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6 began to decline in the late 20th century

In 2023, a nonprofit advocacy group called Grassroots Wildland Firefighters worked with Arizona Senator Kyrsten Sinema and other federal legislators to introduce the Wildland Firefighter Paycheck Protection Act, which temporarily increased benefits and raised pay for nonseasonal (permanent) wildland firefighters by up to 42 percent while also increasing hourly pay for seasonal workers by two dollars an hour

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Yet adherence rates in community-based populations are notably lower than in controlled trials, especially among younger adults and women, suggesting a gap between clinical efficacy and practical effectiveness 12,13

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