16 The Open Occupational Health & Safety Journal, 2010, 2, 16-18 1876-2166/10 2010 Bentham Open Open Access Burnout Predicts Health Behaviors in Ambulance Workers Ioanna Moustou 1 , Efharis Panagopoulou* ,2 , Anthony J. Montgomery 3 and Alexios Benos 2 1 Thermi Health Center, Thessaloniki, Greece 2 Lab of Hygiene, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece 3 Department of Educational and Social Policy, University of Macedonia, Greece Abstract: Introduction: Ambulance workers report higher levels of burnout compared to other health professionals which puts them at risk for a variety of health problems. Despite the evidence about the link between burnout and worsened health, it is still not known whether this relationship is a direct one or mediated by health behaviours. The purpose of the article is to examine the association between burnout and health behaviours in ambulance workers. Materials and Methodology: 347 ambulance workers participated in this cross-sectional study. A series of multiple regres- sion models were tested to examine the associations of burnout to eating and exercise behaviour, smoking, and drinking, controlling for age, working experience, caseload, and social support. Results: Burnout and workload positively predicted consumption of fast-food meals per week while burnout was the only predictor of reduced weekly exercise. Burnout and workload positively predicted frequency of social drinking while burn- out was the sole predictor of the quantity of drink-units consumed socially. Social support predicted frequency and quan- tity of drinking at home. Discussion: This study shows that burnout is related to unhealthy eating, reduced exercise behavior and excessive drink- ing among ambulance workers. In addition it highlights the fact that alcohol consumption in different settings is related to different needs. The implications of these findings for the healthcare sector are discussed. Keywords: Health behaviors, ambulance workers, burnout. INTRODUCTION Occupational stress and in specific, job burnout, a par- ticular type of prolonged job stress has been linked to car- diovascular problems, psychosomatic complaints, and in- creased vulnerability to infectious diseases [1]. There is in- creasing evidence that burnout levels among ambulance per- sonnel rank among the highest in health professionals [2]. Consequently ambulance workers are at high risk of devel- oping health problems associated with burnout. Ambulance workers report more frequently lower back pain problems, stomach problems, headaches and sleeping problems in comparison with other occupational populations [3-4]. They also retire earlier in comparison with the general working population and other health professionals [5]. This high rate of early retirement has been linked to mental disorders, and alcohol-dependency problems [6]. However, very few studies have examined whether the reported association between burnout and health is a direct one or it is moderated by health behaviors, such as smoking, drinking, unhealthy eating or exercising [7, 8]. Even fewer studies have examined the association of burnout to health behaviors in ambulance personnel [9]. The purpose of the present study was to examine the as- sociation between burnout and health behaviors in a sample *Address correspondence to this author at the Lab of Hygiene Medical School Aristotle University Thessaloniki, 54124, Thessaloniki Greece; Tel: +302310999137; Fax: +302310999701; E-mail: EFHARIS@the.forthnet.gr of ambulance workers. Health behaviors were categorized into high-risk behaviors, such as smoking or drinking, and protective behaviors, such as exercising or having breakfast. Based on previous studies among health professionals indi- cating that burnout decreases with age and working experi- ence, while it increases with increased workload, age work- ing experience, and workload, were examined as potential confounders [10, 11]. In addition previous studies have shown that people with high levels of social support engage in health-protective behaviors [12]. Therefore the potential confounding role of social support was also examined in the study. MATERIALS AND METHODOLOGY Participants A self-administered questionnaire together with an invi- tation letter and information about the study were sent to all ambulance workers registered in the ambulance service in North Greece. The final sample consisted of 347 ambulance workers, representing a response rate of 62%. Participants were 57% male, with an average age of 33.8 (SD=5.9) years. They worked for an average of 5.8 (SD= 6.6.) years in the ambulance service, and for 42 hours per week (SD= 8). 57% of participants were married or lived together with their part- ner. Materials Burnout was assessed using the Maslach Burnout Inven- tory (MBI) [13]. This scale has been previously validated