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Previous epidemiological research indicates that police officers have an elevated risk of death relative to the general population overall and for several specific causes. Despite the increased risk for mortality found in previous research, controversy still exists over the life expectancy of police officers. The goal of the present study was to compare life expectancy of male police officers from Buffalo New York with the U.S. general male population utilizing an abridged life table method. On average, the life expectancy of Buffalo police officers in our sample was significantly lower than the U.S. population (mean difference in life expectancy = 21.9 years; 95% CI: 14.5-29.3; p < 0.0001). Life expectancy of police officers was shorter and differences were more pronounced in younger age categories. Additionally, police officers had a significantly higher average probability of death than did males in the general population (mean difference = 0.40; 95% CI: 0.26-0.54; p < 0.0001). The years of potential life lost (YPLL) for police officers was 21 times larger than that of the general population (Buffalo male officers vs. U.S. males = 21.7, 95% CI: 5.8-37.7). Possible reasons for shorter life expectancy among police are discussed, including stress, shift work, obesity, and hazardous environmental work exposures.
... Compared with workers in the general population, officers whose sleep is chronically disrupted, as a consequence of either personal factors such as medical disorders, intolerance to shift work and schedule changes, or involvement in off-duty activities or because of employer scheduling and work-hour practices, suffer from disproportionately high levels of cardio- vascular, gastrointestinal, and metabolic diseases; chronic insomnia, sleep apnea, and other sleep disorders; and psycho- logical disorders including depression, suicide, and family dysfunction.  Research linking long and erratic work hours to these sorts of disorders is substantial and the findings are compelling. 1,12 Shorter-term links between sleep loss and the sorts of on-the-job accidents and injuries that most fre- quently kill or seriously harm police officers also are well documented. ...
...  Research linking long and erratic work hours to these sorts of disorders is substantial and the findings are compelling. 1,12 Shorter-term links between sleep loss and the sorts of on-the-job accidents and injuries that most fre- quently kill or seriously harm police officers also are well documented. 1,12,13 Figures 76-1 and 76-2 show the sources of on-the-job injury and death for police officers. ...
... 1,12 Shorter-term links between sleep loss and the sorts of on-the-job accidents and injuries that most fre- quently kill or seriously harm police officers also are well documented. 1,12,13 Figures 76-1 and 76-2 show the sources of on-the-job injury and death for police officers. As is evident in Figure 76-1, felonious killings of police officers declined steadily from 1980 to 2013. ...
Fatigue is one of the most common health and safety hazards faced by police officers, as well as other first responders and military personnel in similar operational environments. Whether caused by extended-duty hours, night work, lack of rest, or circadian disruption, fatigue contributes to high levels of mortality and morbidity in these occupational groups. It also degrades cognitive performance, differentially impairing the parts of the brain that are most important for making sound judgments, deciding on appropriate courses of action, and exercising restraint in the face of threat and provocation. This impairment is particularly problematic in civilian police work, which we use here as a general model for all first responders and the military. Police, just like military personnel assigned to ground counterinsurgency operations and peacekeeping assignments, often face aggressors who are difficult to distinguish from bystanders in ambiguous, fastpaced, and complex situations in which they must identify and neutralize threats. The consequences of either failing to exercise restraint and minimize civilian casualties or failing to effectively neutralize an enemy can be equally dire—for operators on the ground and for strategic objectives. Analogous challenges confront other first responders and military specialties. Because the social, organizational, and individual causes of sleep loss among these occupational groups are inextricably linked, in this chapter a review is presented of the systematic interactions that must be taken into account to understand and treat sleep problems and disorders among this critical population. How such an approach provides opportunities for sleep physicians to improve both patient treatment and public health by working with operational agencies is discussed.
... Heart disease causes 45% of the deaths among US firefighters (FFs) while they are on duty . Police officers (POs) have a poorer health prognosis and more metabolic disorders than the general population [2, 3] . The majority of prospective studies have found that occupational sitting was associated with a higher risk of diabetes mellitus and mortality . ...
... However , the maximal power (W max ) was significantly higher in ). Worldwide, POs belong to a community with a high prevalence of obesity [53, 54] and cardiovascular risk factors  and a lower life expectancy  compared with the general population. It is unknown why POs are more obese and have a comparatively high rate of metabolic syndrome. ...
This study examined the association between the physical work environment and physiological performance measures, physical activity levels and metabolic parameters among German civil servants. A main focus in this study was to examine the group differences rather than measuring the absolute values in an occupational group.
We prospectively examined 198 male German civil servants (97 firefighters [FFs], 55 police officers [POs] and 46 sedentary clerks [SCs]). For each parameter, the groups were compared using a linear regression adjusted for age.
The 97 FFs showed a similar maximal aerobic power (VO2max l/min) of 3.17±0.44 l/min compared with the POs, who had a maximal aerobic power of 3.13±0.62 l/min (estimated difference, POs vs. FFs: 0.05, CI: -0.12-0.23, p=0.553). The maximal aerobic power of the FFs was slightly higher than that of the SCs, who had a maximal aerobic power of 2.85±0.52 l/min (-0.21, CI: -0.39-0.04, p=0.018 vs. FFs). The average physical activity (in metabolic equivalents [METS]/week) of the FFs was 3818.8±2843.5, whereas those of the POs and SCs were 2838.2±2871.9 (-808.2, CI: 1757.6-141.2, p=0.095) and 2212.2±2292.8 (vs. FFs: -1417.1, CI: -2302-531.88, p=0.002; vs. POs: -2974.4, CI: -1611.2-393.5, p=0.232), respectively. For the FFs, the average body fat percentage was 17.7%±6.2, whereas it was 21.4%±5.6 for the POs (vs. FFs: 2.75, CI: 0.92-4.59, p=0.004) and 20.8%±6.5 for the SCs (vs. FFs: 1.98, CI: -0.28-4.25, p=0.086; vs. POs: -0.77, CI: 3.15-1.61, p=0.523). The average waist circumference was 89.8 cm±10.0 for the FFs, 97.8 cm±12.4 (5.63, CI: 2.10-9.15, p=0.002) for the POs, and 97.3±11.7 (vs. FFs: -4.89, CI: 1.24-8.55, p=0.009; vs. POs: -0.73, CI: -5.21-3.74, p=0.747) for the SCs.
The FFs showed significantly higher physical activity levels compared with the SCs. The PO group had the highest cardiovascular risk of all of the groups because it included more participants with metabolic syndrome; furthermore, the POs had an average of 2.75% higher body fat, lower HDL cholesterol values and higher waist circumferences compared with the FFs and higher LDL cholesterol values compared with the SCs. Our data indicate that sedentary occupations appear to be linked to obesity and metabolic syndrome in middle-aged men.
... In the USA, police officers have an elevated risk of death relative to the general population overall. Possible reasons for shorter life expectancy among police officers include shift work, obesity, hazardous environmental work exposures and stress ( Violanti et al., 2013). Encountering violent individuals and life-threatening incidents are significant stressors for police officers ( Can & Hendy, 2014;Violanti & Aron, 1995). ...
... Looking at various studies around the world, about 25% to 30% of police officers have a stress-related physical health problem, [27,28] with an explanation that they are exposed to numerous types of risk factors including environmental stress, administrative pressure, rotating shifts, high work load, depression , less sleep, poor nutrition, and less physical activities. A few studies have suggested that work stress is associated with higher prevalence of MetS in police officers who belong to a community with more adverse risk factors and higher mortality rates than the general population. Hartley et al  also found a positive association between job stress and the number of MetS components. ...
Nonalcoholic fatty liver disease (NAFLD) and occupational stress have been recognized as major public health concerns. We aimed to explore whether occupational stress was associated with NAFLD in a police population.
A total of 6559 male police officers were recruited for this prospective study in April 2007. Among them, 2367 eligible subjects participated in follow-up from 2008 to 2011. NAFLD was diagnosed based on standard criteria. Occupational stress was evaluated by Occupational Stress Inventory-Revised scores.
The incidence of NAFLD was 31.2% in the entire police. After adjusting for traditional risk factors, moderate occupational stress (MOS), high occupational stress (HOS), and high personal strain (HPS) were risk factors (MOS: hazard ratio [HR] = 1.237, 95% confidence interval [CI] = 1.049–1.460; HOS: HR = 1.727, 95% CI = 1.405–2.124; HPS: HR = 3.602, 95% CI = 1.912–6.787); and low occupational stress (LOS) and low personal strain (LPS) were protective factors (LOS: HR = 0.366, 95% CI = 0.173–0.776; LPS: HR = 0.490, 95% CI = 0.262–0.919) for NAFLD in the entire police cohort. HOS and HPS remained robust among traffic police.
HOS and HPS were independent predictors for the development of NAFLD in a Chinese police population. Additional future prospective investigations are warranted to validate our findings.
