The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) firefighter study: testing mediating mechanisms.

This paper examines the mechanisms by which PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects), a health promotion intervention, improved healthy eating and exercise behavior among firefighters, a population at high risk for health problems due to occupational hazards. In a randomized trial, 397 firefighters participated in either the PHLAME team intervention with their work shift or a control condition. Intervention sessions taught benefits of a healthy diet and regular exercise, and sought to improve social norms and social support from coworkers for healthy behavior. At posttest, team intervention participants had increased their fruit and vegetable consumption as compared to control participants. An increase in knowledge of fruit and vegetable benefits and improved dietary coworker norms partially mediated these effects. Exercise habits and VO2 max were related to targeted mediators but were not significantly changed by the team intervention. Partial support was found for both the action and conceptual theories underlying the intervention. Our findings illustrate how an effective program's process can be deconstructed to understand the underpinnings of behavior change and refine interventions. Further, fire stations may improve the health of firefighters by emphasizing the benefits of healthy diet and exercise behaviors while also encouraging behavior change by coworkers as a whole.