Posttraumatic stress disorder (PTSD) affects up to 13-17% of active duty military personnel who deployed after 9/11 and significantly impacts military readiness. However, behavioral health providers in the Military Health System (MHS) face significant challenges in implementing evidence-based psychotherapies (EBPs) such as Written Exposure Therapy (WET). One of the main obstacles is the limited capacity to schedule and conduct weekly therapy sessions due to large patient panels and heavy workloads. This study uses a Hybrid Type 1 implementation-effectiveness design to increase access to WET by task sharing delivery with behavioral health technicians (BHTs). We will compare BHT-delivered WET plus treatment as usual (TAU) to TAU alone in a Phase II randomized clinical trial with 150 active-duty participants. The primary aims are to evaluate the clinical effectiveness of BHT-delivered WET, patient acceptability, and BHT treatment fidelity. Secondary aims include identifying barriers and facilitators to WET implementation. Participants will be randomly assigned to BHT-delivered WET or TAU alone, with WET delivered weekly over five sessions either in-person or via telehealth. Quality control will be maintained through rigorous BHT training, supervision, and fidelity assessments. Community-Based Participatory Research methods will ensure stakeholder engagement and feedback throughout the study. Data analysis involves linear mixed-effects models and rapid qualitative analysis to assess outcomes. The results will demonstrate the effectiveness of WET in routine care settings and the feasibility of BHT-delivered WET as an implementation strategy. The findings have the potential to enhance PTSD treatment accessibility and inform best practices within the MHS and similar settings.

OBJECTIVE:Firefighters experience frequent traumatic events and occupational stressors, increasing risk for posttraumatic stress disorder (PTSD), insomnia, and nightmares, which are frequently comorbid and interrelated. However, firefighter schedules and mental health stigma limit engagement in weekly therapy. The present study was a randomized pilot feasibility trial of an integrated, accelerated, culturally adapted treatment for firefighters with clinically significant PTSD, insomnia, and nightmare symptoms. METHOD:Participants (N = 49) were randomized to immediate or delayed treatment. Treatment integrated written exposure therapy for PTSD and cognitive behavioral therapies for insomnia and nightmares and was delivered in a 4-day group therapy "workshop" with one individual session before and after the workshop. Participants completed diagnostic interviews at baseline and 1-month posttreatment and self-report surveys through 3-month posttreatment. RESULTS:Most indices of program feasibility were positive despite logistical challenges impacting enrollment and treatment uptake. In addition, there were large group by time interaction effects for reductions in symptoms of PTSD (g = 1.70) and insomnia (g = 1.47) and a medium effect for nightmares (g = 0.72). Improvements in symptoms of all three targeted disorders and depressive symptoms were maintained through 3-month posttreatment. CONCLUSIONS:This study supports the efficacy of accelerated, integrated PTSD and sleep disorder treatment. To our knowledge, this is the first controlled study of a culturally adapted mental health intervention for firefighters. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Firefighters face elevated risks of alcohol misuse due to occupational stress, trauma exposure, and cultural norms within the fire service. This beta test study evaluated the feasibility, acceptability, and preliminary outcomes of From Bottle to Nozzle, a digitally delivered alcohol awareness and prevention intervention tailored for firefighters. Fifty fire service personnel were invited to participate; 46 consented and completed baseline questionnaires, and 22 completed the full program. The intervention consisted of five self-paced online modules incorporating multimedia content, quizzes, and self-assessments that addressed alcohol history, fire service culture, risk-reduction strategies, communication, and health effects. Pre- and post-intervention assessments measured changes in alcohol-related knowledge, alcohol use, motivation to reduce drinking, and usability. Reinforcement messages were delivered via text and email. Alcohol-related knowledge improved significantly post-intervention, particularly in the general and total knowledge domains. Moderate drinkers showed reductions in drinking days and AUDIT scores. Among heavy drinkers, overall consumption declined slightly, though binge-drinking episodes increased. Changes in motivation to reduce drinking were mixed. Usability ratings were high, with an 80% module completion rate and favorable feedback on program brevity and format, though navigation and video length were noted as challenges. From Bottle to Nozzle demonstrated strong feasibility and acceptability. While knowledge gains were robust, behavioral outcomes were mixed, highlighting the need for larger controlled studies with extended follow-up.

