John Violanti

University at Buffalo, The State University of New York | SUNY Buffalo · epidemiology & environmental health

The COVID-19 pandemic introduced a significant and unprecedented exacerbation of community mental health challenges. We compared the prevalence of mental health treatment (MHT) before and during the COVID-19 pandemic among US workers. Self-reported MHT data (N = 30,680) were obtained from the Sample Adult data of the National Health Interview Surve...

Objectives: We examined associations of the metabolic syndrome severity score (MSSS) and the metabolic syndrome (MetSyn) components with central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE). Methods: Participants in this cross-sectional study were 253 officers from the Buffalo Cardio-Metabolic Occupational P...

Purpose This study examined the national prevalence of cluster suicides among law enforcement personnel at the county level, the influence on future suicides and risk factors associated with clusters. Design/methodology/approach Law enforcement suicide data were obtained from The National Violent Death Reporting System (NVDRS) and categorized into...

Purpose The goal of the present study is to determine the proportionate mortality and national rate of duty-related deaths from COVID-19 among US law enforcement officers during the year 2020. Design/methodology/approach Data for the current study were obtained from the National Law Enforcement Officer Memorial Fund (NLEOMF) database for the year...

Shift work is a significant police stressor. Shift work can lead to sleep deprivation and disruption of circadian rhythms which in turn can lead to psychological and physiological health complications. Examples are depression, anxiety, fatigue, and somatic disease. Nighttime shift work can impair cognitive functioning, making it difficult to make r...

Suicide deaths among our first responder populations have gained growing national attention. Yet, many remain misinformed about the true extent of suicide within law enforcement ranks, with some believing this is a new phenomenon. However, those working and researching in the field know suicide has been a leading cause of mortality for decades. Unf...

Suicide is the consequence of a hidden danger in law enforcement. It is an indicator of the intolerable strain of police work and life away from work. Witnessing death, abused children, and inordinate stress weigh heavily as precipitants to depression and suicide among police. Culturally approved alcohol use, maladaptive coping, firearms availabili...

Police officers experience exposures associated with increased inflammation, such as the stress associated with shiftwork and poor-quality diet, both of which have been shown to affect sleep duration and quality. This study examined the longitudinal and cross-sectional effects of the Energy-density Dietary Inflammatory Index (E-DII™) on objectively...

Resolving the mental health crises in police work

Psychological and physical dangers of police work

This book takes an in-depth look at the phenomenon of police officer suicide. Centered on statistical information collected from cases of officer suicide from 2017 to 2019, this volume helps readers understand the circumstances surrounding death by suicide amongst law enforcement personnel and makes recommendations for identification and prevention...

Background Adverse Childhood Experiences (ACEs) are associated with numerous adverse health outcomes in adulthood. Our objective was to investigate associations between ACEs and sleep measures among 206 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. Methods ACEs (independent variable) was assessed using the ACE...

Purpose The purpose of this study is to examine cross-sectional associations between adverse childhood experiences (ACEs) and mental health among police officers. Design/methodology/approach The sample was from the Buffalo Cardio-Metabolic Occupational Police Stress study data (132 male and 51 female officers). Standardized surveys were administer...

Purpose This study is a mortality assessment on police officers (68-years, 1950–2018) and includes all causes of death. Design/methodology/approach The authors investigated 1,853 police deaths (1950–2018) using sources of mortality that included the National Death Index, NY State, and available records from the Buffalo NY police department. Standa...

We examined the association between self-reported sleep quality, sleep duration, and dietary patterns among police officers in the Buffalo Cardio-Metabolic Occupational Stress (BCOPS) study. 422 police officers aged 21–74 (2004–2009). We used a cross-sectional study design and obtained sleep quality and duration from responses to the 19-item Pittsb...

Few studies have examined shiftwork adaptation among police officers or potential differences in disease biomarkers among adapted and maladapted shiftworkers. This study characterized shiftwork adaptation among 430 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Police officers working fixed night shifts...

