Andrea L. Davis

Barriers and facilitators of consumer use of nutrition labels at sit-down restaurant chains.

OBJECTIVE Numerous localities have mandated that chain restaurants post nutrition information at the point of purchase. However, some studies suggest that consumers are not highly responsive to menu labelling. The present qualitative study explored influences on full-service restaurant customers’ noticing and using menu labelling. DESIGN Five focus groups were conducted with thirty-six consumers. A semi-structured script elicited barriers and facilitators to using nutrition information by showing excerpts of real menus from full-service chain restaurants. SETTING Participants were recruited from a full-service restaurant chain in Philadelphia, Pennsylvania, USA, in September 2011. SUBJECTS Focus group participants were mostly female, African American, with incomes <

Expecting the unexpected: a mixed methods study of violence to EMS responders in an urban fire department

US 60 000, mean age 36 years and education 14·5 years. At recruitment, 33 % (n 12) reported changing their order after seeing nutrition information on the menu. RESULTS Three themes characterized influences on label use in restaurants: nutrition knowledge, menu design and display, and normative attitudes and behaviours. Barriers to using labels were low prior knowledge of nutrition; displaying nutrition information using codes; low expectations of the nutritional quality of restaurant food; and restaurant discounts, promotions and social influences that overwhelmed interest in nutrition and reinforced disinterest in nutrition. Facilitators were higher prior knowledge of recommended daily intake; spending time reading the menu; having strong prior interest in nutrition/healthy eating; and being with people who reinforced dietary priorities. CONCLUSIONS Menu labelling use may increase if consumers learn a few key recommended dietary reference values, understand basic energy intake/expenditure scenarios and if chain restaurants present nutrition information in a user-friendly way and promote healthier items.

Situational pressures that influence firefighters' decision making about personal protective equipment: A qualitative analysis

Background Struck by injuries experienced by females were observed to be higher compared to males in an urban fire department. The disparity was investigated while gaining a grounded understanding of EMS responder experiences from patient‐initiated violence. Methods A convergent parallel mixed methods design was employed. Using a linked injury dataset, patient‐initiated violence estimates were calculated comparing genders. Semi‐structured interviews and a focus group were conducted with injured EMS responders. Results Paramedics had significantly higher odds for patient‐initiated violence injuries than firefighters (OR 14.4, 95%CI: 9.2–22.2, P < 0.001). Females reported increased odds of patient‐initiated violence injuries compared to males (OR = 6.25, 95%CI 3.8–10.2), but this relationship was entirely mediated through occupation (AOR = 1.64, 95%CI 0.94–2.85). Qualitative data illuminated the impact of patient‐initiated violence and highlighted important organizational opportunities for intervention. Conclusions Mixed methods greatly enhanced the assessment of EMS responder patient‐initiated violence prevention. Am. J. Ind. Med. 59:150–163, 2016.

Injury risks of EMS responders: evidence from the National Fire Fighter Near-Miss Reporting System

OBJECTIVES Firefighters are exposed to hazardous conditions as a result of their occupation and often understand the dangers of these toxic exposures; yet, it remains unclear why some refrain from wearing personal protective equipment (PPE) in dangerous situations. We were intrigued by the gap between demonstrated safety knowledge and lack of connection to observed or self-reported safety behaviors, an issue about which there is limited consensus among scholars. METHODS In a national study of fire service safety climate, 123 firefighters across 12 fire departments participated in 62 interviews and 10 focus groups. RESULTS Firefighter identity, goal seduction, and situation aversion were the strongest factors of PPE non-compliance, whereas PPE empowerment and individual will promoted PPE use within a fire department. CONCLUSIONS Understanding situations where PPE use is both practiced and neglected is imperative to improving fire service safety culture. Peer-pressure and leading by example at the peer and organizational levels appear to be essential considerations firefighters undertake when choosing whether or not to engage in safety behavior.