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Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of opioid use disorder and overdose due to chronic pain and mental health conditions. The pharmaceutical industry’s role in misrepresenting opioid risks—leading to over USD 50 billion in legal settlements—has included targeted marketing to vulnerable populations. This study examines Janssen Pharmaceuticals’ “Imagine the Possibilities Pain Coalition” (IPPC), which aimed to increase opioid use among veterans with chronic non-cancer pain. Insights from this public health industry document analysis offer guidance for military medicine and healthcare policymaking. Methods: Using the Opioid Industry Document Archive (OIDA), housed at Johns Hopkins University and the University of California, San Francisco, researchers conducted retrospective content analysis. Documents referencing veterans were identified through keyword searches on Johns Hopkins’ SciServer portal and reviewed using CoCounsel, an AI-based legal document platform using a human-in-the-loop approach. Relevant documents were examined by the authors to extract material aligned with the research focus. Results: The IPPC employed strategies to influence opioid prescribing for veterans. These included educational materials that minimized addiction risks and exaggerated long-term benefits and empathy-driven narratives prioritizing immediate pain relief over potential harms. Ghostwriting ensured favorable perspectives on opioids in scientific literature, aligning with broader industry strategies to promote opioids for chronic pain. Conclusions: The targeted marketing of opioids to veterans has exacerbated the opioid crisis, as documented in government reports and litigation. Rigorous oversight of industry-funded coalitions and evidence-based practices are critical to insulating military healthcare from corporate influence and addressing the opioid crisis among veterans.

Firefighters are vulnerable to opioid misuse given the adverse effects their occupation has on mental and physical health. Yet there are limited data on opioid misuse within this population. This study examined the prevalence of illicit prescription opioid use among a nationally representative sample of U.S. firefighters and factors related to opioid misuse. Data were collected through reliable questionnaires from 617 firefighters prior to participating in an intervention designed to mitigate the negative impacts of trauma. The lifetime prevalence of illicit prescription opioid use was 14% compared to 13% in the general U.S. population. The most commonly misused opioids were hydrocodones with trade names Vicodin, Lortab, and Lorcet (72% of those illicitly using opioids). Illicit prescriptions opioid use was not significantly correlated with any demographics examined. However, firefighters who engaged in illicit opioid use exhibited poorer mental health, more alcohol-related problems, and an increased likelihood of misusing other prescription medications. In a regression analysis, alcohol consumption issues, Post-Traumatic Stress Disorder (PTSD), and the illicit use of sedatives and tranquilizers emerged as significant predictors of illicit prescription opioid use. Illicit prescription opioid use by firefighters is a potential problem especially when considered along with other factors such as mental health. Longitudinal studies are needed to further deepen our knowledge about this issue.

Background Insomnia, nightmares, and posttraumatic stress disorder (PTSD) are prevalent co-occurring problems among fire service members and associated with significant distress and dysfunction. This report describes an accelerated treatment program targeting symptoms of PTSD, insomnia, and nightmares by combining Written Exposure Therapy (WET) for PTSD, Cognitive Behavioral Therapy for Insomnia (CBTi), and Cognitive Behavioral Therapy for Nightmares (CBTn) and the iterative procedures used to develop the intervention. Methods In Phase 1, we developed a treatment program outline and solicited feedback from stakeholders (firefighters, fire service leaders, and behavioral health specialists; N = 45). After integrating feedback, we conducted open pilot testing of the treatment protocol with two groups of fire service members with PTSD symptoms, insomnia, and nightmares (N = 5). Results The intervention includes an individual virtual preparatory session, a group workshop conducted over four consecutive days, and an individual virtual booster session. Open pilot evaluation suggests that participants experienced reductions in PTSD symptoms, insomnia, and nightmares, and were satisfied with the treatment program. Discussion WET, CBTi, and CBTn are compatible interventions that can be integrated into an accelerated group treatment format. Initial evaluation supports the feasibility and helpfulness of this model with firefighters. Additional controlled evaluation of the program is warranted.

