DHS-Harvard Firefighters’ Studies

Grant Number: U.S. Department of Homeland Security Award Number EMW-2006-FP-01493
P.I. Stefanos N. Kales MD, MPH, FACP, FACOEM; Harvard School of Public Health

Publications

1. Baur DM, Leiba A, Christophi CA, Kales SN. Low fitness is associated with exercise abnormalities among asymptomatic firefighters. Occup Med (Lond). 2012;62(7):566-569. doi:10.1093/occmed/kqs112
2. Baur DM, Christophi CA, Tsismenakis AJ, Jahnke SA, Kales SN. Weight- perception in male career firefighters and its association with cardiovascular risk factors. BMC Public Health. 2012;12:480. Published 2012 Jun 25. doi:10.1186/1471-2458-12-480
3. Baur DM, Christophi CA, Cook EF, Kales SN. Age-Related Decline in Cardiorespiratory Fitness among Career Firefighters: Modification by Physical Activity and Adiposity. J Obes. 2012;2012:710903. doi:10.1155/2012/710903
4. Baur DM, Christophi CA, Kales SN. Metabolic syndrome is inversely related to cardiorespiratory fitness in male career firefighters. J Strength Cond Res. 2012;26(9):2331-2337. doi:10.1519/JSC.0b013e31823e9b19
5. Durand G, Tsismenakis AJ, Jahnke SA, Baur DM, Christophi CA, Kales SN. Firefighters’ physical activity: relation to fitness and cardiovascular disease risk. Med Sci Sports Exerc. 2011;43(9):1752-1759. doi:10.1249/MSS.0b013e318215cf25
6. Tsismenakis AJ, Christophi CA, Burress JW, Kinney AM, Kim M, Kales SN. The obesity epidemic and future emergency responders. Obesity (Silver Spring). 2009;17(8):1648-1650. doi:10.1038/oby.2009.63
7. Kales SN, Tsismenakis AJ, Zhang C, Soteriades ES. Blood pressure in firefighters, police officers, and other emergency responders. Am J Hypertens. 2009;22(1):11-20. doi:10.1038/ajh.2008.296

Grant Number: U.S. Department of Homeland Security Award Number EMW-2009-FP-00835
P.I. Stefanos N. Kales MD, MPH, FACP, FACOEM; Harvard School of Public Health

Publications

1. Farioli A, Christophi CA, Quarta CC, Kales SN. Incidence of sudden cardiac death in a young active population. J Am Heart Assoc. 2015;4(6):e001818. Published 2015 Jun 11. doi:10.1161/JAHA.115.001818
2. Farioli A, Christophi CA, Quarta CC, Kales SN. Incidence of sudden cardiac death in a young active population. J Am Heart Assoc. 2015;4(6):e001818. Published 2015 Jun 11. doi:10.1161/JAHA.115.001818
3. Farioli A, Yang J, Teehan D, Baur DM, Smith DL, Kales SN. Duty-related risk of sudden cardiac death among young US firefighters. Occup Med (Lond). 2014;64(6):428-435. doi:10.1093/occmed/kqu102
4. Kales SN, Smith DL. Sudden cardiac death in the fire service. Occup Med (Lond). 2014;64(4):228-230. doi:10.1093/occmed/kqu057
5. Yang J, Farioli A, Korre M, Kales SN. Modified Mediterranean diet score and cardiovascular risk in a North American working population. PLoS One. 2014;9(2):e87539. Published 2014 Feb 4. doi:10.1371/journal.pone.0087539
6. Yang J, Teehan D, Farioli A, Baur DM, Smith D, Kales SN. Sudden cardiac death among firefighters ≤45 years of age in the United States. Am J Cardiol. 2013;112(12):1962-1967. doi:10.1016/j.amjcard.2013.08.029
7. Smith DL, Barr DA, Kales SN. Extreme sacrifice: sudden cardiac death in the US Fire Service. Extrem Physiol Med. 2013;2(1):6. Published 2013 Feb 1. doi:10.1186/2046-7648-2-6
8. Baur DM, Leiba A, Christophi CA, Kales SN. Low fitness is associated with exercise abnormalities among asymptomatic firefighters. Occup Med (Lond). 2012;62(7):566-569. doi:10.1093/occmed/kqs112
9. Baur DM, Christophi CA, Tsismenakis AJ, Jahnke SA, Kales SN. Weight- perception in male career firefighters and its association with cardiovascular risk factors. BMC Public Health. 2012;12:480. Published 2012 Jun 25. doi:10.1186/1471-2458-12-480
10. Baur DM, Christophi CA, Cook EF, Kales SN. Age-Related Decline in Cardiorespiratory Fitness among Career Firefighters: Modification by Physical Activity and Adiposity. J Obes. 2012;2012:710903. doi:10.1155/2012/710903
11. Baur DM, Christophi CA, Kales SN. Metabolic syndrome is inversely related to cardiorespiratory fitness in male career firefighters. J Strength Cond Res. 2012;26(9):2331-2337. doi:10.1519/JSC.0b013e31823e9b19
12. Durand G, Tsismenakis AJ, Jahnke SA, Baur DM, Christophi CA, Kales SN. Firefighters’ physical activity: relation to fitness and cardiovascular disease risk. Med Sci Sports Exerc. 2011;43(9):1752-1759. doi:10.1249/MSS.0b013e318215cf25

