OBJECTIVE: This study estimated risk of metabolic syndrome (MetSyn) and its components among police officers including differences by sex. METHODS: Police officers were examined at baseline and two follow-up examinations after 7 and 12 years. MetSyn was defined using the 2005 guidelines from AHA/NHLBI. Risk for incident MetSyn and its components at follow-up exams and risk ratios in males compared to females were estimated using modified Poisson regression. RESULTS: The 7 (n = 276) - and 12- (n = 191) year incidence of MetSyn was 20.4% and 22.2%, respectively. MetSyn components with lowest and highest incidence were reduced HDL cholesterol and abdominal obesity. The 7-year risk of developing glucose intolerance was two-fold higher in males compared to females. CONCLUSION: Longitudinal analysis of incidence of MetSyn and its components is important for understanding future cardiovascular disease (CVD) morbidity and mortality.

Physical inactivity may exacerbate the adverse health effects associated with shift work. We investigated the association of shift work with leisure-time physical inactivity (LTPI). A cross-sectional analysis included 33 983 adults from National Health Interview Survey who self-reported their work schedule and leisure-time physical activity. Participants were classified in to two groups as either (a) inactive or (b) insufficiently/sufficiently. Prevalence ratios were derived using SUDAAN. Analyses were stratified by sex. In this sample of U.S. workers, 27% were shift workers, 26% were physically inactive, and 47% did not meet recommended levels of leisure-time physical activity. Inactivity level was 23% higher in women than in men among shift workers but did not differ by sex among daytime workers (PR = 1.02, 95% CI: 0.96-1.07). Evening or night work was associated with higher LTPI among women but not men. LTPI was 17% higher in women working the night shift, and 24% higher in those on the evening shift compared to those working the daytime shift. These findings suggest that shift work may contribute to increased LTPI, with effects that may be particularly pronounced in women. Interventions addressing LTPI among shift workers may help mitigate the adverse health effects that have been linked to shift work in prior studies.

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. Standardized Mortality Ratios were calculated. Death codes were obtained from 8th and 9th International Classification of Disease revisions in accordance with the year of death. FINDINGS –: Compared to the US general population, white male police officers from 1950-2018 had elevated mortality rates for some causes of death, including diseases of the circulatory system, malignant neoplasms, cirrhosis of the liver, and mental disorders. Black and female officers had lower mortality rates for all causes of death compared to the general population. RESEARCH LIMITATIONS/IMPLICATIONS –: The findings of elevated risk for chronic disease among police need to be studied in relation to stress, lifestyle, and exposure to chemical and physical agents. There is a special need to further study officers from minority populations as larger samples become available. PRACTICAL IMPLICATIONS –: The results of this study will provide police and occupational health practitioners with objective evidence to determine the health impact of work on law enforcement officers. ORIGINALITY/VALUE –: This study is longest running mortality assessment on police officers ever conducted (1950-2018) and includes white, black, and female officers.

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 salivary cortisol samples collected upon awakening, and 15, 30, and 45 min thereafter as well as three additional samples at lunchtime, dinnertime, and bedtime. Total area under the curve with respect to increase (AUCW(I) for waking and AUCD(I) for diurnal), total area under the curve with respect to ground (AUCW(G) for waking and AUCD(G) for diurnal), and diurnal slope were determined and used in this study. Unadjusted and adjusted (age, sex, and race/ethnicity) associations were examined using linear regression. The mean age of the officers was 48 years and 72% were males. The depersonalization component of burnout was negatively associated with AUCD(G) (β = -108.4; p = 0.036). Similarly, as exhaustion increased, AUCW(I) (β = -9.58, p = 0.038), AUCD(G) (β = -114.7, p = 0.029) and the diurnal slope (β = -0.000038; p = 0.017) decreased. The Professional efficacy was not associated with any of the cortisol parameters. These results suggest that certain characteristics of burnout may be associated with diminished cortisol secretion in this group of urban police officers. Our findings add to previous studies examining associations of burnout with the cortisol awakening response. Future longitudinal studies are needed to evaluate the temporal relationship between burnout and these cortisol parameters.

