarettes are legal, and they should be allowed to make their own decisions — that policies limiting tobacco use are unfair.

For a job that is not health-dependent, this approach could arguably be acceptable. The challenge comes when looking at the risk factors of crews as a whole.

We know that cigarettes are a significant risk factor for cardiovascular disease and contribute significantly to the risk of a fireground heart attack. Heart attacks occurring on the fireground are a risk not only to the firefighters’ experiencing them but also to the rest of the crews who have to respond to the emergency.

There are many policies that firefighters must adhere to that others do not. Having a beard is not against the law, and any adult man is free to grow one. That is, unless they have to maintain a seal on the SCBA mask, in which case the beard puts them at risk; so, there are policies against them.

The not-so-great news is that the rates of smokeless tobacco use among firefighters is high. In fact, it is double the rates of the general population and other similar occupations.

Some attribute this to shifting from cigarettes to smokeless. Yet, only 15 percent of firefighters report using smokeless because of restrictions on cigarettes.

While smokeless tobacco use is arguably less harmful than cigarettes both to the user and in terms of second hand smoke, it still carries its own level of risk for cancer and heart disease.

So there is still work to do getting those rates down. But, as the fire service has shown, it can be done.

Sara Jahnke, PhD, is the director and a senior scientist with the Center for Fire, Rescue & EMS Health Research at the National Development & Research Institutes - USA. With over a decade of research experience on firefighter health, Dr. Jahnke has been the principal investigator on 10 national studies as well as dozens of studies as a co-investigator. Her work has focused on a range of health concerns, including the health of female firefighters, behavioral health, risk of injury, cancer, cardiovascular risk factors, and substance use, with funding from the Assistance to Firefighters Grant R&D Program, the National Institutes of Health and other foundations. Jahnke has more than 100 publications in the peer-reviewed medical literature. Awards include the 2019 Endowed Lecture at the annual conference of the American College of Epidemiology; the 2018 President’s Award for Excellence in Fire Service Research as well as the Excellence in Research, Safety, Health & Survival Award, both from the International Association of Fire Chiefs (IAFC); and the 2016 John Granito Award for Excellence in Firefighter Research from the International Journal of Fire Service Leadership and Management. Connect with Jahnke on LinkedIn, Twitter or via email.