Clinician training is often not sufficient to increase the adoption of evidence-based psychotherapies (EBPs). To address organizational barriers that may limit use of EBPs, a tailored implementation strategy-Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS)-was developed. TACTICS involved external facilitation (appointing a local implementation team and external coach, conducting need assessment interviews, creating site-specific implementation plans, and weekly coaching for the site champion) augmented with a planning rubric and resources for making operational changes. The effect of adding TACTICS after clinician training was evaluated in a cluster-randomized stepped-wedge trial across eight military treatment facilities. Psychotherapists (n = 212) received training in prolonged exposure (PE) therapy. TACTICS was subsequently introduced with timing randomized by site. PE utilization was measured via natural language processing of notes from 26,429 psychotherapy encounters across 3459 patients. After accounting for time effects, TACTICS increased PE use compared to training alone (OR = 1.05-2.21, p < .03). Nonetheless, overall use of PE declined over time (OR = 0.067-0.316, p < .001). In post-hoc analyses, declining use of PE over time was strongly associated with a decreasing supply of psychotherapy appointments per patient (r = .98). These findings suggest that local implementation support improves EBP adoption beyond training alone. However, lasting use may require broader system supports such as adequate staffing and policies that encourage use of EBPs.

BACKGROUND:Firefighters are occupationally exposed to hazardous chemical mixtures. Silicone passive sampling devices capture unique exposures over time with minimal impact to the participant and allow for the analysis of a broad chemical space. OBJECTIVE:Silicone dog tags were worn by firefighters while on- and off-duty to measure individual exposures, identify potential occupational exposures, and assess their relation to occupational variables including fire response frequency, rank, and years as a firefighter. METHODS:Fifty-six firefighters were recruited from two fire departments with relatively high and low call volumes in the Kansas City metropolitan area to wear two different silicone dog tags as passive samplers while on- and off-duty. Each dog tag was worn for a cumulative 30-day exposure period. Extracts of the dog tags were analyzed with gas chromatography, mass spectrometry methods for 43 flame retardants (FRs), 21 volatile organic compounds (VOCs), 42 polychlorinated biphenyls (PCBs), and 63 polycyclic aromatic hydrocarbons (PAHs). RESULTS:Ninety-two total chemicals were detected, with eight chemicals not previously reported in firefighter exposure studies. Based on the magnitude and frequency of increased exposure in on-duty dog tags, relative to paired off-duty dog tags, five PBDEs and sec-butylbenzene were identified as potential occupational exposures; sec-butylbenzene and PBDE 49 have not previously been reported in firefighter exposure studies to the authors' knowledge. Multivariate analyses for these six compounds indicated that firefighter rank, fire response rates, and years in the fire service were poor indicators of increased occupational exposure. The greatest on-duty exposures to PBDEs were found in the low-call volume department among operational firefighters. Dog tags from firefighters at the high-call volume department accounted for 75% of PCB detections; one particular fire response may have contributed to this. Additionally, there was measurable similarity in total chemical exposure profiles between paired on- and off-duty tags for some firefighters. IMPACT:This study used personal silicone passive samplers in the configuration of dog tags worn around the neck to quantify firefighter occupational exposure in on-duty samples relative to paired off-duty samples for several chemical categories: flame retardants, VOCs, and PCBs. Five PBDEs and sec-butylbenzene were identified as potential occupational exposures, however their prevalence in on-duty tags was not associated with frequency of fire responses, firefighter rank, or years the firefighter has been in the fire service. Additionally, similarity between chemical exposures in on- and off-duty tags from the same firefighter invites further investigation into individual behaviors influencing occupational and para-occupational exposures.

Objective: This study aimed to describe the demand for, supply of, and clinic processes associated with behavioral health care delivery in the Military Health System and to examine the clinic-level factors associated with receipt of a minimally adequate dosage of psychotherapy. Methods: This retrospective study used administrative behavioral health data from eight military treatment facilities (N= 25,433 patients; N= 241,028 encounters) that were participating in a larger implementation study of evidence-based psychotherapy for posttraumatic stress disorder. Minimally adequate dosage of psychotherapy was defined in two ways: at least three sessions within a 90-day period and at least six sessions within a 90-day period. The authors then used a path model to examine clinic-level factors hypothesized to predict psychotherapy dosage, including care demand, supply, and processes. Results: Patients had an average of 2.5 psychotherapy appointments per quarter. Wait times for intake, between intake and the first psychotherapy session, and between follow-up sessions all averaged 17 days or longer. Path modeling showed that a higher patient-to-encounter ratio was associated with a longer wait time between follow-up psychotherapy appointments. In turn, a longer wait time between appointments was associated with a lower probability of receiving an adequate dosage of psychotherapy. However, a greater proportion of care delivered in groups was associated with a greater probability of receiving at least six sessions of psychotherapy. Conclusions: Receipt of a minimally adequate dosage of psychotherapy in the Military Health System is hindered by clinic staffing and workflows that increase wait times between follow-up psychotherapy appointments.