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 2020. The database contains deaths designated as caused by incidents that occurred while in the line of duty. The chi-square test and two-sample t-test were used to compare characteristics of officers who died of COVID-19 versus other causes of death. Both the proportionate mortality and rates of death were calculated. To compute the rate of death, the authors obtained data on the total number of law enforcement officers employed in the United States (and therefore at risk) for the year 2020 from Bureau of Labor Statistics. Findings: COVID-19 deaths (n = 182) accounted for 62% of all duty-related law enforcement officer deaths during 2020. The national rate of death due to COVID-19 (12.8/100,000 per year) for law enforcement officers was higher compared to all other causes of death combined (8.0/100,000 per year). Research limitations/implications: A limitation of the study is the uncertainty of a definitive assessment that the viral infection was acquired through work (versus at home or other non-work-related community settings). Although highly unlikely, deaths designated as duty related entail financial benefits for the survivors and may be a potential source of bias. Given the complexity of personal exposures, the percentage of COVID-19 deaths attributed to duty may represent an over or under estimation of the actual value. Therefore, the data should be interpreted cautiously. Practical implications: These findings provide police organizations with information needed to understand the risk of death among officers during the COVID-19 pandemic and to make informed decisions about future preparedness strategies. Originality/value: There are presently no published scientific studies that examine both the proportionate mortality and national rate of death from COVID-19 among law enforcement officers for the year 2020. © 2022, Emerald Publishing Limited.

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 questionnaire. Sleep measures were assessed using the Pittsburgh Sleep Quality Index and actigraphy. ANOVA/ANCOVA were used to investigate associations between ACEs and sleep measures. RESULTS: The mean self-reported sleep duration was significantly lower among participants who reported ≥1 ACEs compared to those who reported no ACEs (6.0 ± 0.11 vs. 6.4 ± 0.14 h; multivariate-adjusted p = 0.035). Sleep efficiency was significantly lower among participants who reported ≥1 ACEs compared to those who reported none (mean = 88.7%, 95% CI = 87.7-89.6 vs. 90.2%, 89.2-91.2; unadjusted p = 0.031) but was slightly attenuated and lost statistical significance after multivariate-adjustment (88.8%, 87.8-89.7 vs. 90.1%, 88.9-91.1; p = 0.094). Compared to participants who reported no ACEs, those who reported ≥1 ACEs had a higher mean activity index score (36.9 ± 0.96 vs. 31.2 ± 1.25; multivariate-adjusted p = 0.001); a higher mean wake after sleep onset (WASO) (44.3 ± 2.24 vs. 35.3 ± 2.92 min; multivariate-adjusted p = 0.019); and a higher sleep fragmentation index (3.8 ± 1.65 vs. 3.3 ± 1.20 unadjusted p = 0.044 and 3.8 ± 0.13 vs. 3.3 ± 0.18; multivariate-adjusted p = 0.062). Among men (but not women) who reported ≥1 ACEs, self-reported sleep duration was significantly lower (5.9 ± 0.13 vs. 6.4 ± 0.15 h; multivariate-adjusted p = 0.025) and activity index was significantly higher (39.1 ± 1.3 vs. 33.2 ± 1.51; multivariate-adjusted p = 0.004) compared to those who reported no ACEs. CONCLUSION: Exposure to ≥1 ACE was associated with worse sleep measures.

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 and subjectively measured sleep among police officers. Data were derived from the Buffalo Cardio-Metabolic Occupational Police Stress Cohort (n = 464 at baseline), with longitudinal data collected from 2004 to 2019. A food frequency questionnaire obtained estimated dietary intake from which E-DII scores were calculated. Dependent variables were objectively (Micro Motion Logger Sleep Watch™) and subjectively (Pittsburgh Sleep Quality Index) measured sleep quality and quantity. The analyses included a series of linear mixed-effects models used to examine cross-sectional and longitudinal associations between the E-DII and sleep quantity and quality. Cross-sectionally, more pro-inflammatory diets were associated with higher wake-after-sleep-onset but improved subjective sleep quality. In models accounting for both longitudinal and cross-sectional effects, for every 1-unit increase in the E-DII scores over time (representing a pro-inflammatory change), wake-after-sleep-onset increased by nearly 1.4 min (p = 0.07). This result was driven by officers who primarily worked day shifts (β = 3.33, p = 0.01). Conversely, for every 1-unit increase in E-DII score, the Pittsburgh Sleep Quality Index global score improved. More pro-inflammatory diets were associated with increased wake-after-sleep-onset, an objective measure of sleep quality. Intervention studies to reduce dietary inflammatory potential may provide greater magnitude of effect for changes in sleep quality.