Shiftwork has been associated with elevated depressive symptoms; police officers frequently work shifts and may experience depressive symptoms. This study assessed the association between depressive symptoms and shiftwork in a police cohort from Buffalo, New York, USA using a repeated cross-sectional design with data collected in 2004–2009 (n = 428...

Purpose: To characterize changes in work hours across a career in law enforcement. Methodology: N=113 police officers enrolled in the BCOPS cohort were studied. The police officers started their careers in law enforcement between 1994 and 2001 at a mid-sized, unionized police department in northwestern New York, and continued to work at this polic...

The aim of this cross-sectional study was to assess the associations of burnout with cortisol parameters in 197 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (2010–2014). The Maslach Burnout Inventory-General Survey assessed depersonalization, exhaustion, and professional efficacy. Officers provided sali...

Purpose The purpose of this paper is to update the assessment of national data on law enforcement worker suicide based on the National Occupational Mortality Surveillance database (NOMS, Centers for Disease Control and Prevention). Design/methodology/approach Death certificate data for 4,441,814 decedents, age 18–90 who died in one of the 26 repor...

Purpose This study examined trends in the prevalence of cardiovascular disease (CVD) and CVD risk factors among U.S. older adults and workers. We also investigated correlations between the temporal prevalence of CVD and selected risk factors (hypertension, obesity, physical inactivity, smoking, and treated diabetes) among participants. Methods Dat...

Introduction: Injuries at work may negatively influence mental health due to lost or reduced working hours and financial burden of treatment. Our objective was to investigate, in U.S. workers (a) the prevalence of serious psychological distress (SPD) by injury status (occupational, non-occupational, and no injury) and injury characteristics, and (...

Purpose We examined cross-sectional associations of sleep measures with central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) and investigated whether sex and race/ethnicity modified these associations. Methods Participants (N = 202; 78% white; 71% men) were enrolled in the Buffalo Cardio-metabolic Occupational Police...

Introduction: Shiftwork is inevitable in law enforcement. Officers are scheduled around-the-clock to protect and serve communities. Many police departments are also understaffed; consequentially, officers’ work schedules often include long work hours. Shift work and long work hours can result in sleep loss, poor sleep quality, and fatigue. In turn,...

Introduction Shiftwork is inevitable in law enforcement. Officers are scheduled around-the-clock to protect and serve communities. Many police departments are also understaffed; consequentially, officers’ work schedules often include long work hours. Shift work and long work hours can result in sleep loss, poor sleep quality, and fatigue. In turn,...

Introduction Poor sleep quality may be attributed to several occupational factors and has been linked to adverse health outcomes, including cardiovascular disease. Recent epidemiologic studies suggest rest-activity circadian rhythm (RAR) as a possible determinant of poor sleep quality. The focus of these studies has been on the magnitude of the par...

Purpose: The purpose of this paper is to assess whether shift work, sleep loss, and fatigue are related to short-term unplanned absences in policing. Methodology: N=367 police officers from the Buffalo Police Department were studied. Day-by-day work and sick leave data were obtained from the payroll. Absenteeism was defined as taking a single sic...

Introduction: Biomathematical models of fatigue (BMMF) predict fatigue during a work-rest schedule on the basis of sleep-wake histories. In the absence of actual sleep-wake histories, sleep-wake histories are predicted directly from work-rest schedules. The predicted sleep-wake histories are then used to predict fatigue. It remains to be determined...

Introduction: In the United States, the policies used to schedule police officers’ work hours vary greatly from department to department. Because of the 24/7 nature of policing, departments use shift work to staff officers around-the-clock. Further, many departments are chronically understaffed, and it is not uncommon for officers’ schedules to inc...

Purpose Law enforcement is a dangerous profession not only due to assaults, accidents and homicides but also due to health risks. This study examined trends in the national frequency and rate of law enforcement job-related illness deaths in the United States over a 22-year period (1997–2018). Design/methodology/approach Data were obtained from the...

Actigraphy, a method for inferring sleep/wake patterns based on movement data gathered using actigraphs, is increasingly used in population-based epidemiologic studies because of its ability to monitor activity in natural settings. Using special software, actigraphic data are analyzed to estimate a range of sleep parameters. To date, despite extens...