... Poorer physical and psychological health places them at greater risk of lifestyle-related diseases, such as cardiovascular disease (CVD) and diabetes, and overall mortality.  Years of police service is associated with CVD risk, 6 greater body weight 7 and physical inactivity. 8 Individuals working in the police force are employed in varied and diverse roles. ...
... When we are able to provide prospective analyses of health and psychological factors in this occupation, we will be in a better position to isolate policing as an agent of untoward outcomes. Exposure and job socialization have a profound impact on police officers, and future research should include etiologic studies that can evaluate potential occupational factors that lead to increased risks (O' Hara et al., 2013;Violanti, Fekedulegn, Hartley, Andrew, Gu, Burchfiel, 2013). Based on the results of this review, we can with some assurance state that police work serves as a fertile arena for assessment of the health consequences of stress. ...
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 effects in police officers.
A review of recent empirical research on police stress and untoward psychological and physiological health outcomes in police officers.
The results offer a conceptual idea of the empirical associations between stressful workplace exposures and their impact on the mental and physical well-being of officers.
Research limitations/implications –:
A key limitation observed in prior research is the cross-sectional study design; however, this serves as a motivator for researchers to explore these associations utilizing a longitudinal study design that will help determine causality.
This review provides empirical evidence of both mental and physical outcomes associated with police stress and the processes involved in both. Research findings presented in this paper are based on sound psychological and medical evidence among police officers.
... The resulting disruption of circadian rhythms leads to sleep loss and its associated detrimental effects on health: increased cardiovascular disease, metabolic syndrome, sleep disorders, and possibly even increased mortality. 107,108 The effects of shift work are felt early (84% of five cohorts of EM residents felt a need for intervention for their sleep deprivation and selfperceived exhaustion) and become more pronounced with age. 109,110 Sleep deprivation is associated with worse patient care, decreased job satisfaction, and less personal well-being, all of which contribute to burnout. ...
Each year more than 400 physicians take their lives, likely related to increasing depression and burnout. Burnout—a psychological syndrome featuring emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment—is a disturbingly and increasingly prevalent phenomenon in healthcare, and emergency medicine (EM) in particular. As self-care based solutions have proven unsuccessful, more system-based causes, beyond the control of the individual physicians, have been identified. Such system-based causes include limitations of the electronic health record, long work hours and substantial educational debt, all in a culture of “no mistakes allowed.” Blame and isolation in the face of medical errors and poor outcomes may lead to physician emotional injury, the so-called “second victim” syndrome, which is both a contributor to and consequence of burnout. In addition, emergency physicians (EP) are also particularly affected by the intensity of clinical practice, the higher risk of litigation, and the chronic fatigue of circadian rhythm disruption. Burnout has widespread consequences, including poor quality of care, increased medical errors, patient and provider dissatisfaction, and attrition from medical practice, exacerbating the shortage and maldistribution of EPs. Burned-out physicians are unlikely to seek professional treatment and may attempt to deal with substance abuse, depression and suicidal thoughts alone. This paper reviews the scope of burnout, contributors, and consequences both for medicine in general and for EM in particular.
... Obesity can be a predictor of early mortality; therefore, with a BMI of 30-35, life expectancy decreases from 2 to 4 years and with a BMI of 40-45 this expectation is reduced from 8 to 10 years. Police officers tend to consume a high-fat diet and the decrease in their physical activity is responsible for high levels of occupational stress . In our study it was found that 70 (93.3%) ...
... Stress may be related to lower mean life expec- tancy in officers. Differences are more signifi- cant in younger age groups . Metabolic syn- drome and atherosclerosis [5,15] are more prev- alent than in the general population and the risk of death from cardiac incidents is caused among others by the neuroendocrine reaction and in- creased activity of the sympathetic system . ...
Aims: To evaluate the causes of incapacity for continued work in the police force due to health issues and to see whether there are any differences related to gender. Materials and methods: An analysis of certification which confirmed incapacity to work and medical records of 130 patients with documented mental disorders who require more than 5 years of psychiatric treatment. The study uses a structured sociodemographic and medical questionnaire designed specifically for this purpose. Results: The mean age of the group was 48 years for women and 44 years for men. Years of service of women was mostly 21 to 25 years and more, whereas seniority of men was between 21 and 25 years. The period of treatment in psychiatric health clinics was longer for women. The most common cause for incapacity for work was chronic neurotic disorders (87.69% of women and 98.41% of men). Conclusions: The results of this study indicate that in the analysed sample of police officers the main cause of incapacity to work were chronic neurotic neurasthenic disorders. Length of service as well as age of police officers at the time of retirement from the police force was higher for women. Neurotic disorders often coexisted with somatic disorders, among which were hypertension and degenerative disorders of the spine. Neurotic and neurasthenic disorders qualified the individuals to the third-level disability category owing to their service in the police force.
... Law enforcement officers (LEOs) suffer from premature mortality ( Violanti et al., 1998Violanti et al., , 1996Violanti et al., , 2013, intentional and unintentional injury (Hartley, Burchfiel, Fekedulegn, Andrew, Knox and Violanti, 2011;), cancers ...
Purpose: Law enforcement officers (LEOs) suffer from premature mortality, intentional and unintentional injury, suicide and are at an increased risk for several non-communicable disease outcomes including cardiovascular disease and several cancers, compared to those employed in other occupations. Repeated exposure to stressful and traumatic stimuli is a possible mechanism driving these adverse health outcomes among LEOs. To better identify the sources of these health problems, the purpose of this paper is to determine the feasibility of conducting a cohort study using physiological measures of stress (e.g. heart rate) with LEOs; perceptions of the FitBit device, including LEO buy-in and attitudes associated with the protocol. Design/methodology/approach: Data were collected from ten recent graduates of the Dallas Police Training Academy. Findings: Results suggest that officer buy-in and protocol compliance was high. Officers were eager to participate in this study, and completion of weekly surveys was 100 percent. Minute-level missing data from wearable devices was relatively low (25 percent), and 90 percent of participants wore the FitBit devices on more than 90 percent of study days. Originality/value: Results from this study suggest that wearable physiological devices can be effectively used in law enforcement populations to measure stress.
... Public health and cost implications of work-related hazards OHS injuries and diseases affect the physical, social and psychosocial wellbeing of police officers, which has various public health implications . Some studies indicate that police officers are at risk of dying at a younger age than the general population. ...
Occupational hazards, injuries and diseases are a major concern among police officers, including in Sub-Saharan Africa. However, there is limited locally relevant literature for guiding policy for the South African Police Service (SAPS). The purpose of this review was to describe the occupational hazards, injuries and diseases affecting police officers worldwide, in order to benchmark policy implications for the SAPS.
We conducted a systematic review of studies using Google Scholar, PubMed and Scopus.
A total of 36 studies were included in this review. Six revealed that police officers’ exposure to accident hazards may lead to acute or chronic injuries such as sprains, fractures or even fatalities. These hazards may occur during driving, patrol or riot control. There were two studies, which confirmed physical hazards such as noise induced hearing loss (NIHL), due to exposure to high levels of noise. Three studies on chemical hazards revealed that exposure to high concentrations of carbon dioxide and general air pollution was associated with cancer, while physical exposure to other chemical substances was linked to dermatitis. Four studies on biological hazards demonstrated potential exposure to blood borne diseases from needle stick injuries (NSIs) or cuts from contaminated objects. One study on ergonomic hazards showed that musculoskeletal disorders can result from driving long distances and lifting heavy objects. There were 15 studies that indicated psychological hazards such as post-traumatic stress disorder (PTSD) as well as stress. Moreover, four studies were conducted on organizational hazards including burnout, negative workplace exposure and other factors.
This review outlined the global impact of occupational hazards, injuries and diseases in the police force. It served as a benchmark for understanding the policy implications for South Africa, where there is paucity of studies on occupational health and safety.
... When we are able to provide prospective analyses of health and psychological factors in this occupation, we will be in a better position to isolate policing as an agent of untoward outcomes. Exposure and job socialization have a profound impact on police officers, and future research should include etiologic studies that can evaluate potential occupational factors that lead to increased risks (O' Hara et al., 2013;Violanti, Fekedulegn, Hartley, Andrew, Gu, Burchfiel, 2013). Based on the results of this review, we can with some assurance state that police work serves as a fertile arena for assessment of the health consequences of stress. ...
... Additionally, mortality rates among police are overwhelming. The average life expectancy of an officer who reaches age 50 is an additional 7.8 years compared to an additional 35 years for the general public ( Violanti et al., 2013). ...
The nature of police work includes toxic work environments and uncertain danger which imparts a unique type of occupational stress spillover or the transfer of stress from work life to home life for law enforcement officers. Work stress places officers at risk for negative health and psychosocial outcomes. While it has been shown that occupational stress can compromise the well-being of police officers, little is known about how spillover can effect other areas of life for officers such as marital relationships. This study investigates the association between work demands, emotional stress spillover, and marital functioning in a law enforcement sample. Data from 1,180 married law enforcement respondents to the Police Officer Questionnaire which included 148 items assessing work stress, health, family, and support were examined. Responses were analyzed using regression analyses. Results showed that career demands and emotional spillover were statistically significant predictors of the variance in marital functioning. Social and emotional spillover of work-related stress carries negative consequences for communication and emotion regulation within law enforcement marriages.