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 with symptoms characteristic of adaptation and maladaptation were identified using latent class analysis (n = 242). Two approaches were applied, one with police-specific symptoms and another using more general symptoms as shiftwork adaptation indicators. Biomarkers of inflammation, heart rate variability, and cardiometabolic risk were then compared between shiftwork adaptation groups, and with officers working day shifts, after adjusting for confounding. When analyses included police-specific symptoms, maladapted shiftworkers (n = 73) had more self-reported stress, sleep disturbances, fatigue, and less social support than adapted shiftworkers (n = 169). Using more general symptoms, maladapted officers (n = 56) reported more stress and depression, and less social support than adapted officers (n = 186). In police-specific models, adjusted (least-squares) means (± standard error) of circulating interleukin-6 (IL-6) concentrations in maladapted officers (0.8 ± 0.1 ln[pg/ml]) were modestly elevated relative to adapted shiftworkers (0.7 ± 0.1 ln[pg/ml], p = .09) and relative to permanent day workers (0.5 ± 0.1 ln[pg/ml], p ≤ 0.01), and leptin levels in maladapted officers (9.6 ± 0.1 ln[pg/ml]) exceeded those in the adapted (9.4 ± 0.1 ln[pg/ml], p ≤ 0.01) and day shift groups (9.4 ± 0.1 ln[pg/ml], p = .03). In the general model, adjusted mean tumor necrosis factor-alpha (TNF-α) concentrations among maladapted officers (5.6 ± 0.23 pg/ml) exceeded the adapted (4.8 ± 0.2 pg/ml, p ≤ 0.01) and day workers (5.0 ± 0.2 pg/ml, p = .04), and insulin among maladapted officers was higher (2.4 ± 0.1 ln[uu/ml]) than the adapted group (1.8 ± 0.1 ln[uu/ml], p = .03). No differences were observed for the other biomarkers. The results suggest that maladaptation among police officers working fixed night shifts may lead to increases in leptin, insulin, IL-6, and TNF-α; however, the cross-sectional design and possible residual confounding preclude interpretation of cause and effect. Prospective studies are planned to further characterize the relationship between shiftwork maladaptation and biomarkers of chronic disease risk in this police officer cohort.

Purpose: To characterize changes in work hours across a career in law enforcement. Design/methodology/approach: 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 police department for at least 15 years. Day-by-day work history records were obtained from the payroll department. Work hours, leave hours and other pay types were summarized for each calendar year across their first 15 years of employment. Linear mixed-effects models with a random intercept over subject were used to determine if there were significant changes in pay types over time. Findings: A total of 1,617 individual-years of data were analyzed. As the police officers gained seniority at the department, they worked fewer hours and fewer night shifts. Total paid hours did not significantly change due to seniority-based increases in vacation time. Night shift work was increasingly in the form of overtime as officers gained seniority. Overtime was more prevalent at the beginning of a career and after a promotion from police officer to detective. Originality/value: Shiftwork and long work hours have negative effects on sleep and increase the likelihood of on-duty fatigue and performance impairment. The results suggest that there are different points within a career in law enforcement where issues surrounding shiftwork and long work hours may be more prevalent. This has important implications for predicting fatigue, developing effective countermeasures and measuring fatigue-related costs. © 2021, Emerald Publishing Limited.

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) and 2010-2014 (n = 261). Electronic payroll records were used to quantitatively classify officers on the day, evening, or night shift based on the shift they spent most of their working hours. Two self-reported depressive symptomology measures were used as outcomes - the Center for Epidemiological Studies - Depression (CES-D) scale and the Beck Depression Inventory (BDI). Repeated measures linear and logistic regression analyses were used to estimate least squares means or odds, respectively, of depressive symptom questionnaire scores by shiftwork category. Those working the evening/night shift had higher odds for depressive symptoms according to the BDI (based on a cut-point score of 14) than those working the day shift (OR = 4.60, 95% CI = 1.15-18.39). Similar results were observed for the evening shift group. No differences in mean CES-D or BDI scores were observed between groups for short-term shiftwork, long-term shiftwork, or shift changes. After stratifying by stress, as measured by the Perceived Stress Scale (PSS), total Impact of Events (IES), and the Spielberger Police Stress Survey (SPSS), mean values for depressive symptoms were higher in the high-stress categories regardless of shiftwork status. Further research should include biomarkers for depression, a longitudinal study design with a larger cohort, and joint effects of shiftwork and stress on depressive symptoms.

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: Data were obtained from the National Health Interview Survey (2004-2018) for U.S. adults aged ≥50 years (N=207,539), of which 84,180 were employed. Temporal trends in prevalence were assessed by fitting weighted regression models to the age-standardized prevalence to the 2010 U.S. POPULATION: The relationship between temporal prevalence of CVD with each risk factor was assessed using Spearman's correlation coefficient. RESULTS: Among all older adults, the prevalence of CVD significantly declined (β=-0.16, p<0.001) during 2004-2018; similar decline was observed among employed adults (β=-0.16, p=0.001). Temporal prevalence in CVD was positively correlated to physical inactivity (r=0.73, p=0.002) and smoking (r=0.81, p<0.001), but not to any of the other risk factors. CONCLUSION: Among employed adults aged ≥50 years, the prevalence of CVD, physical inactivity, and smoking dramatically declined over the past 15 years. The temporal decline in prevalence of CVD was significantly associated with decline prevalence of physical inactivity and smoking.