Grant Number: U.S. Department of Homeland Security Award Number EMW-2011-FP-00663
P.I. Stefanos N. Kales MD, MPH, FACP, FACOEM; Harvard School of Public Health

Publications

1. Korre M, Porto LG, Farioli A, et al. Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters. Am J Cardiol. 2016;118(11):1769-1773. doi:10.1016/j.amjcard.2016.08.058
2. Farioli A, Christophi CA, Quarta CC, Kales SN. Incidence of sudden cardiac death in a young active population. J Am Heart Assoc. 2015;4(6):e001818. Published 2015 Jun 11. doi:10.1161/JAHA.115.001818
3. Farioli A, Yang J, Teehan D, Baur DM, Smith DL, Kales SN. Duty-related risk of sudden cardiac death among young US firefighters. Occup Med (Lond). 2014;64(6):428-435. doi:10.1093/occmed/kqu102
4. Kales SN, Smith DL. Sudden cardiac death in the fire service. Occup Med (Lond). 2014;64(4):228-230. doi:10.1093/occmed/kqu057
5. Yang J, Teehan D, Farioli A, Baur DM, Smith D, Kales SN. Sudden cardiac death among firefighters ≤45 years of age in the United States. Am J Cardiol. 2013;112(12):1962-1967. doi:10.1016/j.amjcard.2013.08.029
6. Smith DL, Barr DA, Kales SN. Extreme sacrifice: sudden cardiac death in the US Fire Service. Extrem Physiol Med. 2013;2(1):6. Published 2013 Feb 1. doi:10.1186/2046-7648-2-6

Grant Number: U.S. Department of Homeland Security Award Number EMW-2013-FP-00749
P.I. Denise Smith, PhD; Skidmore College

Publications

1. Smith DL, Haller JM, Korre M, et al. The Relation of Emergency Duties to Cardiac Death Among US Firefighters. Am J Cardiol. 2019;123(5):736-741. doi:10.1016/j.amjcard.2018.11.049
2. Smith DL, Haller JM, Korre M, et al. Pathoanatomic Findings Associated With Duty-Related Cardiac Death in US Firefighters: A Case-Control Study. J Am Heart Assoc. 2018;7(18):e009446. doi:10.1161/JAHA.118.009446
3. Smith DL, DeBlois JP, Kales SN, Horn GP. Cardiovascular Strain of Firefighting and the Risk of Sudden Cardiac Events. Exerc Sport Sci Rev. 2016;44(3):90-97. doi:10.1249/JES.0000000000000081
4. Kales SN, Smith DL. Firefighting and the Heart: Implications for Prevention. Circulation. 2017;135(14):1296-1299. doi:10.1161/CIRCULATIONAHA.117.027018

Grant number: US Federal Emergency Management Agency (FEMA, Washington D.C., USA) Assistance to Firefighters Grant (AFG) program’s award EMW-2014-FP-00612