This study investigated the associations of baseline sleep onset latency, wake after sleep onset, longest wake episode, number of awakenings, sleep efficiency and sleep duration with incident hypertension during a 7‐year follow‐up (n = 161, 68% men) and the joint effect of insufficient sleep and obesity on incident hypertension. Sleep parameters we...

Purpose –: Chronic exposure to occupational stress may lead to depressive symptoms in police officers. The association between police stress and depressive symptoms and the potential influences of coping and hardiness were evaluated. The paper aims to discuss this issue. Design/methodology/approach –: Stress level was assessed in the Buffalo Car...

Introduction: In operational settings, managing fatigue and sustaining performance are critical to maintaining safety and productivity. Biomathematical models have been developed to predict fatigue and performance from sleep-wake histories enabling the construction of work schedules that minimize fatigue and performance impairment. Often, however,...

Objective: Police officers have higher rates of cardiovascular disease (CVD) morbidity and mortality than the U.S. general population. Officers are exposed to conventional and unexpected workplace stressors. The hypothalamic-pituitary-adrenal (HPA) axis plays a major role responding to stressor exposure by releasing cortisol. Prolonged release or...

Objective: Studies show that serum levels of 25-hydroxyvitamin D (25(OH)D), a biomarker for vitamin D status, are lower in persons with higher adiposity levels and that police officers have been found to have a high prevalence of obesity. The purpose of this study was to examine relationships between several adiposity measures and 25(OH)D, and als...

Purpose Balancing work and family in dual-earner households can be stressful. Research suggests that increased work-family conflict (WFC) significantly predicts poor psychological health and increased stress in police officers. The purpose of this paper is to assess whether child care stress was associated with anxiety symptoms and if stressful wor...

Objective: To assess the association of shift work with biomarkers of subclinical cardiovascular disease and examine the moderating role of body mass index (BMI) in a police cohort METHODS:: A cross-sectional analysis was conducted among officers who were categorized as working the day, evening, or night shift. Comparisons with inflammatory biomar...

Purpose: We hypothesized that effort-reward imbalance (ERI) is associated with an atypical cortisol response. ERI has been associated with higher job stress. Stress triggers cortisol secretion via the hypothalamic-pituitary-adrenal (HPA) axis, and significant deviation from a typical cortisol pattern can indicate HPA axis dysfunction. Methods: 1...

Background Police officers' stress perception, frequency of stressful events (stressors), and police work characteristics may contribute to poor sleep quality through different mechanisms. Methods We investigated associations of stress severity (measured by stress rating score) and frequency of stressors with sleep quality and examined the influen...

Protective psychosocial factors may reduce the risk of stress-related illnesses in policing. We assessed the association between protective factors and depressive symptoms among 242 police officers. Participants were from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004–2014). Coping, hardiness, personality traits, and so...

The role of coping in the association between stress and posttraumatic stress disorder (PTSD) is not clear. We investigated the effects of active and passive coping strategies on the associations between police stress (administrative and organization pressure, physical and psychological threats, and lack of support) and PTSD symptoms in 342 police...

The present study examined associations of effort–reward imbalance (ERI) and overcommitment at work with burnout among police officers using data from 200 (mean age = 46 years, 29% women) officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress Study. ERI and overcommitment were assessed using Siegrist’s “effort/reward” question...

Purpose: The purpose of this paper is to provide a review of law enforcement suicide research from 1997 to 2016. Design/methodology/approach: The PRISMA systematic review methodology was implemented. A SCOPUS search identified a total of 97 documents. After applying all exclusion criteria, the results included a list of 44 articles in the review. F...

Objective: To examine the association of the cortisol awakening response (CAR) with change in brachial artery flow-mediated dilation (FMD%) in police officers over a seven-year period. Methods: Baseline CAR was obtained from four saliva samples taken fifteen minutes apart immediately after awakening. Analysis of covariance was used to compare th...