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 (b) the association between injury status and SPD. Methods: Self-reported injuries within the previous three months were collected annually for 225,331 U.S. workers in the National Health Interview Survey (2004–2016). Psychological distress during the past 30 days was assessed using the Kessler 6 (K6) questions with Likert-type scale (0–4, total score range: 0–24). SPD was defined as K6 ≥ 13. Prevalence ratios (PR) from fitted logistic regression models were used to assess relationships between injury and SPD after controlling for covariates. Results: The prevalence of SPD was 4.74%, 3.58%, and 1.56% in workers reporting occupational injury (OI), non-occupational injury (NOI), and no injury, respectively. Workers with head and neck injury had the highest prevalence of SPD (Prevalence: OI = 7.71%, NOI = 6.17%), followed by workers with scrape/bruise/burn/bite (6.32% for those with OI). Workers reporting OI were two times more likely to have SPD compared to those without injury (PR = 2.19, 95%CI: 1.62–2.96). However, there was no significant difference in SPD between workers with OI and workers with NOI (PR = 0.98, 95%CI: 0.65–1.48). Conclusion: The prevalence of SPD varied by injury status with the highest being among workers reporting OI. We found that the workers reporting OI were significantly more likely to have SPD than those without injury, but not more than those with NOI. Practical Applications: Mental health management programs by employers are necessary for workers who are injured in the workplace.

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 Stress study (2011-2014). Wrist actigraphy was used to assess sleep measures including sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, number of awakenings, and longest wake episode. CRAE and CRVE were obtained from fundus photography of retina and were averaged from both eyes per officer. RESULTS: We observed significant associations between sleep efficiency and CRVE (beta = -2.81 microm; P= .046), and between longest wake episode and CRVE (beta = 3.24 microm; P= .021). Adjustments for demographics, lifestyles, and physical and psychological factors attenuated these associations. Sex modified the independent associations of sleep onset latency and longest wake episode with CRVE. One standard deviation (SD) increase in sleep onset latency was associated with 4.81 microm larger CRVE (P= .028) (P-interaction = 0.098), and one SD increase in longest wake episode was associated with 4.62 microm larger CRVE (P= .032) (P-interaction = 0.115) among men. Race/ethnicity also modified the association between longest wake episode and CRVE (P-interaction = 0.088). A significant association was observed only among white officers (beta = 4.96 microm; P= .025). CONCLUSIONS: We found that poor sleep quality, measured by longest wake episode, was positively and independently associated with retinal venular diameter among white and male officers. Longitudinal studies are warranted to assess whether poor sleep quality is a risk factor for retinal diameter changes.

Background: Cognitive impairment is a public health burden. Our objective was to investigate associations between work hours and cognitive function. Methods: Multi-Ethnic Study of Atherosclerosis (MESA) participants (n = 2,497; 50.7% men; age range 44–84 years) reported hours per week worked in all jobs in Exams 1 (2000–2002), 2 (2002–2004), 3 (2004–2005), and 5 (2010–2011). Cognitive function was assessed (Exam 5) using the Cognitive Abilities Screening Instrument (version 2), a measure of global cognitive functioning; the Digit Symbol Coding, a measure of processing speed; and the Digit Span test, a measure of attention and working memory. We used a prospective approach and linear regression to assess associations for every 10 hours of work. Results: Among all participants, associations of hours worked with cognitive function of any type were not statistically significant. In occupation-stratified analyses (interaction p = 0.051), longer work hours were associated with poorer global cognitive function among Sales/Office and blue-collar workers, after adjustment for age, sex, physical activity, body mass index, race/ethnicity, educational level, annual income, history of heart attack, diabetes, apolipoprotein E-epsilon 4 allele (ApoE4) status, birth-place, number of years in the United States, language spoken at MESA Exam 1, and work hours at Exam 5 (β = –0.55, 95% CI = –0.99, –0.09) and (β = –0.80, –1.51, –0.09), respectively. In occupation-stratified analyses (interaction p = 0.040), we also observed an inverse association with processing speed among blue-collar workers (adjusted β = –0.80, –1.52, –0.07). Sex, race/ethnicity, and ApoE4 did not significantly modify associations between work hours and cognitive function. Conclusion: Weak inverse associations were observed between work hours and cognitive function among Sales/Office and blue-collar workers.