Publications

1. Kales SN, Smith DL. Firefighting and the Heart: Implications for Prevention. Circulation. 2017 Apr 4;135(14):1296-1299. doi: 10.1161/CIRCULATIONAHA.117.027018. PMID: 28373524.
2. Sotos-Prieto M, Cash SB, Christophi CA, Folta S, Moffatt S, Muegge C, Korre M, Mozaffarian D, Kales SN. Rationale and design of feeding America’s bravest: Mediterranean diet-based intervention to change firefighters’ eating habits and improve cardiovascular risk profiles. Contemp Clin Trials. 2017 Oct;61:101-107. doi: 10.1016/j.cct.2017.07.010. Epub 2017 Jul 11. PMID: 28710052.
3. Korre M, Sotos-Prieto M, Kales SN. Survival Mediterranean Style: Lifestyle Changes to Improve the Health of the US Fire Service. Front Public Health. 2017 Dec 18;5:331. doi: 10.3389/fpubh.2017.00331. PMID: 29326915; PMCID: PMC5741604.
4. Sotos-Prieto M, Christophi C, Black A, Furtado JD, Song Y, Magiatis P, Papakonstantinou A, Melliou E, Moffatt S, Kales SN. Assessing Validity of Self-Reported Dietary Intake within a Mediterranean Diet Cluster Randomized Controlled Trial among US Firefighters. Nutrients. 2019 Sep 19;11(9):2250. doi: 10.3390/nu11092250. PMID: 31546768; PMCID: PMC6769698.
5. Jin Q, Black A, Kales SN, Vattem D, Ruiz-Canela M, Sotos-Prieto M. Metabolomics and Microbiome as potential tools to evaluate the effects of Mediterranean Diet. Nutrients 2019, 11, 207; doi:10.3390/nu11010207.
6. Hershey MS, Sotos-Prieto M, Ruiz-Canela M, Martinez-Gonzalez MA, Cassidy A, Moffatt S, Kales SN. Anthocyanin Intake and Physical Activity: Associations with the Lipid Profile of a US Working Population. Molecules. 2020 Sep 24;25(19):4398. doi: 10.3390/molecules25194398. PMID: 32987892; PMCID: PMC7582364.
7. Sotos-Prieto M, Ruiz-Canela M, Song Y, Christophi C, Mofatt S, Rodriguez-Artalejo F, Kales SN. The Effects of a Mediterranean Diet Intervention on Targeted Plasma Metabolic Biomarkers among US Firefighters: A Pilot Cluster-Randomized Trial. Nutrients. 2020 Nov 24;12(12):3610. doi: 10.3390/nu12123610. PMID: 33255353; PMCID: PMC7761450.
8. Romanidou M, Tripsianis G, Hershey MS, Sotos-Prieto M, Christophi C, Moffatt S, Constantinidis TC, Kales SN. Association of the Modified Mediterranean Diet Score (mMDS) with Anthropometric and Biochemical Indices in US Career Firefighters. Nutrients. 2020 Nov 30;12(12):3693. doi: 10.3390/nu12123693. PMID: 33265967; PMCID: PMC7759922.
9. Hershey MS, Sotos-Prieto M, Ruiz-Canela M, Christophi CA, Moffatt S, Martínez-González MÁ, Kales SN. The Mediterranean lifestyle (MEDLIFE) index and metabolic syndrome in a non-Mediterranean working population. Clin Nutr. 2021 May;40(5):2494-2503. doi: 10.1016/j.clnu.2021.03.026. Epub 2021 Mar 31. PMID: 33932793.
10. Romero Cabrera JL, Sotos-Prieto M, García Ríos A, Moffatt S, Christophi CA, Pérez-Martínez P, Kales SN. Sleep and Association With Cardiovascular Risk Among Midwestern US Firefighters. Front Endocrinol (Lausanne). 2021 Nov 11;12:772848. doi: 10.3389/fendo.2021.772848. PMID: 34858343; PMCID: PMC8632221.
11. Christodoulou A, Christophi CA, Sotos-Prieto M, Moffatt S, Kales SN. Eating Habits among US Firefighters and Association with Cardiometabolic Outcomes. Nutrients. 2022 Jul 4;14(13):2762. doi: 10.3390/nu14132762. PMID: 35807942; PMCID: PMC9268786.
12. Hershey MS, Chang CR, Sotos-Prieto M, Fernandez-Montero A, Cash SB, Christophi CA, Folta SC, Muegge C, Kleinschmidt V, Moffatt S, Mozaffarian D, Kales SN. Effect of a Nutrition Intervention on Mediterranean Diet Adherence Among Firefighters: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2023 Aug 1;6(8):e2329147. doi: 10.1001/jamanetworkopen.2023.29147. PMID: 37589978; PMCID: PMC10436136.

Grant Number: Program Award Number EMW-FP-PP-00445, EMW- 2017- FP-. PP- 00445
PI: Smith D, Skidmore College. CHA Subcontract (PI: Kales SN) Period Closed.

Publications

1. Romero-Cabrera JL, Ankeny J, Fernández-Montero A, Kales SN, Smith DL. A Systematic Review and Meta-Analysis of Advanced Biomarkers for Predicting Incident Cardiovascular Disease among Asymptomatic Middle-Aged Adults. Int J Mol Sci. 2022 Nov 4;23(21):13540. doi: 10.3390/ijms232113540. PMID: 36362325; PMCID: PMC9656299.

Grant Number: U.S. Department of Homeland Security Award Number EMW-2018-FP-00562
PI: Steven M. Moffatt, M.D.
Period of Performance: 09/20/2019 – 09/19/2023

Background

Firefighting involves exposure to carcinogens, which can cause or promote cancer. Studies have consistently shown an association between firefighting and increased risk of cancer incidence and mortality. Previous studies among firefighters did not provide detailed information on occupational, medical, and lifestyle exposures. As a result, there is a lack of evidence-based knowledge on firefighters’ risk of the development of occupational cancer. This study will identify the prevalence and factors associated with the risk of cancer among career and volunteer firefighters.