INTRODUCTION Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers. MATERIALS AND METHODS As part of a larger project to increase the use of prolonged exposure therapy in the military health system, we conducted a needs assessment at eight military treatment facilities. The needs assessment included analysis of clinic administrative data and a series of stakeholder interviews with behavioral health clinic providers, leadership, and support staff. Key barriers were matched with potential solutions using a rubric developed for this project. Identified facilitators, barriers, and potential solutions were summarized in a collaboratively developed implementation plan for increasing prolonged exposure therapy tailored to each site. RESULTS There was a greater than anticipated consistency in the barriers reported by the sites, despite variation in the size and type of facility. The identified barriers were grouped into four categories: time-related barriers, provider-related barriers, barriers related to patient education and matching patients to providers, and scheduling-related barriers. Potential solutions to each barrier are described. CONCLUSIONS The findings highlight the numerous organizational-level barriers to implementing evidence-based psychotherapy in the military health system and offer potential solutions that may be helpful in addressing the barriers.

Objective: To assess the daily relationship between prior-night total sleep time (TST) and next-day, afternoon sleep propensity among firefighters operating from two popular fire department shift schedules. Methods: Dataset included 22 firefighters (24/48 shift schedule) and 20 firefighters (48/96 shift schedule). Daily TST was assessed using actigraphy and daily sleep propensity was assessed using the Epworth Sleepiness Scale (ESS), completed every afternoon. Results: Separate one-way repeated measures ANOVA indicated statistically significant differences among daily sleep propensity within each shift schedule. Separate Pearson product moment correlations indicated moderate relationships between prior-night TST and next-day, afternoon sleep propensity. Conclusion: When firefighters slept less, sleep propensity the following day increased. Least TSTs occurred on nights prior to commuting suggesting firefighters likely begin shifts without sufficient sleep and drive home without sufficient sleep, then experience greatest sleep propensity.

BACKGROUND:Firefighters are faced with a broad range of toxic exposures during their work, including known and suspected carcinogens. The current study is an update to the previously published meta-analysis of cancer risk among firefighters by Soteriades and colleagues, and focuses on studies published from 2008 to 2020.METHODS:A comprehensive search of the literature was conducted, including electronic databases and bibliographies of recently published papers. Analyses include stratification of studies conducted in the United States (US) versus other countries. Cancer incidence and mortality rates were compared to the relevant general population. Random effects models were used to calculate summary risk estimates and their 95% confidence intervals.RESULTS:A total of 24 studies were included in the meta-analysis. Among the 42 cancer types covered, incidence was associated with firefighting in US samples for colon, kidney, large intestine, pleura, and prostate cancer, as well as malignant melanoma. There was an increased incidence of Hodgkin's Disease and malignant melanoma and a significantly lower risk of kidney cancer for non-US samples. Significant cancer mortality estimates for US samples included oral/buccal/mouth, other parts of the buccal cavity, pharynx, colon, esophagus, large intestine, lung, Non-Hodgkin's Lymphoma, pancreas, pleura, rectum, and soft tissue sarcoma. No cancer had a significantly higher rate of mortality among non-US samples.CONCLUSIONS:The findings underscore the global cancer burden among firefighters, and indicate that geographically stratifying studies afford a more nuanced risk perspective. Further research should investigate why US firefighters exhibit higher cancer mortality rates compared to international counterparts.

ABSTRACT Objective The purpose of this paper is to investigate intra-tour variation in total sleep time (TST) and sleep-wake cycle among US firefighters working the 24 hours on and 48 hours off shift schedule (24/48) and the 48 hours on and 96 hours off shift schedule (48/96). Methods Twenty-four firefighters were recruited for this sleep study and were evaluated over 18 days during a 24/48 shift schedule and again 6 months after firefighters transitioned to a 48/96 shift schedule. The primary outcome variables included TST, measured by actigraphy, and sleep-wake cycle (in-bed time and sleep offset) using the Emergency Services Sleep Diary. Results Firefighters experienced intra-tour variations in TST and sleep offset. The least TST occurred at home prior to starting shift on the 24/48 and 48/96 schedules (5.80 hours and 5.66 hours, respectively). The second least TST occurred the night preceding shift end (5.84 hours and 5.81 hours, respectively). In contrast to in-bed time, sleep offset varied throughout the schedule and was found to correlate with TST. In addition, shift start/end time appears to be responsible for advanced sleep offset. Conclusion Results indicate that firefighters’ sleep is complex and should not be reduced to singular averages. In both schedules, firefighters arrived at work with insufficient sleep, received insufficient sleep while on shift, and would commute home with insufficient sleep. These findings can inform future firefighter sleep research by accounting for intra-tour variations.