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. Design/methodology/approach: 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 sick day on a regularly scheduled workday. Biomathematical models of fatigue (BMMF) predicted officers' sleep–wake behaviors and on-duty fatigue and sleepiness. Prior sleep, fatigue and sleepiness were tested as predictors of absenteeism during the next shift. Findings: A total of 513,666 shifts and 4,868 cases of absenteeism were studied. The odds of absenteeism increased as on-duty fatigue and sleepiness increased and prior sleep decreased. This was particularly evident for swing shift officers and night shift officers who were predicted by BMMF to obtain less sleep and have greater fatigue and sleepiness than day shift officers. The odds of absenteeism were higher for female officers than male officers; this finding was not due to a differential response to sleep loss, fatigue or sleepiness. Practical implications: Absenteeism may represent a self-management strategy for fatigue or compensatory behavior to reduced sleep opportunity. Long and irregular work hours that reduce sleep opportunity may be administratively controllable culprits of absenteeism. Originality/value: Police fatigue has consequences for police officers, departments and communities. BMMF provide a potential tool for predicting and mitigating police fatigue. BMMF were used to investigate the effects of sleep and fatigue on absenteeism.

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 whether workers organize their sleep similarly across operations and thus whether sleep predictions generalize.Methods: Officers (n = 173) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress study were studied. Officers' sleep-wake behaviors were measured using wrist-actigraphy and predicted using a BMMF (FAID Quantum) parameterized in aviation and rail. Sleepiness (i.e. Karolinska Sleepiness Scale (KSS) ratings) was predicted using actual and predicted sleep-wake data. Data were analyzed using sensitivity analyses.Results: During officers' 16.0 +/- 1.9 days of study participation, they worked 8.6 +/- 3.1 shifts and primarily worked day shifts and afternoon shifts. Across shifts, 7.0 h +/- 1.9 h of actual sleep were obtained in the prior 24 h and associated peak KSS ratings were 5.7 +/- 1.3. Across shifts, 7.2 h +/- 1.1 h of sleep were predicted in the prior 24 h and associated peak KSS ratings were 5.5 +/- 1.2. The minute-by-minute predicted and actual sleep-wake data demonstrated high sensitivity (80.4%). However, sleep was observed at all hours-of-the-day, but sleep was rarely predicted during the daytime hours.Discussion: The sleep-wake behaviors predicted by a BMMF parameterized in aviation and rail demonstrated high sensitivity with police officers' actual sleep-wake behaviors. Additional night shift data are needed to conclude whether BMMF sleep predictions generalize across operations.

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 National Law Enforcement Officers Memorial Fund (NLEOMF) on death frequencies related to health issues at work. Death rates were based on the total number of police officers in the United States [rate = (frequency/population at risk) × 100,000]. Trends were examined using standardized regression. Findings: A total of 646 deaths were attributed to job-related illness. There was a significant upward trend in overall job-related illness deaths (frequency analyses: β = 0.88, p < 0.0001; rate analyses: β = 0.82, p ≤ 0.0001) mainly driven by a significant increase in 911 cancer deaths (frequency analyses: β = 0.88, p < 0.0001; rate analyses: β = 0.88, p ≤ 0.0001). Nearly 82 percent of circulatory deaths were from a heart attack, with an average death age of 46.5 years. Research limitations/implications: Deaths were not included if they failed to meet medical requirements of the NLEOMF. The data are descriptive, do not estimate risk and should be interpreted cautiously. Practical implications: Police wellness programs may help to reduce the danger of deaths associated with job-related illness. Originality/value: This is among the first studies to examine frequency and rate of police health–related deaths due to job exposures.

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 extensive application of actigraphs in sleep research, published literature specifically detailing the methodology for derivation of sleep parameters is lacking; such information is critical for the appropriate analysis and interpretation of actigraphy data. Reporting of sleep parameters has also been inconsistent across studies, likely reflecting the lack of consensus regarding the definition of sleep onset and offset. In addition, actigraphy data are generally underutilized, with only a fraction of the sleep parameters generated through actigraphy routinely used in current sleep research. The objectives of this paper are to review existing algorithms used to estimate sleep/wake cycles from movement data, demonstrate the rules/methods used for estimating sleep parameters, provide clear technical definitions of the parameters, and suggest potential new measures that reflect intraindividual variability. Utilizing original data collected using Motionlogger Sleep Watch (Ambulatory Monitoring Inc., Ardsley, NY), we detail the methodology and derivation of 29 nocturnal sleep parameters, including those both widely and rarely utilized in research. By improving understanding of the actigraphy process, the information provided in this paper may help: ensure appropriate use and interpretation of sleep parameters in future studies; enable the recalibration of sleep parameters to address specific goals; inform the development of new measures; and increase the breadth of sleep parameters used.