... In addition, law enforcement personnel working prolong hours and alternative work shifts suffer from lack of sleep and many other medical issues, which could manifest as negative stressors. For all the reasons above, researches have shown police officers and law enforcement personnel have a shorter life expectancy than the general population ( Violanti et al., 2013). ...
To other professions, in law enforcement, due to the diversity and complexity of police activity, policemen are daily exposed to various dangers resulting from the risky nature of their working environment. Thus, police work must be carried out in the most aggravating circumstances, often with limited staff and only having a few seconds to make critical decisions: whenever using the legal means, specific equipment, intercepting or immobilizing offenders, acting against various violations of the law, police officers are exposed to a very high number of occupational risks, compared to other civil professions. Despite the fact that public security environment risks are constantly evaluated by specialized workers and dedicated tools, compared to the policeman, this activity almost does not happen and it is mostly evasive taking into consideration that this area is within the competence of the high level manager and it is conducted by the human resources structures in the police units. Although this approach is totally wrong, these entities are the only ones in charge of controlling, mitigating or eliminating work related risks generated by police activity. This paper makes a brief assessment of the risks associated with the police operational work, taking into account the indicators taken and analyzed from the existing statistics of the Romanian Ministry of Internal Affairs, while offering new solutions in mitigating risks concerning the physical security of police workers.
A robust body of research findings has established that policing is a dangerous profession. Few scholars, however, have investigated the full picture of the hazards in policing, which includes deaths occurring in both felonious and nonfelonious circumstances. In this study, we examine nearly 50 years of all police officer line‐of‐duty deaths (1970–2016) using data from the Officer Down Memorial Page. We focus on long‐term trends in felonious and nonfelonious deaths annually, as well as on trends in incident‐level characteristics. We also employ interrupted time‐series analysis (ARIMA) to test the “war on cops” thesis post–Ferguson.
The number of line‐of‐duty deaths has declined dramatically over the last five decades. Policing is a much safer profession now than it was 50 years ago. Despite a 75% drop in deaths, however, there has been remarkable stability in geographic‐, temporal‐, and incident‐level characteristics. Also, several notable changes over time reflect favorably on improved safety in policing, such as declines in deaths resulting from aircraft crashes and accidental gunfire. Other trends are troubling, though, such as the stability in deaths during auto pursuits and a two‐fold increase in deaths from vehicular assaults. Currently, the “war on cops” thesis is not supported by any evidence, and we apply the 50‐year lens in this study to provide important context for understanding recent trends in officer deaths.
To systematically review studies of health promotion intervention in the police force. Four databases were searched for articles reporting on prepost single and multigroup studies in police officers and trainees. Data were extracted and bias assessed to evaluate study characteristics, intervention design and the impact of interventions on health. Database searching identified 25 articles reporting on 21 studies relevant to the aims of this review. Few studies (n=3) were of long duration (≥6 months). Nine of 21 studies evaluated structured physical activity and/or diet programmes only, 5 studies used education and behaviour change support-only interventions, 5 combined structured programmes with education and behaviour change support, and 2 studies used computer prompts to minimise sedentary behaviour. A wide array of lifestyle behaviour and health outcomes was measured, with 11/13 multigroup and 8/8 single-group studies reporting beneficial impacts on outcomes. High risk of bias was evident across most studies. In those with the lowest risk of bias (n=2), a large effect on blood pressure and small effects on diet, sleep quality, stress and tobacco use, were reported. Health promotion interventions can impact beneficially on health of the police force, particularly blood pressure, diet, sleep, stress and tobacco use. Limited reporting made comparison of findings challenging. Combined structured programmes with education and behaviour change support and programmes including peer support resulted in the most impact on health-related outcomes.
The association between police occupation and deaths has not been well studied. Here, we evaluate the mortality rate and the Years of Life Lost (YLL) within two police corporations in the Brazilian Federal District (BFD). Mortality data were collected from the personnel divisions of both police institutions – Civil (CPBFD) and Military (MPBFD) – between 2004 and 2013 related to professionals who died, comparing with the mortality data of the BFD population; chi-square independence tests were analyzed and statistical tests applied assuming a 5% significance level. Mostly of the deaths occurred among retired police officers (p<0.001) in the MPBFD, whilst active being 2.5 times greater than in the CPBFD; the average of YLL within the MPBFD is the largest (24.4), followed by the BFD (22.3) and the CPBFD (18.2). The MP is responsible for ostensive policing, with a greater exposure to traumatic events; the CP is involved with crime investigations, dealing with documents. Depending of the activities executed, police officer may be considered an unsafe occupation, being the mortality and the YLL greater than the general population. The results suggest the need for further studies which address the morbidity and mortality of the police officers.
To evaluate the effectiveness of an intervention for improving sleep health in a sample of employees from the Royal Canadian Mounted Police (RCMP).
Using a pre- and post-design we exposed 61 RCMP members to a fatigue-management training program. Pre- and post-intervention surveys included the Pittsburg Sleep Quality Index (PSQI), the World Health Organization Quality of Life (WHOQOL) instrument, and the six item index of psychological distress (Symptom Checklist-90).
We found the training improved member satisfaction with sleep (Wald = 2.58; df = 1; P = 0.03) and reduced symptoms of insomnia (Wald = 5.5; df = 1; P = 0.02). Furthermore, the training reduced the incidence of headaches (Wald = 6.5; df = 1; P = 0.01).
Our findings suggest that a fatigue management training program resulted in positive sleep health benefits for police. We stress the importance of continued evaluation to inform the large-scale implementation of fatigue-management programs.
Law enforcement officers all across the world are exposed to violence, confrontation, and traumatic incidents. They regularly witness death and suffering and are at risk of personal injury. Psychiatric sequelae include an increased risk for trauma-related symptoms, depression, alcohol-use disorders, and stress-related medical conditions. Law enforcement officers have been applying for early disability retirement pensions at an increased rate for stress-related psychiatric and medical conditions. As a result, law enforcement agencies are prematurely losing valuable resources, officers with training and experience. Departments have become proactive in trying to address mental health issues to prevent psychiatric disability by implementing employee wellness plans and stress reduction interventions. Programs have been developed to mitigate the effects of stress on law enforcement personnel. Many law enforcement agencies have developed strategies to encourage early confidential referral for psychiatric treatment. They utilize peer support groups and employee assistance programs and develop alliances with mental health professionals. When these approaches fail, a fitness for duty process can be used to identify impairment in work functioning due to psychiatric factors with the prospect of later returning the officer to full duty. Copyright
The SHIELD (Safety & Health Improvement: Enhancing Law Enforcement Departments) Study is a worksite wellness team-based intervention among police and sheriff departments assessing the program's effectiveness to reduce occupational risks and unhealthy lifestyle behaviors. The SHIELD program focused on improving diet, physical activity, body weight and sleep, and reducing the effects of unhealthy stress and behaviors, such as tobacco and substance abuse. The SHIELD team-based health promotion program was found to be feasible and effective at 6 months in improving diet, sleep, stress, and overall quality of life of law enforcement department personnel. Both intervention and control groups were followed for 24 months, and we report those durability findings, along with qualitative group interview results that provide insight into the changes of the long-term outcomes. Long-term effects were observed for consumption of fruits and vegetables, and there was some evidence for effects on tobacco and alcohol use. Assessment of dietary habits, physical activity behaviors, weight loss maintenance, and substance use is rare more than 1 year following an intervention, and in general, initial positive changes do not persist in prior research. The SHIELD program was feasible, effective, and durable for improving dietary changes.
The work of public officers involves repeated and long-term exposure to heavy workloads, high job strain and workplace violence, all of which negatively impact physical and mental health. This study aimed to evaluate and compare the incidences of diseases among different categories of public officers in Korea, in order to further understand the health risks associated with these occupations.
A cohort study using the National Health Insurance data.
We collated claims data between 2002 and 2014 for 860 221 public officers.
Primary and secondary outcome measures
Age-standardised rates were calculated using the direct standardisation method, and HRs were calculated using the Cox proportional hazard regression models.
Overall, we found that police officers and firefighters had a higher incidence of a range of diseases when compared with national and regional government officers (NRG). The most prominent HRs were observed among police officers for angina pectoris (HR: 1.52, 95% CI 1.49 to 1.54), acute myocardial infarction (HR: 1.84, 95% CI 1.77 to 1.92) and cerebrovascular disease (HR: 1.36, 95% CI 1.31 to 1.40). Firefighters were more susceptible to physical ailments and were at a significantly higher risk for traumatic stress disorders (HR: 1.40, 95% CI 1.26 to 1.56) than NRGs.
Compared withNRGs, police officers had higher HRs for all measured diseases, except for traumatic stress disorders. While firefighters had higher HRs for almost all diseases examined, public education officers had a higher HR for traumatic stress disorders, when compared with NRGs.