Firefighting is inherently dangerous, though recently concerns have shifted from traditional fireground injuries (burns and asphyxiation) to a focus on mental and behavioral health. Although firefighters are remarkably resilient, research suggests many suffer negative psychological consequences from repeated exposures to trauma. While the Stress First Aid (SFA) model has gained increased attention and adoption among fire departments as a model for behavioral health training, it has not been formally evaluated. This cluster randomized controlled trial used a crossover design comparing the immediate SFA group to delayed SFA control to test the impact of the SFA on firefighters’ mental and behavioral health changes after 10–12 months (n = 400; Mage = 37.6, 4.8% women). A convenience sample of 79 firefighters (Mage = 41.4; 8.7% women) provided evaluations on one or more of the training modules. Participants reported satisfaction with all training components (Peer team training 97.6%, Online SFA 94.9%, Curbside Manner 88.4%, After Action Review 89.4%) and reported success in changing personnel’s perception of their department’s ability to respond to behavioral health issues (SFA M = 3.93, Control 3.50; t = 2.52, p = 0.042). Future work should focus on additional resources and training to augment existing efforts to help departments continue their efforts.

Studies showed that tobacco use and excessive alcohol consumption frequently occur, and both are significant causes of preventable morbidity and mortality. Data were collected as part of a national online study of the health of women in the fire service. Multinomial logistic regression was employed to determine factors associated with smoking and drinking characteristics. A total of 2330 women firefighters completed questions regarding tobacco and alcohol use; 3.2% (n = 75) were concurrent users, 0.9% (n = 22) were smokers only, 49.4% (n = 1150) were heavy drinkers only, and 46.5% (n = 1083) were low-risk users. Compared with those who neither smoked nor binge drank, concurrent users were more likely to be younger and live alone or not married. The findings also suggested that smokers, heavy drinkers, or those who were both were more likely to report symptoms of depression and PTSD and a history of physician diagnosis of anxiety disorder compared to low-risk users. Smoking rates are relatively low among women firefighters; however, mental health risks are prevalent, particularly for those who both smoked and drank heavily. Results can be potentially used to inform prevention and treatment research to better address the unique condition of this occupational group.

Few service members with posttraumatic stress disorder (PTSD) receive evidence-based psychotherapy (EBP) in the military health system (MHS). Efforts to increase EBP implementation have focused on provider training but have not adequately addressed organizational barriers. Thus, although behavioral health providers are trained in EBPs, clinic-, facility-, and system-level barriers preclude widespread EBP implementation. Building on work examining barriers to EBP use for PTSD across eight military treatment facilities, we propose recommendations for increasing the implementation of EBPs for PTSD and improving the quality of behavioral health care in MHS outpatient behavioral health clinics. Increasing the use of EBPs for PTSD will require that their use is supported and prioritized through MHS policy. We recommend that psychotherapy appointments are scheduled at least once weekly, as clinically indicated, as this frequency of care is prerequisite for EBP delivery. We propose several recommendations designed to increase system capacity for weekly psychotherapy, including improved triaging of potential patients, incentivizing and supporting group psychotherapy, matching the modality (i.e., group vs. individual) and frequency of treatment to patients' needs, and using behavioral health technicians as clinician extenders. Additional recommendations include providing ongoing support for EBP implementation (e.g., protected time to participate in EBP consultation) and matching patients to providers based on patient's clinical needs and treatment preferences. The barriers to EBP implementation that these recommendations target are interrelated. Therefore, adopting multiple policy recommendations is likely necessary to yield a meaningful and sustained increase in the implementation of EBPs for PTSD in the MHS.

