A qualitative study to assess perceptions, barriers, and motivators supporting smokeless tobacco cessation in the US fire service.

Nattinee Jitnarin,Walker S C Poston,Hannah N Kelley,Sara A Jahnke,Herbert H Severson,Christopher K Haddock

doi:10.1371/journal.pone.0251128

Abstract

While firefighters currently have low smoking rates, rates of smokeless tobacco (SLT) use among this population are remarkably high and substantially greater than similar occupational groups, and the general population. This study explored determinants associated with SLT use, barriers to cessation, and motivators for SLT cessation in the fire service. Key informant interviews were conducted in 23 career firefighters who were current (n = 14) and former (n = 9) SLT users from across the U.S. Discussions were recorded and independently coded according to questions and themes. Major themes that developed among firefighters regarding SLT use determinants included positive perceptions of SLT products, social influences from their peers and family members, acceptability of SLT use in the fire service, and a coping resource for job stress. Firefighters discussed several barriers to SLT cessation, including intrapersonal barriers such as SLT use habits and its dependency, concerns about withdrawal symptoms; and social-environmental barriers including lack of support from health and other services providers, and lack of enforcement of existing tobacco policies regarding SLT use. Firefighters also mentioned both internal and external motivators for cessation. Internal motivators included self-motivation and their health concerns while external motivators included friends and family support, incentives or rewards, and price of SLT products. Findings provide unique perspectives from firefighters on factors that influence SLT use and barriers and motivators to SLT cessation. These are insufficiently assessed and considered by the fire service organizations and their health care providers. Thus, the organizations must understand these issues in order to mitigate barriers and motivate the personnel to quit using SLT. Information gained from firefighters who were current and former SLT users can be used to develop an effective, culturally-tailored intervention that is acceptable to fire service personnel.

Highlights

Firefighters are charged with protecting the citizens and property in the communities they serve
This study explored determinants associated with smokeless tobacco (SLT) use, barriers to cessation, and motivators for SLT cessation in the fire service
When you do the mathematics of it, you’re saving a whole lot of money by not buying it. . . when I did the math on it, I figure in the last year of not chewing, I saved about 2500 dollars.” (P22, former). This is the first study to analyze personal, social, and environmental determinants related to SLT use in fire service, allowing for a greater understanding of factors contributing to SLT use among firefighters who were current SLT users and who successfully quit

Summary

Introduction

Firefighters are charged with protecting the citizens and property in the communities they serve. Exposure to recognized or probable carcinogens, such as benzene, polycyclic aromatic hydrocarbons, and diesel fumes is common on the fire ground and during fire combustion Because of these factors, firefighters experience a greater risk and high proportionate mortality ratio of several forms of cancer [4,5,6,7]. Evidence shows that improving self-efficacy and positive social support significantly impact on individual’s achievement and changing their undesirable behaviors [26,27,28] It was, considered beneficial for our study to apply SCT to explore firefighters’ views and perceptions about SLT use and cessation and to understand how personal, social, and environmental determinants may influence and affect their SLT use behaviors, allowing for tailoring and development of the SLT cessation programs designed to the needs of firefighters who want to quit. The current study explores firefighters’ perspectives about SLT use and cessation based on data from key informant interviews with a national sample of career firefighters who were current and former SLT users

Methods

Participants

Interview methodology

Results

Discussion