Law enforcement officers are a high-risk population for the development of several debilitating mental and physical health problems, increasing the need for effective psychological interventions. This article reviews: (a) mental health problems that police officers are at risk of developing, (b) factors in the law enforcement profession that increase the need for mental health services for officers, (c) the current state of psychological interventions with law enforcement personnel, and (d) how the empirically supported technique of motivational interviewing (MI) may improve the overall success of the psychological treatments most widely used with this population. MI is an interview delivery style that has been shown to be highly successful with treatment-resistant populations. We propose that the incorporation of MI into current mental health services for law enforcement officers may help to reduce their resistance to change, particularly in those mandated for treatment, thus increasing the benefits of the intervention. We also suggest that future research examining the value of MI specifically for law enforcement professionals is warranted.
Short sleep is associated with obesity and may alter the endocrine regulation of hunger and appetite.
We tested the hypothesis that the curtailment of human sleep could promote excessive energy intake.
Eleven healthy volunteers [5 women, 6 men; mean +/- SD age: 39 +/- 5 y; mean +/- SD body mass index (in kg/m(2)): 26.5 +/- 1.5] completed in random order two 14-d stays in a sleep laboratory with ad libitum access to palatable food and 5.5-h or 8.5-h bedtimes. The primary endpoints were calories from meals and snacks consumed during each bedtime condition. Additional measures included total energy expenditure and 24-h profiles of serum leptin and ghrelin.
Sleep was reduced by 122 +/- 25 min per night during the 5.5-h bedtime condition. Although meal intake remained similar (P = 0.51), sleep restriction was accompanied by increased consumption of calories from snacks (1087 +/- 541 compared with 866 +/- 365 kcal/d; P = 0.026), with higher carbohydrate content (65% compared with 61%; P = 0.04), particularly during the period from 1900 to 0700. These changes were not associated with a significant increase in energy expenditure (2526 +/- 537 and 2390 +/- 369 kcal/d during the 5.5-h and 8.5-h bedtime periods, respectively; P = 0.58), and we found no significant differences in serum leptin and ghrelin between the 2 sleep conditions.
Recurrent bedtime restriction can modify the amount, composition, and distribution of human food intake, and sleeping short hours in an obesity-promoting environment may facilitate the excessive consumption of energy from snacks but not meals.
An empirical examination of retired police officers' length of retirement and age at death: A research note
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dimensions of stress in law enforcement. Florida Fraternal Order of Police Journal, Spring, 10-20.
Posttraumatic stress disorder (PTSD) is a chronic, disabling disorder that affects 8%–9% of the population at some point in their lifetime. The disorder is associated with significant morbidity and functional impairment, affecting both patients and family members, and its costs are similar to those of other severe mental disorders. The pathophysiology of PTSD involves a complex interplay between trauma-related factors and the neurobiological and psychosocial influences that determine individual differences in resilience and vulnerability. Despite its wide prevalence, PTSD remains an underrecognized disorder, with proper diagnosis complicated by a variety of factors, including stigma, comorbidity and symptom overlap, and high diagnostic thresholds. Through careful assessment of trauma and PTSD in all patients, health care providers may more readily identify individuals at risk of PTSD and in need of interventions early on, thereby improving outcome and potentially limiting the chronic and disabling course of the illness. Recent research demonstrates efficacy for both pharmacologic and psychosocial interventions in treating PTSD. First-line pharmacotherapeutic options are the selective serotonin reuptake inhibitors. Among the most effective psychosocial interventions are cognitive behavioral approaches that use exposure and cognitive restructuring techniques.
Stress and stress-related illness are recognised as an occupational health hazard. There is an increasing number of police officers reporting mental illness as a result of stress at work. This represents a challenge for occupational health nurses working within the police and more importantly for police forces themselves. Previous research indicated that management style, and lack of consultation, communication and support were all causes of stress to police officers. The aim of this research is to describe the issues surrounding stress within a police force from the perspective of police superintendents.
Reports the findings of an earlier study which was conducted to determine the comprehensiveness of wellness programs provided by the 50 state police agencies/departments of public safety for their commissioned law enforcement officers. The study also focused on the attitude of the personnel directors about the effectiveness of their wellness programs. A national survey was sent to each personnel director of the 50 state police agencies/departments of public safety. The survey, with an overall return rate of 98 per cent, addressed five components of wellness: physical fitness, stress management, psychological and mental health, nutrition and dietary related issues, and alcohol and chemical dependency. Although 29 agencies stated they had a wellness program, none offered all five of the wellness components identified above. Of the 20 agencies which stated they did not have a wellness program, all provided at least some aspect of one of the five wellness components. Also identifies areas in which more emphasis should be placed in order to establish a comprehensive wellness program. It can also serve as a basis for an expanded study in the area of wellness.
Purpose – Working on the night shift is a potential source of occupational stress and has been associated with sleep disorders. The purpose of this paper is to investigate the association between shift work and sleep problems among police officers from Buffalo, New York. Design/methodology/approach – Randomly selected officers (n=111) responded to questions on sleep quality and quantity. Shift work data were obtained from daily payroll records from 1994 to the exam date (1999-2000). Prevalence ratios (PR) were obtained using Poisson regression models that examined associations of shift work with sleep quality and quantity. Findings – Among police officers, night shift work was significantly and independently associated with snoring and decreased sleep duration. Originality/value – Although the sleep questions were similar to those used in validated sleep questionnaires, a major strength of this study was the availability of daily work history data on all officers for up to five years prior to the current examination.
review the literature on the physical health outcomes associated with traumatic events / review the literature on the physical health outcomes associated with posttraumatic stress disorder (PTSD) / argue that PTSD is an important mediator through which trauma may be related to adverse outcomes / review biological and psychological correlates of PTSD that might predispose affected individuals toward increased risk for medical problems / [the] review includes 4 categories of health outcome: 1) self-reports; 2) utilization of medical services; 3) morbidity as indicated by physician diagnosis or laboratory tests; and 4) mortality (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study examined associations of posttraumatic stress disorder (PTSD) symptoms with subclinical cardiovascular disease in police officers. A stratified sample of 100 police officers was randomly selected from the Buffalo, New York, Police Department. Cardiovascular disease biomarkers were assessed by ultrasound of the brachial artery (flow-mediated dilation [FMD]). PTSD symptoms were measured with the Impact of Event Scale (IES). FMD was lowest in the severe PTSD symptom category when compared to the mild PTSD symptom category (1.91 vs. 5.15% increase, respectively; p=.21) even after adjustment for lifestyle and demographics. In conclusion, higher PTSD symptomatology in this police sample was associated with a nearly twofold reduction in brachial artery FMD, a biomarker for subclinical cardiovascular disease. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this study was to examine the association of police officer stress with metabolic syndrome (MetSyn) and its individual components. Participants included 288 men and 102 women from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. Police stress was measured using the Spielberger police stress survey. MetSyn was defined using 2005 guidelines. Results were stratified by gender ANCOVA was used to describe differences in number of MetSyn components across police stress categories after adjusting for age and smoking status. Logistic regression was used to calculate odds ratios for having each MetSyn component by increased police stress levels. The multivariate-adjusted number of MetSyn components increased significantly in women across tertiles of the three perceived stress subscales, and administrative and organizational pressure and lack of support indices for the previous month. No association was found among male officers. Abdominal obesity and reduced high density lipoprotein cholesterol (HDL-C) were consistently associated with police stress in women. Police stress, particularly organizational pressure and lack of support, was associated with MetSyn among female but not male police officers. Given the stress of policing and the adverse cardiovascular disease (CVD) risk factors prevalent among police officers, exploring the association between specific types of police stress and subclinical CVD is important.
Police officers have one of the poorest cardiovascular disease (C'D) health profiles of any occupation. The goal of this study was to determine if police officers in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (between 2004 and 2009) had a more adverse CV profile than the general US. employed population. Nearly one-half (46.9%) of the officers worked a non-day shift compared to 9% of U.S. workers. The percent of officers with depression was nearly double (12.0% vs. 6.8%) and officers were nearly four times more likely to sleep less than six hours in a 24-hour period than the general population (33.0% vs. 8.0%). A higher percentage of officers were obese (40.5% vs. 32.1%), had the metabolic syndrome (26.7% vs. 18.7%), and had higher mean serum total cholesterol levels (200.8 mg/dL vs. 193.2 mg/dL) than the comparison employed populations. In addition to having higher levels of traditional CVD risk factors, police officers had higher levels of non-traditional CVD risk factors. These findings highlight the need for expanding the definition of a health disparity to include occupation. Future studies should expand this comparison to additional traditional and non-traditional CVD risk factors and to other occupational groups.
To quantify the link between lower, subclinically symptomatic, levels of psychological distress and cause-specific mortality in a large scale, population based study.
