Feeding America's Bravest: Mediterranean Diet-Based Interventions to Change Firefighters' Eating Habits and Improve Cardiovascular Risk Profiles

Aims and hypothesis:

Recognizing the benefits and safety of the Mediterranean diet in CVD prevention, the investigators seek to develop behavioral change strategies in the fire service to modify the existing food culture based on key principles of the Mediterranean diet. Using education, participation and incentives, the investigators propose to motivate firefighters and their families to incorporate Mediterranean diet principles at work and home. The research design will allow us to measure the effectiveness of our Mediterranean Nutrition Interventions (MDNIs) in the "field settings" of the fire services for changing eating behavior and modifying CVD risk. Additionally, the cost-effectiveness of these strategies for future wider implementation will be examined. Specifics aims are:

1. Develop a multi-pronged, MDNI behavior change strategies including: diet/lifestyle education; discounted access to key Mediterranean diet foods; electronic education platforms and reminders; and targeted incentives. MDNI components will be refined via surveys, literature review and local/national firefighter input including labor/management and fire service focus groups.

Hypothesis (1). Cost-effective, fire-service MDNIs will be developed for the career randomized controlled trial (RCT). 2. Cluster Randomized Diet Intervention-Phase I- the Indianapolis Fire Department (IFD) has over 1,000 members. All 45 IFD firehouses will be cluster randomized into two groups and then individual members will be consented regarding study participation. Group 1 will receive an active 12-month MDNI, while Group 2 will receive no intervention. 3. Cluster Randomized Diet Intervention -Phase II: Group 1 will cross-over to "self-sustained continuation" for 12 months to examine persistence of behavior change during this less intense, self-directed maintenance diet intervention. Group 2 will cross-over to receive the MDNI for 6 months (assessing a shorter MDNI), followed by a final 6 months of self-sustained continuation. Our existing modified Mediterranean diet score (mMDS) will be further integrated with other validated scores and nutrition questionnaires. Questionnaires, mMDS and clinical data will be collected longitudinally throughout both phases of the RCT.

Hypotheses (2-3). Both MDNI lengths will improve mMDS, reduce weight, and improve Cardiovascular Disease (CVD) risk profiles in career firefighters. The 12 month MDNI will produce greater persistence of adherence than a 6 month MDNI. Cost-effective methods that combine messaging and discounts for improving firefighters' diets will be developed and validated, and these low cost methods will be adaptable for widespread translation and implementation throughout the career fire service.