Methods

This is a case-control study among Indiana firefighters. The study utilizes the fire service department and medical records, a questionnaire, and blood tests to identify: 1) occupational, 2) medical, and 3) lifestyle factors statistically associated with cancer incidence and mortality among Indiana firefighters.

Significance

The study will identify the occupational exposures and risks associated with the development of cancer incidence and mortality in both career and volunteer firefighters. This evidence-based information will be utilized to inform the Indiana fire service department how to better prevent the occupation-associated risk of cancers among firefighters.

Publications

1. Lidoriki I, Sotos-Prieto M, Smith DL, Kales SN. Firefighting-Associated Cancers: Can Healthier Body Weight and Eating be Potential Countermeasures? Journal of Occupational and Environmental Medicine 2019; 61: e69-e71.
2. Smith DL, Matias A, Bode ED, Korre M, Lidoriki I, Sotos-Prieto M, Kales SN. Firefighting-Associate Cancers: Can Increased Physical Activity and Improved Cardiorespiratory Fitness be Potential Countermeasures? J Occup Environ Med. 2021 Apr 8. doi: 10.1097/JOM.0000000000002217.
3. Sidossis, A., Lan, F.-Y., Hershey, M.S., Hadkhale, K., & Kales, S.N. (April 2023). Cancer and potential prevention with lifestyle among career firefighters: A narrative review. Cancers, 15(9), 2442. https://doi.org/10.3390/cancers15092442

Grant Number: U.S. Department of Homeland Security Award Number EMW-2020-FP-00063
P.I. Stefanos N. Kales MD, MPH, FACP, FACOEM; Harvard School of Public Health
Period of Performance: 09/08/2021 – 09/07/2024

Purpose and Aims

• Aim 1: Develop a prototype smartphone application (app) for future Healthy Lifestyle (HLS) Interventions directed at new firefighters.
• Aim 2: Field pilot test (beta-testing) the HLS app with new firefighters in their academy and firefighting probationary environments.  
• Aim 3: Validate the HLS app for its ability to maintain adherence to the HLS program for 3-6 months and for its effects on maintaining/improving HLS parameters (Lifestyle Scores, body composition, physical fitness, behavioral health (trauma/depression) screens).

Relevance

Research documents that health/fitness improve during training academies, but after graduation, these training-derived gains are rapidly lost. Developing and sustaining healthy lifestyles over firefighters’ career-spans are key to the fire service’s goals of reducing cancer, cardiovascular disease (CVD) and behavioral health risks.

Methods

Aim 1: Develop a prototype smartphone application (app) for future Healthy Lifestyle (HLS) Interventions directed at new firefighters. The steps will sequentially include the following with continuous refinements throughout: content analysis across all HLS domains, usability testing, building a viable prototype app, “alpha” or internal testing by the research team. Subsequently, “pre-beta” testing by our fire service panel and other firefighters (n=15-20) will be completed. Pre-beta participants will then be engaged in focus groups for final refinements of the prototype before field tests of the “end-user” version.

Aim 2: Field pilot test (beta-testing) the HLS app with new firefighters (n=30) in their academy and probationary firefighting environments. After completing pilot testing period, the Beta testing participants will give feedback in Focus Groups (n=20) and via surveys (n=30) to get additional “end-consumer” advice to further refine the content and usability of the application and linked materials.

Aim 3: Validate the refined HLS app for ability to maintain adherence to the HLS program for 3-6 months (n=75) and examine its effects on maintaining/improving HLS parameters (Lifestyle Scores, body composition, physical fitness, behavioral health (trauma/depression) screens). Results will be adjusted for the potential influence of new firefighters’ demographic and working conditions. The latter will include volunteer/career status and fire crew, station and department cultures/policies. After the validation study, we will conduct final Focus Groups (n=25) and surveys (n=75) to obtain further feedback to make additional content and usability refinements of the app and linked materials to create an improved final product for further study in future intervention trials.

Anticipated Outcomes

We will create a viable, user-friendly HLS app that is well-suited to new firefighters. Most firefighters who are open and willing to use the app will remain engaged at least weekly with the app and for at least three to six months. After adjustment for working and demographic conditions, users of the app should produce biologically plausible changes in the direction of better maintenance/improvement HLS parameters as compared to baseline data and historical control data.

Publications

Hershey MS, Bouziani E, Chen XYM, Lidoriki I, Hadkhale K, Huang YC, Filippou T, López-Gil JF, Gribble AK, Lan FY, Sotos-Prieto M, Kales SN. Surviving & Thriving; a healthy lifestyle app for new US firefighters: usability and pilot study protocol. Front Endocrinol (Lausanne). 2023 Oct 5;14:1250041. doi: 10.3389/fendo.2023.1250041. PMID: 37908746; PMCID: PMC10614295.