Individual participant meta-analysis of 10 large prospective cohort studies from the Health Survey for England. Baseline psychological distress measured by the 12 item General Health Questionnaire score, and mortality from death certification.
68,222 people from general population samples of adults aged 35 years and over, free of cardiovascular disease and cancer, and living in private households in England at study baseline.
Death from all causes (n = 8365), cardiovascular disease including cerebrovascular disease (n = 3382), all cancers (n = 2552), and deaths from external causes (n = 386). Mean follow-up was 8.2 years (standard deviation 3.5).
We found a dose-response association between psychological distress across the full range of severity and an increased risk of mortality (age and sex adjusted hazard ratio for General Health Questionnaire scores of 1-3 v score 0: 1.20, 95% confidence interval 1.13 to 1.27; scores 4-6: 1.43, 1.31 to 1.56; and scores 7-12: 1.94, 1.66 to 2.26; P<0.001 for trend). This association remained after adjustment for somatic comorbidity plus behavioural and socioeconomic factors. A similar association was found for cardiovascular disease deaths and deaths from external causes. Cancer death was only associated with psychological distress at higher levels.
Psychological distress is associated with increased risk of mortality from several major causes in a dose-response pattern. Risk of mortality was raised even at lower levels of distress.
Policing is one of the most dangerous and stressful occupations and such stress can have deleterious effects on health. The purpose of this study was to examine the association between depressive symptoms and metabolic syndrome (MetSyn) in male and female police officers from two study populations, Buffalo, NY and Spokane, WA. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. MetSyn was defined using the 2005 AHA/NHBLI guidelines. Analysis of covariance was used to describe differences in number of MetSyn components across depressive symptom categories. The number of MetSyn components increased significantly across categories of CES-D for Spokane men only (p-trend = 0.003). For each 5-unit increase in CES-D score, odds increased by 47.6% for having hypertriglyceridemia, by 51.8% for having hypertension, and by 56.7% for having glucose intolerance. Exploring this association is important since both are predictors of future chronic health problems and the results could be helpful in developing future gender-specific prevention and intervention efforts among police officers.
Law enforcement is a high-stress occupation that is prone to increasing the prevalence and incidence of cardiovascular disease. Epidemiological studies suggest that police officers and related public safety personnel have an increased risk of cardiovascular morbidity and mortality. Currently employed police personnel have a high prevalence of traditional risk factors, including hypertension, hyperlipidemia, metabolic syndrome, cigarette smoking, and a sedentary lifestyle. Obesity may be more common in police officers compared with civilians, whereas diabetes is present less frequently. Law enforcement personnel are also exposed to occupation-specific risk factors that include sudden physical exertion, acute and chronic psychological stress, shift work, and noise. Workplace programs to promote the health and fitness of police officers are commonly lacking, but can be an effective means for reducing cardiovascular risk. Physicians should be familiar with the essential job tasks required for police officers to determine whether the individual is fit for duty. Governmental agencies have established strategic goals to reduce cardiovascular complications and improve the health and wellness of public safety personnel.
This study presents findings from an updated retrospective cohort mortality study of male police officers from January 1, 1950 to December 31, 1990 (n = 2,593; 58,474 person-years; 98% follow-up). Significantly higher than expected mortality rates were found for all cause mortality (Standardized mortality ratio [SMR] = 110; 95% confidence interval [95% CI] = 1.04-1.17), all malignant neoplasms (SMR = 125; 95% CI = 1.10-1.41), cancer of the esophagus (SMR = 213; 95% CI = 1.01-3.91), cancer of the colon (SMR = 187; 95% CI = 1.29-2.59), cancer of the kidney (SMR = 2.08, 95% CI = 100-3.82), Hodgkin's disease (SMR = 313; 95% CI = 1.01-7.29), cirrhosis of the liver (SMR = 150; 95% CI = 1.00-2.16), and suicide (SMR = 153; 95% CI = 1.00-2.24). All accidents were significantly lower (SMR = 53; 95% CI = 0.34-0.79). Mortality by years of police service showed higher than expected rates for (1) all malignant neoplasms in the 1- to 9-years-of-service group; (2) all causes, bladder cancer, leukemia, and arteriosclerotic heart disease in the 10 to 19-year group; and (3) colon cancer and cirrhosis of the liver in the over 30 years of service group. Hypotheses for findings are discussed.
This study explored the self-reported prevalence of cardiovascular disease (CVD) and accompanying risk factors among 165 male retirees 43 years and older (M = 56.2, SD = 7.1) from the Milwaukee Police Department (MPD) compared to 671 individuals of similar age and income who responded to the 2005 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS). CVD and other risk factors were more prevalent in the MPD retirees than the general population (CVD 15.2% vs. 9.5%, p = .036; hypertension 51.5% vs. 36.2%, p = .001; hypercholesterolemia 62.4% vs. 44.4%, p = .001; overweight and obesity 85.1% vs. 74.7%, p = .005). In addition, other factors associated with CVD prevalence included working in law enforcement (odds ratio = 1.70; 95% confidence interval = 1.03 to 2.79). Results suggest an association between employment in law enforcement and an increase in CVD morbidity.
This study examined whether atypical work hours are associated with metabolic syndrome among a random sample of 98 police officers. Shift work and overtime data from daily payroll records and reported sleep duration were obtained. Metabolic syndrome was defined as elevated waist circumference and triglycerides, low HDL cholesterol, hypertension, and glucose intolerance. Multivariate analysis of variance and analysis of covariance models were used for analyses. Officers working midnight shifts were on average younger and had a slightly higher mean number of metabolic syndrome components. Stratification on sleep duration and overtime revealed significant associations between midnight shifts and the mean number of metabolic syndrome components among officers with less sleep (p = .013) and more overtime (p = .007). Results suggest shorter sleep duration and more overtime combined with midnight shift work may be important contributors to the metabolic syndrome.
This report presents national anthropometric reference data for the U.S. population aged 3 months and older in 1988-1994.
Data in this report are from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted on a complex, stratified, multistage probability sample of the civilian, noninstitutionalized U.S. population. A total of 31,241 persons were examined. The anthropometric measurements taken included weight, height, recumbent length, circumferences, limb lengths, joint breadths, and skinfold thicknesses. Body mass index values were computed from measured height and weight values.
The tables in this report include weighted population means, standard errors of the means, and selected percentiles of body measurement values. Because measurements varied by sex and age (and by race and ethnicity in adults), results are reported by these subgroups.
These data add to the knowledge about trends in child growth and development and are useful in monitoring overweight and obesity in the U.S. population.
Employment as an urban police officer was hypothesized to be associated with increased structural subclinical cardiovascular disease (CVD), measured by carotid artery intima-media thickness (IMT).
The sample of men and women consisted of police officers (n = 312) and the general population (n = 318), free of clinical CVD.
Officers had elevated levels of age-adjusted CVD risk factors (blood pressure, total cholesterol, smoking prevalence) compared with the population sample. In age-, gender-, and traditional risk factor-adjusted models, police officers exhibited increased mean common carotid IMT (police = 0.67 mm, population = 0.64 mm; P = 0.03) and mean maximum carotid IMT (police = 0.99 mm, population = 0.95 mm; P = 0.13).
Police officers have increased levels of atherosclerosis compared with a general population sample, which was not fully explained by elevated CVD risk factors; thereby potentially implicating other mechanisms whereby law enforcement work may increase CVD risk.
The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies.
Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975-85], mean BMI 25 [SD 4] kg/m(2)). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66 552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 other.
In both sexes, mortality was lowest at about 22.5-25 kg/m(2). Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m(2) higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m(2) [HR] 1.29 [95% CI 1.27-1.32]): 40% for vascular mortality (HR 1.41 [1.37-1.45]); 60-120% for diabetic, renal, and hepatic mortality (HRs 2.16 [1.89-2.46], 1.59 [1.27-1.99], and 1.82 [1.59-2.09], respectively); 10% for neoplastic mortality (HR 1.10 [1.06-1.15]); and 20% for respiratory and for all other mortality (HRs 1.20 [1.07-1.34] and 1.20 [1.16-1.25], respectively). Below the range 22.5-25 kg/m(2), BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BMI.
Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22.5-25 kg/m(2). The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30-35 kg/m(2), median survival is reduced by 2-4 years; at 40-45 kg/m(2), it is reduced by 8-10 years (which is comparable with the effects of smoking). The definite excess mortality below 22.5 kg/m(2) is due mainly to smoking-related diseases, and is not fully explained.
California employees' retirement system experience study. cardiovascular disease risk and morbidity among aging law enforcement officers
CalPERS (2010). California employees' retirement system
experience study. cardiovascular disease risk and morbidity among aging law enforcement officers. Los Angeles,
CA. Actuarial Office.