Ladders and lifting: How gender affects safety behaviors in the fire service

Objectives We analysed near-miss and injury events reported to the National Fire Fighter Near-Miss Reporting System (NFFNMRS) to investigate the workplace hazards and safety concerns of Emergency Medical Services (EMS) responders in the USA. Methods We reviewed 769 ‘non-fire emergency event’ reports from the NFFNMRS using a mixed methods approach. We identified 185 emergency medical calls and analysed their narrative text fields. We assigned Mechanism of Near-Miss/Injury and Nature of Injury codes and then tabulated frequencies (quantitative). We coded major themes regarding work hazards and safety concerns reported by the EMS responders (qualitative). Results Of the 185 emergency medical calls, the most commonly identified Mechanisms of Near-Miss/Injury to EMS responders was Assaults, followed by Struck-by Motor Vehicle, and Motor Vehicle Collision. The most commonly identified weapon used in an assault was a firearm. We identified 5 major domains of workplace hazards and safety concerns: Assaults by Patients, Risks from Motor Vehicles, Personal Protective Equipment, Relationships between Emergency Responders, and Policies, Procedures and Practices. Conclusions Narrative text from the NFFNMRS is a rich source of data that can be analysed quantitatively and qualitatively to provide insight into near-misses and injuries sustained by EMS responders. Near-miss reporting systems are critical components for occupational hazard surveillance.

42 Creating focus: the fire service organisational culture of safety survey

ABSTRACT This research explores the degree to which gender affects safety behaviors and outcomes in the fire service. Semistructured focus groups and interviews were conducted based on findings from the literature on women and gender in the fire service. Four focus groups (N = 22) and eight interviews were recorded, transcribed, and coded using NVivo 10 software. This methodology explored if female gender improves safety behaviors through (1) weighing the risks and benefits of dangerous situations, (2) focusing on biomechanics and technique, (3) asking for help, (4) being motivated to report injuries, (5) being heard by colleagues, and (6) illuminating a hostile work environment’s contribution to safety. Participants report that women have less of a “tough guy” attitude than their male colleagues and felt that deviating from the modernist American hyper-masculine norm may have a positive impact on their work practices and injury outcomes. If women in the fire service perceive risk differently than their male colleagues, perhaps strengthening efforts to recruit women and creating a culture that values their perspective will improve the occupation’s overall safety outcomes. Further research is necessary to quantify these gender differences and their relationship to safety outcomes.

A Strained 9-1-1 System and Threats to Public Health

Purpose Safety climate is a strong predictor of occupational near-misses, injuries, and line of duty deaths. Safety climate is the measurable aspect of organisational safety culture and is used by industries such as healthcare, construction, and manufacturing to gauge and improve safety performance. The FOCUS (The Fire Service Organisational Culture of Safety) survey was developed to assess baseline and longitudinal safety climate assessment, enabling intervention development and evaluation. Methods An exploratory sequential mixed-methods design was employed. Ten focus groups and 63 interviews totaling 120 participants in 13 US fire departments were conducted. From coding of the resulting transcripts, 70 candidate safety climate items were field-tested in a geographically-stratified random sample of 130 fire departments with over 780 stations and 10 000 respondents. The results were psychometrically validated through structural equation modelling and factor analysis. Results Through examination of focus group and interview language, survey items were made relevant for the fire service. The psychometric evaluation of the survey results yielded a two-factor solution. Differences in climate perception between leaders and followers were observed. The FOCUS instrument was predictive of safety outcomes such as injuries, as well as burnout, job satisfaction, and engagement. Conclusions The use of a mixed method study design ensured accurate climate measurement and appropriate survey construction. FOCUS will advance fire service injury prevention efforts through use of a validated tool to understand, maintain, or change the culture that creates safety. Significance Injury prevention has traditionally focused on passive methods to reduce injuries. However, we know that a portion of achieving lower injury rates must address human behaviour. Injury training has not introduced its practitioners to the role that climate assessment (aka ‘culture’) plays in injury risk. Integrating methods from occupational health psychology and organisational science can move the needle on injury outcomes.