A large and growing number of workers are managing chronic physical and mental health conditions while working, necessitating attention from both researchers and leaders and practitioners in organizations. Much of the current discourse around research and practice in this area is focused on prevention of chronic disease and rehabilitation of disability to help workers return to work. Less commonly attended to are workplace factors that can support the quality of working life and the longevity of working life for workers with chronic health conditions. This Special Issue contains a set of interdisciplinary articles examining common stressors for workers with chronic health conditions, including work-health conflict, anticipated stigma, and job insecurity. It also contains articles examining important supportive relational and social and motivational work design factors, including supervisor support, psychosocial safety climate (shared perceptions of work policies, practices, and procedures that are meant to protect worker psychological health and safety), sense of community, organizational fairness, and health-related leeway (freedom available to workers to self-regulate work activities while self-managing day-to-day symptom fluctuations). The focal populations in this set of articles include, broadly, workers with various types of chronic health conditions, and more specifically, workers with mental health conditions, workers with diabetes, and breast cancer survivors. We hope this Special Issue sparks additional interest in these important topics and others that are critical to supporting workers with chronic health conditions in organizations.

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.

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.

Purpose: Balancing work and family in dual-earner households can be stressful. Research suggests that increased work-family conflict (WFC) significantly predicts poor psychological health and increased stress in police officers. The purpose of this paper is to assess whether child care stress was associated with anxiety symptoms and if stressful work events and shift work modified this relationship among 163 Buffalo, NY police officers. Design/methodology/approach: Participants indicated child care stress by reporting how much stress they felt (0 – none to 10 – high) when making child care/daily living arrangements. Shiftwork was assessed from pay-roll data (1994 to date of exam) and by asking, “Do you work opposite shift from your spouse/partner to care for your children?” to assess partner’s shift. The Beck Anxiety Scale and Spielberger Police Stress Survey were used to assess anxiety and work stress, respectively. Effect modification was assessed by stratifying on police stress scores using their median values, and on partner’s shift. All models were adjusted for age, alcohol intake, sex and smoking status. Findings: Results suggest that child care stress was positively associated with anxiety symptoms and that this relationship was moderated by high (>median) work stress factors and afternoon/midnight shift-work, but not having a partner who works opposite shift. These results indicate that child care stress is associated with anxiety symptoms and that this relationship may be modified by work factors. Research limitations/implications: A number of limitations should be considered while interpreting the results. This study is cross-sectional, which prevents causal inferences; therefore, the temporal pattern between exposure and outcome cannot be determined. The independent, dependent and moderating variables are all self-report measures, which may introduce recall bias. Lastly, generalizability is limited to police departments of similar size and geographic area. Practical implications: Police experience high stress as part of their jobs, these results indicate that similar to other professions, WFC can also affect police officers, and is associated with higher levels of anxiety. Originality/value: Few research studies have evaluated the affects of family issues in police. Specifically, the relationship between child care stress and anxiety, and how this relationship may be modified by high work stress.

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.

Purpose: The purpose of this paper is to provide a state-of-the-art review on the topic of police stressors and associated health outcomes. Recent empirical research is reviewed in the areas of workplace stress, shift work, traumatic stress, and health. The authors provide a comprehensive table outlining occupational exposures and related health effects in police officers. Design/methodology/approach: A review of recent empirical research on police stress and untoward psychological and physiological health outcomes in police officers. Findings: 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. Originality/value: 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.

BACKGROUND: Black persons have an excess burden of cardiovascular disease (CVD) compared with white persons. This burden persists after adjustment for socioeconomic status and other known CVD risk factors. This study evaluated the CVD burden and the socioeconomic gradient of CVD among black participants in the JHS (Jackson Heart Study). METHODS AND RESULTS: CVD burden was evaluated by comparing the observed prevalence of myocardial infarction, stroke, and hypertension in the JHS at baseline (2000-2004) with the expected prevalence according to US national surveys during a similar time period. The socioeconomic gradient of CVD was evaluated using logistic regression models. Compared with the national data, the JHS age- and sex-standardized prevalence ratios for myocardial infarction, stroke, and hypertension were 1.07 (95% CI, 0.90-1.27), 1.46 (95% CI, 1.18-1.78), and 1.51 (95% CI, 1.42-1.60), respectively, in men and 1.50 (95% CI, 1.27-1.76), 1.33 (95% CI, 1.12-1.57), and 1.43 (95% CI, 1.37-1.50), respectively, in women. A significant and inverse relationship was observed between socioeconomic status and CVD within the JHS cohort. The strongest and most consistent socioeconomic correlate after adjusting for age and sex was income for myocardial infarction (odds ratio: 3.53; 95% CI, 2.31-5.40) and stroke (odds ratio: 3.73; 95% CI, 2.32-5.97), comparing the poor and affluent income categories. CONCLUSIONS: Except for myocardial infarction in men, CVD burden in the JHS cohort was higher than expected. A strong inverse socioeconomic gradient of CVD was also observed within the JHS cohort.