Elevated blood pressure is a major risk factor for cardiovascular morbidity and mortality. Increased risk begins in the prehypertensive range and increases further with higher pressures. The strenuous duties of emergency responders (firefighters, police officers, and emergency medical services (EMS) personnel) can interact with their personal risk profiles, including elevated blood pressure, to precipitate acute cardiovascular events. Approximately three-quarters of emergency responders have prehypertension or hypertension, a proportion which is expected to increase, based on the obesity epidemic. Elevated blood pressure is also inadequately controlled in these professionals and strongly linked to cardiovascular disease morbidity and mortality. Notably, the majority of incident cardiovascular disease events occur in responders who are initially prehypertensive or only mildly hypertensive and whose average premorbid blood pressures are in the range in which many physicians would hesitate to prescribe medications (140-146/88-92). Laws mandating public benefits for emergency responders with cardiovascular disease provide an additional rationale for aggressively controlling their blood pressure. This review provides a background on emergency responders, summarizes occupational risk factors for hypertension and the metabolic syndrome, their prevalence of elevated blood pressure, and evidence linking hypertension with adverse outcomes in these professions. Next, discrepancies between relatively outdated medical standards for emergency responders and current, evidence-based guidelines for blood pressure management in the general public are highlighted. Finally, a workplace-oriented approach for blood pressure control among emergency responders is proposed, based on the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
The indicator of Potential Years of Life Lost between ages 1 and 70 (PYLL) is proposed with the primary objective of ranking major causes of premature mortality. This proposal is based on a review of existing mortality indicators and indices and of the history of the concept of potential years of life lost. The method of calculation along with the corresponding rate and the age-adjusted rate are discussed and presented with applications to Canadian data and interpretation. Several methodological aspects are discussed, particularly the comparison with more sophisticated approaches based on life tables which do not appear to alter the ranking of major causes of premature death. This indicator fits well into the category of Social Indicators and can help health planners define priorities for the prevention of premature deaths. Epidemiological studies could also make use of this indicator of premature mortality. The simplicity of calculation and ease of comprehension should facilitate its use.
To explore whether exposure among firefighters to fire smoke could lead to an increased risk of cancer, lung disease, and heart disease, the mortality of 4546 firefighters who were employed by the cities of Seattle and Tacoma, WA and Portland, OR for at least one year between 1944 and 1979 were compared with United States national mortalities and with mortality of police officers from the same cities. Between 1945 and 1989, 1169 deaths occurred in the study population and 1162 death certificates (99%) were collected. Mortality due to all causes, ischaemic heart disease, and most other non-malignant diseases was less than expected based upon United States rates for white men. There was no excess risk of overall mortality from cancer but excesses of brain tumours (standardised mortality ratio (SMR) = 2.09, 95% confidence interval (95% CI) 1.3-3.2) and lymphatic and haematopoietic cancers (SMR = 1.31, 95% CI = 0.9-1.8) were found. Younger firefighters (< 40 years of age) appeared to have an excess risk of cancer (SMR = 1.45, 95% CI 0.8-2.39), primarily due to brain cancer (SMR = 3.75, 95% CI 1.2-8.7). The risk of lymphatic and haematopoietic cancers was greatest for men with at least 30 years of exposed employment (SMR = 2.05, 95% CI 1.1-3.6), especially for leukaemia (SMR = 2.60, 95% CI 1.0-5.4).
The concept of years of potential life lost (YPLL) involves estimating the average time a person would have lived had he or she not died prematurely. This measure is used to help quantify social and economic loss owing to premature death, and it has been promoted to emphasize specific causes of death affecting younger age groups. YPLL inherently incorporates age at death, and its calculation mathematically weights the total deaths by applying values to death at each age. The method of calculating YPLL varies from author to author, each producing different rankings of leading causes of premature death. One can choose between heart disease, cancer, or accidents as the leading cause of premature death, depending on which method is used. Confusion in the use of this measure stems from a misunderstanding of the value system inherent in the calculation, as well as from differing views as to values that should be applied to each age at death. (Epidemiology 1990;1:322-329)
(C) Lippincott-Raven Publishers.
Fingerprint detection is an essential component of any crime detection agency. Little information is available regarding the elemental constituents of powders that are available currently. One recent case of lead poisoning coupled with many complaints from the Vancouver identification Squad members initiated a study regarding the elemental composition of, and the occupational exposure to, these powders. Multi-elemental analysis of the powders investigated showed that all contained varying amounts of aluminum, calcium, zinc, iron, magnesium, manganese, and nickel. One powder, however, contained 41% lead. The time spent at the scene of crime during a normal working shift averaged 95.5 min. Assessment of inhalation exposure during this period by personal air sampling pumps never exceeded the occupational exposure standards for these elements. Secondary exposure from dust-contaminated police vehicles and clothing can be an important contributor to overall exposure.
To determine if users of indoor firing ranges may be at risk from lead exposure, we studied a law enforcement trainee class during three months of firearms instruction. Blood lead levels were obtained before training and at four-week intervals during training. Air lead levels were measured three times during instruction. Blood lead levels rose from a pre-training mean of 0.31 mumol/L to 2.47 mumol/L. Mean air lead levels were above 2,000 micrograms/m3, more than 40 times the Occupational Safety and Health Administration's standard of 50 micrograms/m3. Cumulative exposure to lead and the change in blood lead were positively correlated. Control measures need to be studied to determine their efficacy in decreasing or eliminating this health risk.
A proportionate mortality study of police and firefighters in New Jersey was conducted using the records of a comprehensive retirement system. Three reference populations were used: U.S. general population, New Jersey general population, and police as a reference group for the firefighters. Overall neither group differed from the New Jersey male population in the cause of death. Analyses by latency showed an increase in skin cancer and cirrhosis in firefighters and cirrhosis in police. With increased time from first employment, an inverse association was found between heart disease and time of first exposure. This was reflected in statistically significant increased proportionate mortality rates (PMR) for arteriosclerotic heart disease (ASHD) (ICD 410-414) for both working police (PMR = 1.15) and firefighters (PMR = 1.2). Retired police and firefighters had PMRs of 0.96 and 0.98, respectively. Firefighters had a significant increase in nonmalignant respiratory disease (PMR = 1.98) and leukemia (PMR = 2.76) when the police were used as a reference group. Potential causes of the above findings are discussed.
Very little is known about the long-term health risks associated with the high stress police officer occupation. We report here on a retrospective cohort of 2,376 ever-employed white male police officers employed between January 1950 and October 1979. Vital status was obtained for 96%, the officers accumulating a total of 39,462 person-years. Six-hundred sixty-one deaths were observed. Total mortality from all causes was comparable to that of the overall U.S. white male population (standardized mortality ratio [SMR] = 106). Significantly increased mortality was seen for all malignant neoplasms combined (SMR = 127), cancer of the esophagus (SMR = 286), and cancer of the colon (SMR = 180). Significantly lower than expected mortality was seen for infectious diseases (SMR = 26), respiratory diseases (SMR = 64), and accidents (SMR = 60). Internal cohort comparisons revealed that policeman exhibited significantly higher mortality from suicide compared to all other municipal employees (rate ratio = 2.9). Analysis of mortality by length of service as a police officer showed that those employed 10-19 years were at significantly increased risk of digestive cancers and cancers of the colon and lymphatic and hematopoietic tissues and decreased risk for all diseases of the circulatory system. Policeman employed more than 40 years had significantly elevated SMRs for all causes, all malignant neoplasms combined, digestive cancers, cancers of the bladder and lymphatic and hematopoietic tissues, and arteriosclerotic heart disease. Risk of mortality from arteriosclerotic heart disease tended to increase with increasing years employed. These findings are discussed in light of the police stress literature. The hypotheses generated in this study must be tested through study of the role of important confounders including reactions to stress on the job.
A total of 3,868 urban policemen in Rome were investigated through a historical cohort study with emphasis on mortality from cardiovascular disease and cancer. Overall mortality from cardiovascular disease, respiratory conditions, digestive and genitourinary diseases, and accidents was lower than expected. An excess risk of ischemic heart disease was observed among subjects aged less than 50 years [14 deaths, standardized mortality ratio (SMR = 1.63), 95% CI = 0.89-2.73], corresponding to workers with a short duration of employment and a short latency since first employment. Overall cancer mortality was as expected and no excess was found for lung cancer (82 deaths, SMR = 1.05). Increased mortality was observed from colon cancer (16 deaths, SMR = 1.47), melanoma (four deaths, SMR = 2.34), bladder cancer (13 deaths, SMR = 1.27), renal cancer (seven deaths, SMR = 1.39), and non-Hodgkin's lymphoma (six deaths, SMR = 1.51), although none of the excesses were statistically significant. Two deaths from male breast cancer (SMR = 14.36) and three from cancer of endocrine glands were found (SMR = 3.44). Nested case-control studies were conducted to evaluate cancer mortality risk by job category. Bladder cancer was significantly increased among car drivers (OR = 4.17); for kidney cancer, an increased odds ratio (OR = 2.27) was found among motorcyclists; non-Hodgkin's lymphoma clustered among motorcyclists (OR = 5.14). In summary, excess risk for specific cancer sites (colon, male breast, and endocrine glands) might be linked to occupational exposures; professional drivers seem to be at higher risk of bladder cancer, kidney cancer, and non-Hodgkin's lymphoma.
