Recently, concern over firefighter health and wellness in the United States has escalated due to increasing obesity rates, on-duty cardiovascular event risk, and job stress. A range of barriers to health and wellness have been identified within firefighter culture, but the way these barriers manifest in firefighters' lives is not well-understood. Using a qualitative approach with multiple data sources, we sought to answer the question, "What impacts the health of firefighters in West Virginia?" Eight focus groups and Photovoice data from nine participants were inductively analyzed using guidelines from consensual qualitative research. House tours were also used in order to provide contextualizing ethnographic data. Overall, seven factors were identified as impacting firefighters' health in West Virginia including stress, nutrition, physical activity, sleep, motivation, time, and other miscellanies factors impacting firefighter health. Second cycle coding showed complex relationships between these individual factors.