Shift workers suffer from a constellation of symptoms associated with disruption of circadian rhythms including sleep abnormalities, and abnormal hormone secretion (e.g. melatonin, cortisol). Recent, but limited, evidence suggests that shift workers have elevated levels of circulating white blood cells (WBCs) compared to their day working counterparts. Interestingly, recent reviews highlight the strong linkage between the immune system and circadian rhythms which includes, but is not limited to, circulating cell populations and functions. The elevated levels of these WBCs may be associated with the increased chronic disease risk observed among this group. The purpose of this analysis was to examine the cross-sectional association between long- and short-term (3, 5, 7, and 14 days) shiftwork (SW) and counts of WBCs among officers in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) cohort. Data collection for this analysis took place among 464 police officers working in Buffalo, New York, USA between 2004 and 2009. Precise SW histories were obtained using electronic payroll records. Officers were assigned a shift type based on the shift (i.e. day, evening, night) that they spent a majority (i.e. ≥50%) of their time from 1994 to the data collection date for long-term SW. The same process was applied to SW over 3, 5, 7, and 14 days prior to data collection. A fasted blood sample collected in the morning of a non-work day was used for characterization of WBCs (total), neutrophils, monocytes, lymphocytes, eosinophils, and basophils. Potential confounding factors included demographic characteristics (e.g. age, sex, race), occupational characteristics (e.g. rank), health behaviors (e.g. smoking, alcohol consumption, diet), anthropometrics, and other biomarkers (e.g. lipids, hemoglobin A1C, leptin). Generalized linear models were used to estimate least square means of the immune cells according to SW categorization for long- and short-term SW histories. Compared to the day shift group, those working long-term night shifts had greater absolute numbers of total WBCs, neutrophils, lymphocytes, and monocytes (all p < 0.05). Those working mainly on the night shift over 7-days had elevated counts of WBCs, lymphocytes, and monocytes (p < 0.05) compared to those mainly working day shifts. Results based on 3-, 5-, and 14-day SW were similar to the 7-day results. This study corroborates other studies with similar findings. However, this analysis provided insights into the effect of both long- and short-term SW on the number of circulating WBCs. SW may lead to disruption of circadian-influenced components of the immune system, which in term, may result in various chronic diseases. These findings, plus previous findings, may provide evidence that SW may lead to immune system dysregulation. Future research is needed to understand whether increases in immune cells among shift workers may be associated with the increased disease risk among this group.

OBJECTIVES: This study examines relationships between the frequency and intensity of police work stressors and cardiac vagal control, estimated using the high frequency component of heart rate variability (HRV). METHODS: This is a cross-sectional study of 360 officers from the Buffalo New York Police Department. Police stress was measured using the Spielberger police stress survey, which includes exposure indices created as the product of the self-evaluation of how stressful certain events were and the self-reported frequency with which they occurred. Vagal control was estimated using the high frequency component of resting HRV calculated in units of milliseconds squared and reported in natural log scale. Associations between police work stressors and vagal control were examined using linear regression for significance testing and analysis of covariance for descriptive purposes, stratified by gender, and adjusted for age and race/ethnicity. RESULTS: There were no significant associations between police work stressor exposure indices and vagal control among men. Among women, the inverse associations between the lack of support stressor exposure and vagal control were statistically significant in adjusted models for indices of exposure over the past year (lowest stressor quartile: M = 5.57, 95% CI 5.07 to 6.08, and highest stressor quartile: M = 5.02, 95% CI 4.54 to 5.51, test of association from continuous linear regression of vagal control on lack of support stressor beta = -0.273, P = .04). CONCLUSIONS: This study supports an inverse association between lack of organizational support and vagal control among female but not male police officers.