A retrospective cohort study was conducted among an international group of 46 law enforcement chemists and 13 Washington State clandestine drug laboratory investigation team members with more than 2,800 combined investigations. Each participant completed a questionnaire concerning previous drug laboratory investigations and adverse health effects during response activities. Methamphetamine laboratories accounted for 81-97% of all responses. Total illness incident rates varied between 0.75-3.4% of responses. Most exposures were through inhalation, and many occurred in the years prior to use of personal protective equipment. Symptoms were primarily those of headache and respiratory, mucous membrane, and skin irritation. Most illness episodes occurred during the processing phase of laboratory responses, and none occurred during the entry phase. A majority of illness episodes occurred in laboratories with leak/spills, fire/explosion, or uncontrolled reactions. Responding to an active laboratory was associated with a 7 to 15-fold risk of becoming ill as compared with setup, in-transit, or former (equipment removed) laboratory responses. No other laboratories characteristics were consistently associated with a significantly elevated relative risk of adverse health effects.
The prevalence of coronary heart disease (CHD) risk factors in law enforcement personnel compared to that in the general population was studied by determining the predicted 10-year risk for developing CHD (CHD10, expressed as %) in subjects from the Iowa Department of Public Safety and comparing it to the average CHD10 for similarly aged subjects in the Framingham Heart Study cohort. The Iowa data included measures on 388 men from 30 to 64 years old, 246 of whom were measured in 1980-1981 and again in 1992-1993. The CHD10 came from an algorithm developed using the Framingham data; it included measures of age, gender, cholesterol, HDL-C, systolic blood pressure, smoking habit, glucose level, and left ventricular hypertrophy (ECG criteria). For this group, average CHD10 was reported by age in five-year increments [Circulation 83:356, 1991]. The Iowa subjects (n = 388) did not show a statistically significant difference in CHD10 from the reference population (8.9% versus 7.9%). The change with age was very similar in the two groups: for Iowa (n = 388) the estimate was CHD10 = -16.5 + .59 (age); for Framingham it was CHD10 = -17.5 + .60 (age). The change in individual risk factors with time was also similar in both groups; the per year change in CHD10 in the Iowa subjects, which was measured twice (n = 246, 0.63%), did not differ statistically from the 0.60% change predicted by the Framingham model. These results suggest that, for the risk factors considered here, the 10-year probability of developing CHD among Iowa law enforcement personnel is similar to that found in the Framingham population.
This study examines internal and external risk factors for posttraumatic stress symptoms in 262 traumatized police officers. Results show that 7% of the entire sample had PTSD, as established by means of a structured interview; 34% had posttraumatic stress symptoms or subthreshold PTSD. Trauma severity was the only predictor of posttraumatic stress symptoms identified at both 3 and 12 months posttrauma. At 3 months posttrauma, symptomatology was further predicted by introversion, difficulty in expressing feelings, emotional exhaustion at time of trauma, insufficient time allowed by employer for coming to terms with the trauma, dissatisfaction with organizational support, and insecure job future. At 12 months posttrauma, posttraumatic stress symptoms were further predicted by lack of hobbies, acute hyperarousal, subsequent traumatic events, job dissatisfaction, brooding over work, and lack of social interaction support in the private sphere. Implications of the findings regarding organizational risk factors are discussed in the light of possible occupational health interventions.
This study examined the effects of duty-related stress on police officers. Using a sample of 100 suburban police officers, an anonymous questionnaire requested demographic information and included a measure of duty-related stressors, SCL-90-R, the Posttraumatic Stress Disorder scale of the Impact of Events Scale-Revised, and a locus of control scale. Also assessed was whether Critical Incident Stress Debriefing was experienced. The results showed significant correlations between scores on duty-related stress, somatization, and symptoms of PTSD. 13% of the sample met the DSM-IV (1994) diagnostic criteria for PTSD. Results of the regression analysis showed the best predictors for the diagnosis of PTSD were associated with the factor of Exposure to Death and Life Threat, which corresponds to the DSM-IV AI criteria. Finally, 63% of the respondents stated that a critical incident debriefing would be beneficial following an extremely stressful event related to duty.
It remains uncertain if law enforcement officers experience an elevated cardiovascular disease morbidity and, if so, whether their profession contributes to this incidence. Consequently, the self-reported incidence of cardiovascular disease (CVD) (coronary heart disease, myocardial infarction, stroke, coronary artery bypass graft surgery, angioplasty) and CVD risk factors (age, diabetes, elevated body mass index (> or = 27.8 kg.m-2), hypercholesterolemia, hypertension, tobacco use) in 232 male retirees, > or = 55 years of age, from the Iowa Department of Public Safety were compared with 817 male Iowans of similar age. CVD incidence was higher in the law enforcement officers than the general population (31.5% vs 18.4%, P < 0.001). Using multiple logistic regression, factors found to be associated with CVD included the law enforcement profession (odds ratio [OR] = 2.34; 95% confidence interval [95% CI] = 1.5-3.6), hypercholesterolemia (OR = 2.37; 95% CI = 1.7-3.3); diabetes (OR = 2.22; 95% CI = 1.4-3.6), hypertension (OR = 1.79; 95% CI = 1.3-2.5), tobacco use (OR = 1.67; 95% CI = 1.07-2.6), and age (OR = 1.06; 95% CI = 1.03-1.08). These results suggest that employment as a law enforcement officer is associated with an increased cardiovascular disease morbidity and this relationship persists after considering several conventional risk factors.
This study aims to describe the prevalence of smoking, snuff use, and exposure to environmental tobacco smoke (ETS) in relation to occupation among common female and male workers in Sweden. The associations between shift work, job strain, and tobacco use and exposure to ETS are assessed. The results are based on questionnaire data of 2,584 men and 2,836 women randomly selected from 63 occupations in two counties in Sweden. The prevalence of smoking ranges from 10% (95% CI 4.5-16%, police officers) to 42% (95% CI 29-55%, packing workers) in men, and between 8% (95% CI 2-14%, dentists) and 51% (95% CI 37-65%, packing workers) in women. Snuff use is more common among men (range 11-44% in different occupations) than among women (range 0-7%). The prevalence of exposure to passive smoking in this study ranges from 0.9% to 26% in men and from 0% to 30% in women. Shiftwork is significantly associated with current smoking, and job strain is significantly related to exposure to ETS. Ages between 18 and 29 years experienced an increased risk of exposure to ETS compared to older age groups. In conclusion, this study shows that tobacco use and exposure to ETS is still a major problem in the Swedish workplace.
To examine the prevalence of five life-style behaviours among New South Wales police.
A cross-sectional survey using a self-administered questionnaire.
A total of 852 police were recruited from metropolitan Sydney.
Prevalence related to age and sex of self-reported alcohol consumption, cigarette smoking, inadequate exercise, perception of overweight and stress symptoms.
A high level (89%) of participation was achieved in the survey. Almost half (48%) of males and more than two-fifths (40%) of females consumed alcohol excessively including continuous hazardous or harmful consumption and binge drinking. Excessive drinking was more prevalent among younger police. There were 8% of male and 15% of female police who reported that they did not drink alcohol. Over one-quarter (27%) of male and one-third (32%) of female respondents reported smoking. Almost half (46%) of men and women (47%) believed that they were overweight. More than one-fifth (21%) of men and less than one-quarter (24%) of women reported that they did not exercise. Finally, 12% of men and 15% of women reported feeling moderate to severe symptoms of stress.
The police work-force offers an opportunity to screen for a large number of healthy, young and high risk individuals (particularly men) who are hard to reach in other settings and who rarely visit their general practitioner. A sizeable majority (83%) of NSW police had at least one unhealthy life-style behaviour with 19% reporting 3-5 unhealthy factors. The high prevalence of excessive alcohol consumption among police is of particular concern. More active health promotion and provision of brief interventions among police may reduce morbidity and mortality associated with unhealthy life-styles.
Shooting with lead-containing ammunition in firing ranges is a well-known source of lead exposure in adults, and police officers may be at risk of lead intoxication. More stringent national lead regulations stimulated a survey of blood lead (PbB) in Swedish police officers with regular shooting habits.
Police officers considered as the most active shooters on and/or off duty responded to a questionnaire about health, lifestyle, shooting habits, and potential lead exposure. Blood samples were collected and analyzed for PbB and a multivariate regression analysis was performed.
The mean PbB in male officers (n = 75) was 0.24 mumol/L (5.0 micrograms/dL); range 0.05-0.88 mumol/L (1.0-18.2 micrograms/dL), and in female officers (n = 3) it was even lower (0.18 mumol/L; 3.7 micrograms/dL). For both sexes combined, a positive correlation (r = 0.55; P < 0.001) of PbB with the number of bullets annually fired both on and off duty was observed, and this finding remained in a multiple regression analysis including age, smoking habits, and latency from last shooting exercise.