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 were derived from 15-day actigraphy data. Relative risks and 95% confidence intervals were estimated using a robust Poisson regression model. Each 10-min increase in sleep onset latency was associated with an 89% higher risk of hypertension (95% confidence interval [CI] = 1.12-3.20). Each 10-min increase in longest wake episode was associated with a 23% higher risk of hypertension (95% CI = 1.01-1.50) and each 10% decrease in sleep efficiency was associated with a 50% higher risk of hypertension (95% CI = 1.02-2.22). These associations were independent of demographic and lifestyle characteristics, depressive symptoms, shift work, sleep duration and body mass index. Having <6 hr of sleep and a body mass index >/=30 kg/m(2) increased the risk of hypertension (relative risk = 2.81; 95% CI = 1.26-6.25) compared with having >/=6 hr of sleep and a body mass index <30 after controlling for confounders. Relative excess risk due to interaction was 3.49 (95% CI = -1.69-8.68) and ratio of relative risk was 3.21 (95% CI = 0.72-14.26). These results suggest that poor sleep quality is a risk factor for hypertension. Longitudinal studies with larger sample sizes are warranted to examine the joint effect of insufficient sleep and obesity on development of hypertension.

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 Cardio-Metabolic Occupational Police Stress Study (2004–2009) with the Spielberger Police Stress Survey. The frequency and severity of events at work were used to calculate stress indices for the past year. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to measure depressive symptoms during the past week. Linear regression was used to evaluate the association between the stress indices and depressive symptom scores. Models were adjusted for age, sex, race, smoking status and alcohol intake, and stratified by median values for coping (passive, active and support seeking) and hardiness (control, commitment and challenge) to assess effect modification. Findings: Among the 388 officers (73.2 percent men), a significant positive association was observed between total stress and the CES-D score (β=1.98 (SE=0.36); p<0.001). Lower CES-D scores were observed for officers who reported lower passive coping (β=0.94 (SE=0.45); p=0.038) and higher active coping (β=1.41 (SE=0.44); p=0.002), compared with their counterparts. Officers higher in hardiness had lower CES-D scores, particularly for commitment (β=0.86 (SE=0.35); p=0.016) and control (β=1.58 (SE=0.34); p<0.001). Originality/value: Results indicate that high active coping and hardiness modify the effect of work stress in law enforcement, acting to reduce depressive symptoms.

BACKGROUND: Long work hours may be associated with adverse outcomes, including cardiovascular disease. We investigated cross-sectional associations of current work hours with coronary artery calcification (CAC). METHODS: Participants (n = 3046; 54.6% men) were from the Multi-Ethnic Study of Atherosclerosis. The number of hours worked in all jobs was obtained by questionnaire and CAC from computed tomography. The probability of a positive CAC score was modeled using log-binomial regression. Positive scores were modeled using analysis of covariance and linear regression. RESULTS: Sixteen percent of the sample worked over 50 hours per week. The overall geometric mean CAC score was 5.2 +/- 10.0; 40% had positive scores. In fully-adjusted models, prevalence ratios were less than 40 hours: 1.00 (confidence interval [CI]: 0.88-1.12), 40:(ref), 41 to 49:1.13 (CI: 0.99-1.30), and >/=50:1.07 (CI: 0.94-1.23) and longer current work hours were not associated with higher mean CAC scores (<40:56.0 [CI: 47.3-66.3], 40:57.8 [CI: 45.6-73.3], 41 to 49:59.2 [CI: 45.2-77.6], >/=50:51.2 [CI: 40.5-64.8]; P = .686). CONCLUSIONS: Current work hours were not independently associated with CAC scores.

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 excessive levels may result in disease. Our study investigated cross-sectional associations between self-reported work stress and various salivary cortisol parameters. METHODS: A total of 285 police officers (76.5% male) from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004-2009) completed the Spielberger Police Stress Survey, reporting frequency and severity of work events during the past month and year to calculate stress indices. Officers provided saliva samples to measure levels of cortisol secretion. Linear regression assessed associations between stress indices and various cortisol parameters, adjusted for age, gender, race/ethnicity, abdominal height, and smoking status. RESULTS: Significant positive associations were observed between stress indices (overall stress, physical danger stress, and past-month lack of support) and diurnal cortisol (AUCg: total area under the curve). Administrative, overall, and physical danger stress in the past year were significantly associated with the diurnal slope. Overall, administrative, and physical danger stress were significantly associated with bedtime levels. There were no significant associations between the stress indices and the awakening cortisol parameters. CONCLUSIONS: Higher stress ratings were related to blunted diurnal decline in cortisol, suggesting conventional and unexpected police stressors may result in HPA axis dysfunction. Future studies investigating possible associations between elevated cortisol and subclinical CVD are needed.

