Dietary Patterns Following a Firefighter Nutrition Education Programme

Firefighters are exposed to a complex mixture of hazardous and carcinogenic substances through their work, including combustion products, diesel exhaust and contaminated fire effluent. Epidemiological evidence shows elevated risks for several cancers, and in 2022 the International Agency for Research on Cancer (IARC) classified occupational exposure in firefighting as carcinogenic (Group 1).

Risk is shaped not only by future exposure but by cumulative exposure over time, because some fire-related contaminants are persistent or bioaccumulative. Firefighters are also commonly exposed to shift work and circadian disruption, which has itself been associated with increased cancer risk. While improvements in personal protective equipment, decontamination practices, and operational procedures remain essential, evidence from exposure studies and biomonitoring research indicates that these measures alone cannot fully eliminate exposure-related risk, particularly for persistent and bioaccumulative contaminants.

There is therefore growing interest in additional, practical strategies that can support long-term health resilience in firefighters. Diet is one such area, with evidence linking dietary patterns to cancer-relevant processes such as inflammation, oxidative stress, xenobiotic metabolism, and DNA damage and repair; this evidence base is reflected in the guidance of major international cancer and public health organisations including the World Cancer Research Fund, World Health Organization, and International Agency for Research on Cancer.

Within the fire and rescue service, structured nutrition initiatives have historically been rare. Where dietary guidance exists, it usually mirrors general public health advice (healthy eating, weight and fitness) rather than firefighter-specific risks. This can limit engagement for those who already feel fit and for those uninspired by generic advice. In the context of dietary change for firefighter cancer-risk reduction, the limiting factor is often not lack of motivation, but the absence of education and a clear occupational rationale that connects everyday food choices to the specific risks of firefighting. Even if services are well informed regarding suitable dietary intake, dietary behaviours cannot be mandated or enforced within the workplace, and so suitable food choices relies on firefighters themselves.

This project addresses that gap by adopting a novel approach: explicitly framing dietary change around occupational cancer risk, aligned with the 2022 IARC classification. This approach is relevant to all firefighters, regardless of demographic factors, such as body composition or fitness level, and provides a clear basis for engagement. At present, there is little published data describing dietary patterns among UK firefighters, limiting the ability of services to design targeted, evidence-informed interventions.

The RESCUE programme is designed to be practical, culturally appropriate and scalable within real fire service settings. It centres on structured, firefighter-specific education delivered at watch level and reinforced with resources that translate evidence into actionable guidance within existing station "mess" culture. The approach does not rely on individual prescriptions or supplements.

The approach is informed by recent peer-reviewed work synthesising evidence on diet, firefighting exposures and cancer risk, co-authored by the principal investigator in collaboration with Dr Shelly Coe (Oxford Brookes University), which highlighted consistent evidence linking dietary patterns to cancer risk, supported by plausible underlying biological mechanisms, alongside the absence of practical firefighter-specific dietary frameworks. This project builds on that foundation by moving from evidence synthesis to real-world implementation and evaluation.

The project aligns with the objects of the Fire Service Research and Training Trust by supporting research into the prevention of fire and rescue service-related health risks and by contributing to the training of fire and rescue personnel through structured education and transferable resources. By focusing on practical, scalable dietary change, the project also addresses well-recognised determinants of workforce health and operational resilience, supporting a more stable and effective fire and rescue service while maintaining its primary focus on occupational cancer risk.

RESCUE is a service-wide nutrition education programme implemented across Avon Fire \& Rescue Service independently of participation in the research evaluation. The observational evaluation comprises voluntary repeated cross-sectional questionnaire assessments among eligible wholetime operational firefighters before programme implementation and approximately 3, 6 and 12 months afterwards. Participation is invited separately at each assessment, and respondents are not required to have completed a previous questionnaire; the responding samples may therefore differ between assessment points. Participant-generated study codes permit linked longitudinal analyses where responses can be matched across assessments.