In conclusion, occupational and recreational lead exposure from firing ranges still seems to be a source of lead exposure in Swedish police officers, but it no longer appears to be a health risk. Lead-free communication and well-ventilated indoor firing ranges may have been decisive for this encouraging finding.
This study evaluated Changes in the physical activity, fitness and body composition of 103 police officers during a 15-year
follow-up. The absolute aerobic capacity was similar in 1981 and 1996, muscular performance had declined, and body weight
had increased approximately 0.5 kg/year. More than half the subjects (53%) had increased their leisure-time physical activity
in 1996. The correlation was significant between physical activity in 1981 and physical fitness in 1996, but weak between
physical activity in 1996 and fitness in 1996. It was also significant between waist circumference and waist/hip ratio in
1996 and physical activity during the previous 5 and 15 years. No significant correlations were found between physical activity
and work ability or perceived physical or mental job stress. The physical fitness of middle-aged police officers seems to
be predicted strongly by physical activity in early adulthood. Therefore health and fitness promotion measures should start
at that time. This, together with regular systematic training, should help to sustain work ability of middle-aged police officers.
This paper reviews the main findings concerning mechanisms explaining the increased risk of coronary heart disease (CHD) in shiftworkers. We discuss a conceptual model, in which three main shiftwork pathways to CHD are postulated--social problems, behavioral change, and disturbed circadian rhythm. Social problems that are associated with shiftwork might lead to stress. Significant shiftwork-related behavioral problems are smoking and unhealthy food habits. Disturbed circadian rhythm might result in sleep deprivation. Unphysiologic timing of physical activity and food intake in relation to circadian rhythms is another possible explanation for the negative impact on the cardiovascular system.
Various psychosocial factors have been implicated in the etiology and pathogenesis of certain cardiovascular diseases such as atherosclerosis, now considered to be the result of a chronic inflammatory process. In this article, we review the evidence that repeated episodes of acute psychological stress, or chronic psychologic stress, may induce a chronic inflammatory process culminating in atherosclerosis. These inflammatory events, caused by stress, may account for the approximately 40% of atherosclerotic patients with no other known risk factors. Stress, by activating the sympathetic nervous system, the hypothalamic-pituitary axis, and the renin-angiotensin system, causes the release of various stress hormones such as catecholamines, corticosteroids, glucagon, growth hormone, and renin, and elevated levels of homocysteine, which induce a heightened state of cardiovascular activity, injured endothelium, and induction of adhesion molecules on endothelial cells to which recruited inflammatory cells adhere and translocate to the arterial wall. An acute phase response (APR), similar to that associated with inflammation, is also engendered, which is characterized by macrophage activation, the production of cytokines, other inflammatory mediators, acute phase proteins (APPs), and mast cell activation, all of which promote the inflammatory process. Stress also induces an atherosclerotic lipid profile with oxidation of lipids and, if chronic, a hypercoagulable state that may result in arterial thromboses. Shedding of adhesion molecules and the appearance of cytokines, and APPs in the blood are early indicators of a stress-induced APR, may appear in the blood of asymptomatic people, and be predictors of future cardiovascular disease. The inflammatory response is contained within the stress response, which evolved later and is adaptive in that an animal may be better able to react to an organism introduced during combat. The argument is made that humans reacting to stressors, which are not life-threatening but are "perceived" as such, mount similar stress/inflammatory responses in the arteries, and which, if repetitive or chronic, may culminate in atherosclerosis.
Short-term sleep restriction results in impaired glucose tolerance. To test whether habitually short sleep duration increases the risk of developing diabetes, we studied a cohort of 70,026 women enrolled in the Nurses Health Study, without diabetes at baseline, and who responded to a question about daily sleep duration in 1986. Subjects were followed until 1996 for the diagnosis of diabetes (1,969 cases). Long and short sleep durations were associated with an increased risk of diabetes diagnosis. The relative risks (RRs) for short (slept < or =5 h per day) and long (slept > or =9 h per day) sleepers were 1.57 (95% CI 1.28-1.92) and 1.47 (1.19-1.80), respectively. After adjustment for BMI and a variety of confounders, the RR was not significantly increased for short sleepers (1.18 [0.96-1.44]) but remained modestly increased for long sleepers (1.29 [1.05-1.59]). We then performed a similar analysis using only symptomatic cases (n = 1,187). Adjusted RRs for symptomatic diabetes were modestly elevated in both short (1.34 [1.04-1.72]) and long (1.35 [1.04-1.75]) sleepers. Our data suggest that the association between a reduced self-reported sleep duration and diabetes diagnosis could be due to confounding by BMI, or sleep restriction may mediate its effects on diabetes through weight gain. Sleep restriction may be an independent risk factor for developing symptomatic diabetes.
This cross-sectional study determined the prevalence of nephrolithiasis and common cardiovascular disease (CVD) risk factors in a law enforcement officer (LEO) cohort and evaluated the relationship of nephrolithiasis with several CVD risk factors, including the possible effect of ethnicity. Self reported nephrolithiasis and CVD risk factors among currently employed male LEOs from nine states (n = 2,818) were compared to other men in the same states (n = 9,650). Of the LEOs, 6.2% (n = 174) self reported at least one kidney stone (range = 1 to 12, mean 2.3 6 2.1 stones). Twenty five percent of Native American LEOs (n = 7 of 28) self reported a history of stones. In LEOs with a history of nephrolithiasis, overweight defined as body mass index . 25 kg/m2 (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.04, 3.11), hypercholesterolemia (OR = 1.53, 95% CI = 1.09, 2.15), and hypertension (OR = 1.46, 95% CI = 1.02, 2.11) were associated with the disease. These results suggest officers with common CVD risk factors are also at an increased risk for nephrolithiasis. Native American LEOs have a disproportionately higher prevalence of nephrolithiasis than do other ethnic groups.
The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study is one of the first population-based studies to integrate psychological, physiological, and subclinical measures of stress, disease, and mental dysfunction. This pilot study was undertaken to establish a methodology and descriptive results for a larger police study.
A stratified sample of 100 officers was randomly selected from the Buffalo, NY Police Department. Salivary cortisol served as a stress biomarker. Flow mediated dilation (FMD) and carotid intima-media thickness (IMT) were performed with ultrasound. Dual Energy X-Ray Absorptiometry (DEXA) and anthropometric measures assessed body composition. Self-report measures of depression and posttraumatic stress disorder (PTSD) were obtained.
Recruitment attained for the study was 100%. Seventy-five percent showed a cortisol increase upon awakening, 90% a negative diurnal slope, and 77% an increased cortisol response after a high protein lunch challenge. Dexamethasone suppression was evident. FMD showed an increase in mean brachial artery diameter of 3.2% in men and 3.9% in women, and mean IMT was lower (male=0.67 mm; female=0.62 mm) compared to populations of similar age. For males, the mean body-mass index (BMI) was 29.8 kg/m2 and total body fat 23.4%. For females, the mean BMI was 26.7 kg/m2 and total body fat 31.5%. For all officers, 16% met criteria for depression; 36% reported elevated PTSD symptoms.
Compared to populations of similar age, police officers had slightly lower FMD, lower carotid IMT, elevated BMI, and higher reported rates of depression and PTSD. Standardized physiological and psychological data collection and descriptive results confirmed that the methodology of the study is feasible in a working police population.
Although prior evidence exists concerning the association between posttraumatic stress disorder (PTSD) and cardiovascular disease, few studies have examined associations of PTSD symptomatology and the metabolic syndrome in the high stress occupation of police work. The metabolic syndrome is a clustering of cardiovascular disease risk factors that have also been independently associated with psychological conditions. The aim of this study was to examine associations between the PTSD symptoms and metabolic syndrome in police officers. A stratified sample of 115 police officers was randomly selected from the Buffalo, NY Police Department. PTSD symptoms were measured with the Impact of Event scale (IES), divided into categories of subclinical, mild, moderate and severe symptom levels. The metabolic syndrome was considered present if three or more of its component parameters (obesity, elevated blood pressure, reduced high density lipoprotein (HDL) cholesterol, elevated triglycerides, and abnormal glucose levels) were present in each officer. Results indicated a significantly increased prevalence of the metabolic syndrome among those officers in the severe PTSD symptom category compared with the lowest PTSD severity category (prevalence ratio (PR) = 3.31, 95% C.I. = 1.19 - 9.22). Adjustment for age did not alter the association appreciably (PR = 3.12, 95% C.I. = 1.15 - 8.50). Adjustment for several demographic and lifestyle factors (age, education, smoking, alcohol intake) reduced the magnitude of the prevalence ratio slightly for the severe versus subclinical PTSD category (PR = 2.69, 95% C.I. = 0. 79 - 9.13), with adjustment for age and education accounting for most of the attenuation (PR = 2.71, 95% C.I. = 0.99 - 7.37). Thus, officers with severe PTSD symptoms were approximately three times more likely to have the metabolic syndrome and education may account for some of this association.