Objective: The goal of this study was to investigate the role of leisure time physical activity (LTPA) on the association between sleep quality and the cortisol awakening response (CAR) in people with an occupation that exposes them to high levels of stress. Methods: Participants were 275 police officers (age = 42 years ± 8.3, 27% women) enrolle...

Purpose: The purpose of this paper is to examine the association of social avoidance among police, cardiovascular disease (CVD) (metabolic syndrome (MetSyn)), and social support. Design/methodology/approach: Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress study (n = 289). Social avoidance (defined as the t...

The present study examined the association between shift work and fatigue among male (n = 230) and female (n = 78) police officers. A 15-year work history database was used to define dominant shifts as day, afternoon, or night. A 10-item questionnaire created from the Standard Shiftwork Index (SSI) assessed fatigue. Gender-stratified analyses of va...

Background: Police officers in the New Orleans geographic area faced a number of challenges following Hurricane Katrina. Aim: This cross-sectional study examined the effect of social support, gratitude, resilience and satisfaction with life on symptoms of depression. Method: A total of 86 male and 30 female police officers from Louisiana parti...

This exploratory, qualitative study addresses the question: what are the important elements in effective peer support programs for bereaved survivors? Interviews with ten highly experienced experts were analyzed to identify recurrent themes and elements. Findings indicate that effective peer support programs for the bereaved should be: easily acces...

Background: Performance measures are a key component of implementation, dissemination, and evaluation of evidence-based guidelines (EBGs). We developed performance measures for Emergency Medical Services (EMS) stakeholders to enable the implementation of guidelines for fatigue risk management in the EMS setting. Methods: Panelists associated wit...

Background: Administrators of Emergency Medical Services (EMS) operations lack guidance on how to mitigate workplace fatigue, which affects greater than half of all EMS personnel. The primary objective of the Fatigue in EMS Project was to create an evidence-based guideline for fatigue risk management tailored to EMS operations. Methods: Systemat...

Objective: To examine relationships of blood pressure with central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) among 242 police officers. Methods: Computerized retinal images of each eye were taken. Mean values of CRAE and CRVE were compared across hypertension status categories using ANOVA and ANCOVA. Asso...

Purpose –: The purpose of this paper is to provide a state-of-the-art review on the topic of police stressors and associated health outcomes. Recent empirical research is reviewed in the areas of workplace stress, shift work, traumatic stress, and health. The authors provide a comprehensive table outlining occupational exposures and related health...

This systematic literature review assesses the evidence regarding benefits of peer support services for bereaved survivors of sudden or unexpected death. Reports were included that addressed peer support services for adults who experienced death of a family member, close friend, or coworker. Of the 32 studies meeting all inclusion criteria, most sh...

Objective: We examined prevalence, frequency, duration, and recency of injury leave and the association of duty-related injury with perceived stress in U.S. police officers. Methods: This cross-sectional study contained 422 active duty police officers from a mid-sized urban police department. For each participating officer, work history records...

Objective: To investigate associations of central retinal arteriolar equivalent (CRAE), a measure of retinal arteriolar width, and central retinal venular equivalents (CRVE), a measure of retinal venular width, with shiftwork in 199 police officers (72.9% men). Methods: Shiftwork (day, afternoon, night) was assessed using electronic payroll reco...

Police officers often continue to face numerous threats and stressors in the aftermath of a disaster. To date, posttraumatic growth (PTG) has been studied primarily in the context of significant trauma; thus, it is not known whether stressful life events are associated with PTG. This study investigated the development of PTG among 113 police office...

Shift workers suffer from a constellation of symptoms associated with disruption of circadian rhythms including sleep abnormalities, and abnormal hormone secretion (e.g. melatonin, cortisol). Recent, but limited, evidence suggests that shift workers have elevated levels of circulating white blood cells (WBCs) compared to their day working counterpa...

Objectives: This study examines relationships between the frequency and intensity of police work stressors and cardiac vagal control, estimated using the high frequency component of heart rate variability (HRV). Methods: This is a cross-sectional study of 360 officers from the Buffalo New York Police Department. Police stress was measured using...