Although workplace discrimination and mistreatment (WDM) has recently drawn widespread media attention, our understanding of the prevalence of these phenomena remains limited. In the current study, we generated national prevalence estimates of WDM from a community-based cohort of employed black and white men and women aged >=48 years. Measures of WDM in the current job were obtained by computer-assisted telephone interview (2011-2013) involving dichotomous responses (yes or no) to five questions and deriving a composite measure of discrimination (yes to at least one). Prevalence estimates and age- and region-adjusted prevalence ratios were derived with use of SUDAAN software to account for the complex sample design. Analyses were stratified by race and sex subgroups. This sample represents over 40 million U.S. workers aged >=48 years. The prevalence of workplace discrimination ranged from a high of 25% for black women to a low of 11% for white men. Blacks reported a 60% higher rate of discrimination compared to whites; women reported a 53% higher prevalence of discrimination, compared with men. The prevalence of workplace mistreatment ranged from 13% for black women to 8% for white men. Women reported a 52% higher prevalence of mistreatment compared to men, while differences by race were not significant. Mistreatment was 4-8 times more prevalent among those reporting discrimination than among those reporting none. Subgroup differences in mistreatment were confined to the wage-employed. Findings suggest that middle age and older wage-employed blacks and women experience the highest prevalence of WDM; moreover, discrimination is strongly associated with mistreatment. This study contributes to our understanding of at-risk segments of the U.S. labor market and the need for targeted interventions to reduce WDM.

OBJECTIVES: The aim of this study is to determine if parental occupational exposure to 16 agents is associated with autism spectrum disorder (ASD). METHODS: Demographic, health and parental occupational data were collected as part of the CHildhood Autism Risks from Genetics and Environment study. The workplace exposure assessment was conducted by two experienced industrial hygienists for the parents of 537 children with ASD and 414 typically developing (TD) children. For each job, frequency and intensity of 16 agents were assessed and both binary and semi-quantitative cumulative exposure variables were derived. Logistic regression models were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) to assess associations between parental occupational exposures 3 months pre-pregnancy until birth. RESULTS: The OR of ASD in the children of mothers exposed to any solvents was 1.5 times higher than the mothers of TD children (95% CI=1.01-2.23). Cumulative exposure indicated that the OR associated with a moderate level of solvent exposure in mothers was 1.85 (95% CI=1.09, 3.15) for children with ASD compared with TD children. No other exposures were associated with ASD in mothers, fathers or the parents combined. CONCLUSION: Maternal occupational exposure to solvents may increase the risk for ASD. These results are consistent with a growing body of evidence indicating that environmental and occupational exposures may be associated with ASD. Future research should consider specific types of solvents, larger samples and/or different study designs to evaluate other exposures for potential associations with ASD.

The present study examined associations of effort-reward imbalance (ERI) and over-commitment 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" questionnaire. The Maslach Burnout Inventory-General Survey was used to assess burnout and its three subscales (exhaustion, cynicism, and professional efficacy). Analysis of covariance was used to examine mean values of burnout scores across quartiles of ERI and overcommitment. Linear regression was used to test for linear trend. ERI and overcommitment were positively and significantly associated with cynicism and exhaustion (trend p value < .001), while professional efficacy showed an inverse association with overcommitment (p = .026). Cynicism and exhaustion scores were significantly higher in officers who reported both overcommitment and ERI compared with their counterparts (p < .001). The results suggest that ERI and overcommitment at work are determinants of higher cynicism and exhaustion. The inverse association of overcommitment with professional efficacy (an indicator of engagement at work) suggests that extreme involvement in work may negatively affect efficacy. Overcommitment may be related to a need for approval and inability of officers to withdraw from work, even in an off-duty status. Police agencies should consider organizational remedies to maintain acceptable levels of commitment by officers. In addition, there is a need to monitor and improve effort-reward imbalance experienced by officers.

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 biomarkers were performed among shifts using analysis of variance/covariance and further stratified by BMI to assess potential effect modification. RESULTS: Associations were observed between day and night shift workers for leukocytes, tumor necrosis factor alpha and homocysteine. After BMI stratification, higher c-reactive protein (CRP) levels were observed among evening shift workers with a BMI >/= 30 kg/m. versus the day shift. CONCLUSIONS: Future studies examining prospective changes in these markers will allow for more comprehensive evaluation of their association with shift work.

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 influence of police work characteristics including workload, police rank, prior military experience, and shift work on the associations. Participants were 356 police officers (256 men and 100 women) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress Study from 2004 to 2009. A mean stress rating score and mean frequency of stressors occurring in the past month were computed for each participant from the Spielberger Police Stress Survey data. Sleep quality was assessed using the global score derived from the Pittsburgh Sleep Quality Index survey. Linear associations of the stress rating score and frequency of stressors with sleep quality (Pittsburgh Sleep Quality Index global score) were tested. Age, sex, race/ethnicity, and smoking status were selected as potential confounders. Results: The stress rating score was positively and independently associated with poor sleep quality (beta = 0.17, p = 0.002). Only workload significantly modified this association (beta = 0.23, p = 0.001 for high workload group; p-interaction = 0.109). The frequency of stressors was positively and independently associated with poor sleep quality (beta = 0.13, p = 0.025). Only police rank significantly modified the association (beta = 0.007, p = 0.004 for detectives/other executives; p-interaction = 0.076). Conclusion: Both police officers’ perception of stress severity and the frequency of stressors are associated with poor sleep quality. Stress coping or sleep promotion regimens may be more beneficial among police officers reporting high workloads.