This descriptive study examined the top five most frequent and highly rated occupational stressors from the Spielberger Police Stress Survey among 365 police officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004-2009). Prevalence, frequency, and rating of stressors were compared across gender. Poisson regression was used to estimate the prevalence and prevalence ratio (PR) of events. Analysis of variance was used to compare mean frequency of occurrence and mean stress ratings by gender. Many reported stressors dealt with violent situations. Responding to family disputes (83 %) was reported as the most frequent stressor and exposure to battered children (27 %) was the most highly rated stressor (mean rating: 67.6 +/- 35.3). Killing someone in the line of duty (mean rating: 66.3 +/- 43.0) and experiencing a fellow officer being killed (mean rating: 65.3 +/- 40.6) were highly rated but infrequent (0.27 % and 3.6 %, respectively). Male officers tended to report more frequent stressors which took away from their time off duty such as court appearances (PR = 1.26, 1.04-1.52) and working second jobs (PR = 2.37, 1.57-3.57). In contrast, female officers reported experiencing a 37 % higher prevalence of lack of support from supervisor (PR = 0.63, 0.48-0.82) relative to male officers. Results of the present study are discussed within the context of specific police stressors and gender.

Introduction: Policing involves inherent physical and psychological dangers as well as occupational stressors that could lead to chronic fatigue. Although accounts of adverse events associated with police fatigue are not scarce, literature on the association between chronic fatigue and on-duty injury are limited. Methods: Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. A 10-item questionnaire was administered to assess how tired or energetic the officers generally felt irrespective of sleep hours or workload. The questionnaire consisted of five positively worded and five negatively phrased items that measured feelings of vigor/energy and tiredness, respectively. Total as well as separate scores for positive and negative items were computed by summing scores of individual items. Payroll records documenting each officer's work history were used to assess occurrence of injury. Poisson regression was used to estimate prevalence ratios (PR) of injury. Results: Nearly 40% of officers reported feeling drained. Overall prevalence of on-duty injury during the past year was 23.9%. Injury prevalence showed a significant increasing trend across tertiles of total fatigue score: 19.6, 21.7, and 30.8% for lowest, middle and highest tertiles, respectively (trend p-value = 0.037). After controlling for potential confounders, a 5-unit increase in total fatigue score was associated with a 12% increase in prevalence of injury which was marginally significant (p = 0.075). A 5-unit increase in fatigue score of the positively worded items was associated with a 33% increase in prevalence of injury (PR = 1.33, 95% CI: 1.04-1.70, p = 0.022). Conclusion: Officers who do not feel active, full of vigor, alert, or lively had a significantly higher prevalence of non-fatal work place injury compared to their counter parts. Practical applications: With additional prospective evidence, workplace interventions designed to enhance level of energy may reduce feelings of tiredness and hence may prevent workplace injury.

Police officers encounter unpredictable, evolving, and escalating stressful demands in their work. Utilizing the Spielberger Police Stress Survey (60-item instrument for assessing specific conditions or events considered to be stressors in police work), the present study examined the association of the top five highly rated and bottom five least rated work stressors among police officers with their awakening cortisol pattern. Participants were police officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (n=338). For each group, the total stress index (product of rating and frequency of the stressor) was calculated. Participants collected saliva by means of Salivettes at four time points: on awakening, 15, 30 and 45min after waking to examine the cortisol awakening response (CAR). Saliva samples were analyzed for free cortisol concentrations. A slope reflecting the awakening pattern of cortisol over time was estimated by fitting a linear regression model relating cortisol in log-scale to time of collection. The slope served as the outcome variable. Analysis of covariance, regression, and repeated measures models were used to determine if there was an association of the stress index with the waking cortisol pattern. There was a significant negative linear association between total stress index of the five highest stressful events and slope of the awakening cortisol regression line (trend p-value=0.0024). As the stress index increased, the pattern of the awakening cortisol regression line tended to flatten. Officers with a zero stress index showed a steep and steady increase in cortisol from baseline (which is often observed) while officers with a moderate or high stress index showed a dampened or flatter response over time. Conversely, the total stress index of the five least rated events was not significantly associated with the awakening cortisol pattern. The study suggests that police events or conditions considered highly stressful by the officers may be associated with disturbances of the typical awakening cortisol pattern. The results are consistent with previous research where chronic exposure to stressors is associated with a diminished awakening cortisol response pattern.