Studies suggest that exposure to potential endocrine disrupting chemicals (pEDCs) may contribute to adverse health outcomes, but pEDC exposures among firefighters have not been fully characterized. Previously, we demonstrated the military-style silicone dog tag as a personal passive sampling device for assessing polycyclic aromatic hydrocarbon exposures among structural firefighters. This follow-up analysis examined the pEDC exposures based on department call volume, duty shift, and questionnaire variables. Structural firefighters (n = 56) were from one high and one low fire call volume department (Kansas City, MO metropolitan area) and wore separate dog tags while on- and off-duty (ndogtags = 110). The targeted 1530 analyte semi-quantitative screening method was conducted using gas chromatography mass spectrometry (npEDCs = 433). A total of 47 pEDCs were detected, and several less-frequently-detected pEDCs (<75%) were more commonly detected in off- compared to on-duty dog tags (conditional logistic regression). Of the 11 phthalates and fragrances detected most frequently (>75%), off-duty pEDC concentrations were strongly correlated (r = 0.31-0.82, p < 0.05), suggesting co-applications of phthalates and fragrances in consumer products. Questionnaire variables of "regular use of conventional cleaning products" and "fireplace in the home" were associated with select elevated pEDC concentrations by duty shift (paired t-test). This suggested researchers should include detailed questions about consumer product use and home environment when examining personal pEDC exposures.

BACKGROUND: Peak performance is dependent on adequate sleep, yet only 37% of Army soldiers report achieving the recommended 7-9 hours of sleep/night. Physical activity (PA) is associated with improved muscle strength and endurance; muscle strength correlates strongly with vigorous PA. PURPOSE: This study aimed to identify if min/week of moderate, vigorous and strength training PA and sleep predicted soldiers’ fitness performance (i.e., 1-rep max deadlift, pull-up, horizontal jump, and dummy drag). We hypothesized that greater levels of sleep and each PA mode would predict better performance. METHODS: Data were from a 5-year cluster-randomized controlled trial. Participants (N = 119, 77.3% male) were active-duty military, National Guard, and Reserves personnel recruited to participate in 6-months of fitness training. At baseline, participants completed an online survey including questions on moderate-vigorous aerobic activity, strength training minutes, and accumulated sleep. They also completed a 1-rep max deadlift, pull-ups, horizontal jump, and dummy drag test. Multiple linear regression analyses were used to examine significant predictors for each fitness test. RESULTS: Over half of the variance for deadlift weight (R2 = 0.544) was significantly predicted by strength training min/week (β = 0.276, p = 0.001) and sex (male; β = 0.640, p < 0.001). Pull-ups (R2 = 0.435) were significantly predicted by strength training min/week (β = 0.201, p = 0.024) and sex (male; β = 0.514, p < 0.001). Horizontal jump distance (R2 = 0.359) was significantly predicted by strength training min/week (β = 0.279, p = 0.003) and sex (male; β = 0.527, p < 0.001). Dummy drag time (R2 = 0.478) was significantly predicted by sex (male; β = -0.651, p < 0.001). CONCLUSIONS: Exceeding strength training recommendations and male sex were the best performance predictors for the fitness tests. However, moderate or vigorous PA and sleep were not significant predictors for any baseline measure. Army policy surrounding physical fitness should consider prioritizing strength training more to improve performance in these fitness domains. Future research should examine changes in sleep and PA over time to determine how changes in each influence changes in fitness performance. This will help further inform physical training policy priorities.

BackgroundProblem drinking is a perennial concern in the US fire service. A large literature has documented the importance of addressing alcohol norms in intervention research. The purpose of this study was to explore alcohol norms in a national cohort of firefighters (FFs) to inform intervention development in this occupational group.MethodsData were from a national online survey of career and volunteer FFs (N = 674). Participants were recruited through national fire service listservs and a database of FFs who had agreed to be contacted for research.ResultsWhen asked about “acceptable” levels of alcohol consumption, FFs on average suggested levels which exceeded public health guidelines. Further, approximately half of career and volunteer FFs believed that, at least under some circumstances, drinking until intoxicated was normative. When asked how long should elapse between a FFs last drink and reporting for duty, the average suggested lag was 11.2 hours (sd = 4.6). However, among male volunteer FFs who reported heavy drinking, the average was 6.68 hours (sd = 4.77).ConclusionsGiven the high prevalence of heavy and binge drinking in the fire service, it is not surprising that the alcohol norms found in this study were consistent with a culture of drinking. Participants' reports of alcohol use among their peers were consistent with the actual prevalence of problem drinking. Thus, education and prevention efforts in this occupation should focus on changing norms about alcohol use, including linking heavy drinking to other health and safety issues they face.