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 officers. Linear regression model was used in the analyses. The association between physical and psychological stress and PTSD symptoms was stronger in officers who used lower active coping (B = 4.34, p &lt; 0.001) compared to those who utilized higher active coping (p-interaction = 0.027) (B = 1.79, p ≤ 0.003). A similar result was found between lack of support and PTSD symptoms (p-interaction = 0.016) (lower active coping, B = 5.70, p &lt; 0.001; higher active coping, B = 3.33, p &lt; 0.001), but was not significantly different comparing the two groups regarding the association between administrative and organizational pressure and PTSD symptoms (p-interaction = 0.376). Associations of total stress, administrative and organizational pressure, and physical and psychological stressors with PTSD symptoms were significantly stronger in officers who utilized higher passive coping (p-interaction = 0.011, 0.030, and 0.023, respectively). In conclusion, low active or high passive coping methods may exacerbate the effect of work stress on PTSD symptoms. © 2018, This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection.

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) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (conducted between 2004 and 2009). Officers provided four salivary cortisol samples (on awakening and 15, 30, and 45min after awakening). Hours of leisure time physical activity were assessed using the Seven-Day Physical Activity Recall questionnaire. Sleep quality (good/poor) was evaluated using the Pittsburgh Sleep Quality Index (PSQI) scale. Analysis of covariance and repeated measures models were used to examine the association of sleep quality to the two aspects of CAR: cortisol levels (total area under the curve (AUCG), mean, and peak cortisol) and cortisol profiles (the overall pattern in cortisol level during the 45min period following awakening, the increase in cortisol from baseline to average of post awakening values (mean increase), and area under the curve with respect to increase (AUCI)). Analyses were stratified by participant level of reported LTPA (sufficiently vs. insufficiently active, defined as >/= 150 vs.<150min/week of moderate intensity activity, respectively). Since cortisol activity is known to be influenced by gender, we conducted additional analyses also stratified by gender. RESULTS: Overall, results demonstrated that LTPA significantly moderated the association of sleep quality with CAR. Among participants who were sufficiently active, CAR did not differ by sleep quality. However, in those who were insufficiently active during their leisure time, poor sleep quality was associated with a significantly reduced level of total awakening cortisol secretion (AUCG (a.u.)=777.4+/-56 vs. 606.5+/-45, p=0.02; mean cortisol (nmol/l)=16.7+/-1.2 vs. 13.3+/-0.9, p=0.03; peak cortisol (nmol/l)=24.0+/-1.8 vs. 18.9+/-1.5, p=0.03 for good vs. poor sleep quality, respectively). The normal rise in cortisol after awakening was also significantly lower in inactive officers with poor sleep quality than in those with good sleep quality (mean increase (nmol/l)=6.7+/-1.5 vs. 2.3+/-1.2, p=0.03; AUCI (a.u.)=249.3+/-55 vs. 83.3+/-44, p=0.02 for those with good vs. poor sleep quality, respectively). While findings for male officers were consistent with the overall results, CAR did not differ by sleep quality in female officers regardless of LTPA level. CONCLUSION: Findings of this study suggest that poor sleep quality is associated with diminished awakening cortisol levels and dysregulated cortisol patterns over time, but only among officers who were inactive or insufficiently active during their leisure time. In contrast, sleep quality was not associated with any measures of CAR in officers who reported sufficient activity, suggesting a potential protective effect of LTPA. In analyses stratified by gender, findings for male officers were similar to those in the pooled sample, although we found no evidence for a modifying effect of LTPA in women. Future longitudinal studies in a larger population are needed to confirm these findings and further elucidate the relationships between LTPA, sleep quality, and cortisol response.

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 the change in FMD% (FMD%Follow-up-FMD%Baseline) across tertiles of area under the cortisol curve with respect to increase (AUCI). Regression analysis was use to assess trend. RESULTS: Officers (n = 172; 81% men) had a mean +/- SD age of 41 +/- 7.6 years. Men in the lowest AUCI tertile (i.e., atypical waking cortisol pattern) had a significantly larger seven-year mean decline in FMD% (mean +/- SE: -2.56 +/- 0.64) compared to men in the highest tertile (-0.89 +/- 0.69) (p = 0.0087). CONCLUSION: An awakening cortisol AUCI predicted worsening of FMD% approximately seven years later among male officers.