Lifestyle-Related Risk Behaviours in Firefighters: A Scoping Review

Type of review This study will be a scoping review where evidence mapping will be used to describe lifestyle-related risk behaviours in firefighters. PRISMA-ScR guidelines will be used and followed throughout the review process. Review stages This review will include the following stages: • Search • Screening • Extraction • Synthesis Current Review Stage This review is currently in the searching stage. Start Date 1 November 2025 End Date 28 February 2026 Background It is known that firefighters have a high prevalence of cardiovascular disease risk factors. Firefighting is a physically demanding occupation that involves irregular shift work, heat exposure, physical tasks, and significant psychosocial stressors that may affect their lifestyle-related risk behaviours. A scoping review is appropriate to map the characteristics of the evidence across diverse firefighter settings and study designs, to describe how these behaviours are defined. This review will aim to summarise reported lifestyle-related risk behaviour prevalence and associated factors, to identify gaps to inform future research and occupational health programming. Primary Research Question What are the lifestyle-related risk behaviours in firefighters? Main Variables This review will include the following lifestyle-related risk behaviours: • Physical inactivity • Sedentary behaviour • Unhealthy dietary patterns • Insufficient sleep • Substance use Objectives The objectives are to map and describe the evidence on lifestyle-related risk behaviours among firefighters, including: 1. Which lifestyle-related risk behaviours have been investigated in firefighter populations? 2. What measurement characteristics/outcome measurement approaches are used? 3. What prevalence estimates, patterns, and associated factors are reported? 4. What evidence gaps exist across behaviours, settings, populations, and measurement approaches? Software CADIMA will be used through the screening process and data extraction will be conducted in Microsoft Excel. Funding This review does not make use of any funding. Conflicts of Interest There is no potential conflict of interests for this review. Databases Interfaces and Grey Literature A search will be conducted on various databases including PubMed, CINAHL (EBSCOhost), Scopus, Web of Science and PsycINFO. Grey literature will be searched using dissertations/theses sources (ProQuest), institutional repositories, and relevant firefighter/occupational health organisation websites. Citation chasing of included studies and relevant reviews will be conducted to identify additional eligible articles. PCC Framework Population: The review will include male and female firefighters aged 18-65 years, across various service types (municipal/structural, wildland, industrial, airport/aviation, volunteer/reserve) and any duty status (operational and administrative staff within fire services). Concept: Eligible sources must report one or more lifestyle-related risk behaviours such as physical inactivity, sedentary behaviour, unhealthy dietary patterns, insufficient sleep and substance use. Context: Any country and setting will be eligible. Eligibility Criteria Inclusion Criteria: • Any study conducted on firefighter lifestyle-related risk behaviours regardless of date • All type of studies where lifestyle-related risk behaviour measures are reported at baseline and/or as outcomes. • All studies that investigated at least one lifestyle-related risk behaviours in firefighters. Exclusions Criteria: • Studies not in English, without full-text availability and studies focusing primarily on mental health disorders or unrelated occupational exposures. Search strategy Search strategies will combine firefighter terms with lifestyle-related risk behaviours and keywords. Each database will have a unique search string. A Stellenbosch University Faculty Liberian will help create the search string for each database. The concept structure will include: (Firefighters OR Fire fighters OR Fire Service OR Firefighting OR firemen OR First responders OR Emergency responders OR Fire and Rescue Personnel ) AND (“Lifestyle-Related Risk” OR “health behaviour” OR “health behavior” OR “health risk” OR “risk factors” OR “poor health” OR “life style “ OR lifestyle OR “risk behavior” OR "drinking behavior" OR "drug-seeking behavior" OR "risk-taking" OR "drinking behaviour" OR "drug-seeking behaviour" OR "risk-taking" OR “risk behaviour” OR exercise OR “physical inactivity” OR “physical activity” OR “physical fitness” OR sport OR nutrition OR diet OR “energy intake" OR "feeding behavio*" OR energy OR micronutrient* OR macronutrient* OR food OR fruit* OR vegetable* OR fat* OR sugar* OR obesity OR overweight OR “ideal body weight” OR “poor diet” OR “substance-related disorder” OR alcohol OR alcoholism OR “alcohol use” OR “alcohol consumption” OR “binge drinking” OR “alcohol drinking” OR drinking OR addictive OR tobacco OR “use of tobacco” OR “tobacco use” OR cigarettes OR e-cigarettes OR “electronic cigarettes” OR vaping OR dagga OR cannabis OR marijuana OR “drug overdose” OR cocaine OR opiod OR “substance abuse” OR sedentary OR “sitting position” OR “screen time” OR “screen recreation” OR “poor sleep” OR insomnia* OR “sleep deprivation” OR “sleep hygiene” OR “sleep patterns” OR “mental health” OR “mental illness” OR “mental disorder” OR “emotional disturbances” OR “psychological adjustment” OR stress* OR “psychological distress” OR “social distress” OR isolation OR loneliness OR depression OR anxiety OR fatigue OR “psychiatric disorder”) AND (wellbeing OR well-being OR “global functioning” OR “quality of life”) Full, reproducible search strings for each database, including limits used and the final search dates, will be uploaded to OSF as an appendix to support transparency and reproducibility. Screening Search results will be exported into a screening platform (CADIMA) which will remove duplications of article. Two reviewers will independently screen titles/abstracts against eligibility criteria, followed by full-text screening. Disagreements will be resolved through discussion, and the final decision will be made by a third reviewer. The selection process will be reported using a PRISMA-ScR flow diagram, and reasons for exclusion at full-text stage will be recorded and reported. Data charting process Data charting will be conducted independently by two reviewers for an initial subset to ensure consistency before continuing the charting process. Any changes to the charting form will be documented. Data items Planned data items include author, year, country/region, study design, setting (station-based, national, academy), sample size. Participant characteristics (firefighter type, career/volunteer, duty status, rank, gender, age), lifestyle-related risk behaviours assessed (physical inactivity, sedentary behaviour, unhealthy dietary patterns, insufficient sleep and substance use), measurement method (instrument/tool name, objective vs self-report), key results (prevalence/summary measures, patterns, subgroup findings, and reported correlates/associations) and where applicable, intervention characteristics (type, duration, comparator). Where relevant, notes on feasibility and implementation challenges will also be charted. Synthesis of results Results will be synthesised descriptively and mapped to the review questions. The synthesis will include: 1. A summary of included articles according to author, year, country, study design, and firefighter type. 2. Tabulated mapping by lifestyle-related risk behaviour and measurement characteristics/outcome measurement approaches. Evidence gaps (limited data for women, volunteers, certain regions, or objective measures) will be identified. Where appropriate prevalence estimates may be summarised as ranges with clear indication of measurement differences. Reporting and transparency (PRISMA-ScR) The completed review will be reported in accordance with PRISMA-ScR guidelines, including description of eligibility criteria, information sources, full search strategies, selection process with reasons for exclusions, data charting items and methods, and structured presentation of mapped findings. Ethics and dissemination As this scoping review forms part of a master’s thesis, ethical approval was obtained from Stellenbosch University. Findings will be disseminated through peer-reviewed publication, conference presentations, and sharing of outputs on the OSF project page (protocol, search strategies, data charting form, and summary tables/figures where appropriate). Amendments Any amendments to this protocol (changes to eligibility criteria, information sources, search strategy, or data items) will be documented on OSF with the date, description of the change, and reason.