Objective: Police officers in the New Orleans geographic area faced a number of challenges following Hurricane Katrina in 2005. Design: This cross-sectional study examined gratitude, resilience, and satisfaction with life as mediators in the association between social support and post-traumatic stress disorder (PTSD) symptoms in 82 male and 31 f...

There is little research on suicide among corrections personnel. The present study examined age-adjusted proportionate mortality ratios (PMRs) for suicide among corrections personnel compared to the U. S. working population in 23 states during 1999, 2003-2004, and 2007, based on the National Occupational Mortality Surveillance database (NOMS). Age...

There is little research on suicide among corrections personnel. The present study examined age-adjusted proportionate mortality ratios (PMRs) for suicide among corrections personnel compared to the U. S. working population in 23 states during 1999, 2003-2004, and 2007, based on the National Occupational Mortality Surveillance database (NOMS). Age...

Introduction: Policing involves inherent physical and psychological dangers as well as occupational stressors that could lead to chronic fatigue. Although accounts of adverse events associated with police fatigue are not scarce, literature on the association between chronic fatigue and on-duty injury are limited. Methods: Participants were offic...

Aim: In this study, we evaluated whether peritraumatic dissociation (PD) was associated with symptoms of depression and posttraumatic stress disorder (PTSD), and whether this association was modified by trauma prior to police work. Method: Symptoms of depression, PTSD, peritraumatic dissociative experience (PDE), and trauma prior to police work...

Police officers encounter unpredictable, evolving, and escalating stressful demands in their work. Utilizing the Spielberger Police Stress Survey (60-item instrument for assessing specific conditions or events considered to be stressors in police work), the present study examined the association of the top five highly rated and bottom five least ra...

Background Police work is generally sedentary although there may be situations that require physical endurance and strength, such as foot chases and arresting suspects. Factors such as excessive body fat can impede an officer's physical ability to deal with such occurrences. Our objective was to examine associations between officers' body fat perce...

Purpose: Studies describing prevalence and trends of physical activity among workers in the United States are scarce. We aimed to estimate prevalence and trends of "sufficient" leisure-time physical activity (LTPA) during the 2004-2014 time period among U.S. workers. Methods: Data were collected for U.S. workers in the National Health Interview...

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Introduction: Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers. Methods: Self-reported weight, height, and injuries w...

Background: Our objective was to assess the influence of shiftwork on change in endothelial function. Methods: This longitudinal study was conducted in 188 police officers (78.2% men). Shiftwork status (day, afternoon, night) was assessed objectively using daily Buffalo, NY payroll work history records. Brachial artery flow-mediated dilation (FM...

Objective: To investigate associations between shiftwork and diurnal salivary cortisol among 319 police officers (77.7% men). Methods: Information on shiftwork was obtained from the City of Buffalo, NY electronic payroll records. Saliva was collected using Salivettes at seven time points and analyzed for free cortisol concentrations (nmol/L) usi...

This descriptive study examined the top five most frequent and highly rated occupational stressors from the Spielberger Police Stress Survey among 365 police officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004–2009). Prevalence, frequency, and rating of stressors were compared across gender. Poisson regr...

Objective: The aim of the study was to examine association of shift work with sleep quality in police officers. Methods: Data were obtained from the Buffalo Cardio-Metabolic Occupational Police Stress study (n = 363). An electronic work history database was used to define shift as day, afternoon, or night for three durations: past month, 1 year,...

Better sleep quality was associated with dietary patterns high in fruits, vegetables, and dairy products, specifically among women. Depression mediated the association between sleep quality and fruit and vegetable consumption among women and men.

Police work is a high stress occupation and stress has been implicated in work absence. The present study examined (1) associations between specific types of police stress and work absences, (2) distinctions between "voluntary" (1-day) and "involuntary" (> 3-days) absences; and (3) the modifying effect of resiliency. Officers (n=337) from the Buffa...

Background: The authors conducted a retrospective cohort mortality study on police officers from 1950-2005. Methods: Standardized Mortality Ratio (SMR) analyses were conducted separately for white male (n=2761), black (n=286), and female (n=259) officers. Results: Mortality from all causes of death combined for white male officers was signific...