PURPOSE: Studies describing prevalence and trends of physical activity among workers in the United States are scarce. We aimed to estimate prevalence and trends of "sufficient" leisure-time physical activity (LTPA) during the 2004-2014 time period among U.S. workers. METHODS: Data were collected for U.S. workers in the National Health Interview Survey. LTPA was categorized as sufficiently active (moderate intensity, ≥150 minutes per week), insufficiently active (10-149 minutes per week), and inactive (<10 minutes per week). Prevalence of LTPA was adjusted for age using 2010 U.S. working population as a standardized age distribution. RESULTS: Prevalence trends of "sufficient" LTPA significantly increased from 2004 to 2014 (45.6% to 54.8%; P < .001). Among industry groups, the highest prevalence of "sufficient" LTPA was observed among workers in Professional/Scientific/Technical Services (62.1%). The largest increases were observed among workers in Public Administration (51.3%-63.4%). Among occupational groups, "sufficient" LTPA prevalence was lowest in farming/fishing/forestry (30.8%) and highest in life/physical/social science (66.4%). Prevalence of LTPA significantly increased from 2004 to 2014 in most occupational and industry groups. CONCLUSIONS: Among U.S. workers, trends of "sufficient" LTPA significantly increased between 2004 and 2014. Overall, a larger proportion of white-collar compared to blue-collar workers were engaged in "sufficient" LTPA.

OBJECTIVE: To investigate associations between shiftwork and diurnal salivary cortisol among 319 police officers (77.7% men). METHODS: Information on shiftwork was obtained from the City of Buffalo, NY electronic payroll records. Saliva was collected using Salivettes at seven time points and analyzed for free cortisol concentrations (nmol/L) using a chemiluminescence immunoassay. Mean slopes and areas under the curve were compared across shift schedule using analysis of variance (ANOVA)/analysis of covariance (ANCOVA). RESULTS: Officers working primarily on the night shift had a significantly shallower slope. Mean slope (nmol/L/minutes) of the cortisol curve varied significantly across shifts (day: -0.00332 +/- 0.00017, afternoon: -0.00313 +/- 0.00018, night: -0.00257 +/- 0.0002); adjusted P = 0.023. CONCLUSIONS: Our results suggest that night shiftwork is a workplace factor that may alter the response of the hypothalamic-pituitary-adrenal (HPA) axis to the circadian cues responsible for the pattern of the diurnal cortisol curve.

OBJECTIVE: The aim of the study was to examine association of shift work with sleep quality in police officers. METHODS: Data were obtained from the Buffalo Cardio-Metabolic Occupational Police Stress study (n = 363). An electronic work history database was used to define shift as day, afternoon, or night for three durations: past month, 1 year, and 15 years. Sleep quality was determined using the Pittsburgh Sleep Quality Index. RESULTS: The overall prevalence of poor sleep quality was 54%; 44% for day, 60% for afternoon, and 69% for night shift. Poor sleep quality was 70% more prevalent among night-shift officers (P < 0.001) and 49% higher among those on the afternoon shift (P = 0.003) relative to officers working on the day shift. CONCLUSIONS: Night and evening work schedules are associated with elevated prevalence of poor sleep quality among police officers.

BACKGROUND: Shift work and/or sleep quality may affect health. We investigated whether shift work and sleep quality, separately and jointly, were associated with abnormal levels of triglycerides, total cholesterol (TC), and low-and high-density lipoprotein cholesterol in 360 police officers (27.5% women). METHODS: Triglycerides, TC, and high-density lipoprotein were analyzed on the Abbott Architect; low-density lipoprotein was calculated. Shift work was assessed using City of Buffalo payroll work history records. Sleep quality (good, ≤5; intermediate, 6–8; poor, ≥9) was assessed using the Pittsburgh Sleep Quality Index questionnaire. A shift work + sleep quality variable was created: day plus good sleep; day plus poor sleep; afternoon/night plus good; and poor sleep quality. Mean values of lipid biomarkers were compared across categories of the exposures using analysis of variance/analysis of covariance. RESULTS: Shift work was not significantly associated with lipids. However, as sleep quality worsened, mean levels of triglycerides and TC gradually increased but only among female officers (age- and race-adjusted p = 0.013 and 0.030, respectively). Age significantly modified the association between sleep quality and TC. Among officers ≥40 years old, those reporting poor sleep quality had a significantly higher mean level of TC (202.9 ± 3.7 mg/dL) compared with those reporting good sleep quality (190.6 ± 4.0 mg/dL) (gender- and race-adjusted p = 0.010). Female officers who worked the day shift and also reported good sleep quality had the lowest mean level of TC compared with women in the other three categories (p = 0.014). CONCLUSION: Sleep quality and its combined influence with shift work may play a role in the alteration of some lipid measures.

OBJECTIVES: Policing is considered a high-stress occupation and officers have elevated cardiovascular morbidity and mortality. To investigate a potential connection, we evaluated the association between salivary cortisol response to a high-protein meal challenge and the metabolic syndrome (MetSyn), a subclinical disorder associated with increased cardiovascular risk. METHODS: Cross-sectional data were from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004-2009). MetSyn was defined as having ≥3 components: abdominal obesity, hypertension, elevated triglycerides, reduced high-density lipoprotein cholesterol, and glucose intolerance. Officers provided five saliva samples for cortisol analysis, one before challenge (high-protein shake) and four at 15-min intervals thereafter, where the usual response is increase. Regression models were used to examine trends in mean number of MetSyn components across quartiles of area under the curve (AUC) salivary cortisol. Patterns of mean cortisol response were assessed by MetSyn status using repeated-measures analysis of covariance. RESULTS: Prevalence of MetSyn was 25.7% among 373 officers (74.0% male). The mean count of MetSyn components decreased (1.89, 1.75, 1.55, 1.37; P < 0.01) across increasing quartiles of AUC salivary cortisol. Mean salivary cortisol decreased from baseline (5.55, 4.58, 4.47, 4.79, 4.75 nmol/l) in officers with MetSyn and increased (5.08, 5.82, 5.92, 5.82, 5.60 nmol/l) in their counterparts. The test for interaction between MetSyn status and time of saliva collection was statistically significant (P < 0.001). CONCLUSIONS: Reduced cortisol response to a high-protein meal challenge may be associated with MetSyn. Future longitudinal studies could provide useful evidence for planning intervention studies on cardiovascular risk among police officers.

Police officers are chronically exposed to work stress. We examined specific stressors that may be associated with hopelessness, a possible risk factor for suicide in this high suicide risk population. The study included 378 officers (276 men and 102 women) with complete data. Analysis of variance was used to estimate mean levels of hopelessness scores as associated with stress, adjusted for age, gender, and race/ethnicity. Posttraumatic symptoms were tested as a modifier of the association between stress and hopelessness. Increasing stress of administrative practices and lack of support were significantly associated with increasing hopelessness among officers (p < .006 – hopelessness range: 1.64–2.65; and p < .001 – hopelessness range 1.60–2.80, respectively). Posttraumatic stress disorder (PTSD) symptoms significantly modified the association between lack of organizational support and hopelessness (p < .010) with significant association only among individuals with higher PTSD symptoms (p < .001). Results suggest that hopelessness is associated with specific stressors in police work, and this is modified by posttraumatic symptomatology.

BACKGROUND: Although individual metabolic risk factors are reported to be associated with breast cancer risk, controversy surrounds risk of breast cancer from metabolic syndrome (MS). We report the first systematic review and meta-analysis of the association between MS and breast cancer risk in all adult females. METHODS: Studies were retrieved by searching four electronic reference databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and ProQuest through June 30, 2012] and cross-referencing retrieved articles. Eligible for inclusion were longitudinal studies reporting associations between MS and breast cancer risk among females aged 18 years and older. Relative risks and 95% confidence intervals were calculated for each study and pooled using random-effects models. Publication bias was assessed quantitatively (Trim and Fill) and qualitatively (funnel plots). Heterogeneity was examined using Q and I (2) statistics. RESULTS: Representing nine independent cohorts and 97,277 adult females, eight studies met the inclusion criteria. A modest, positive association was observed between MS and breast cancer risk (RR: 1.47, 95% CI, 1.15-1.87; z = 3.13; p = 0.002; Q = 26.28, p = 0.001; I (2) = 69.55%). No publication bias was observed. CONCLUSIONS: MS is associated with increased breast cancer risk in adult women.

OBJECTIVES: To determine whether the dietary inflammatory index (DII) is associated with inflammatory or metabolic biomarkers and metabolic syndrome (MetSyn) among police officers. METHODS: Cross-sectional data from the Buffalo Cardio-Metabolic Occupational Police Stress study were derived from saliva and fasting blood samples, anthropometric measurements, long-term shiftwork histories, and demographic, stress/depression, and food frequency questionnaires (FFQs). Metabolic syndrome was defined using standard criteria. RESULTS: Officers in DII quartiles 2 to 4 were more likely to exceed a threshold of 3.0 mg/L for C-reactive protein (odds ratio [OR] = 1.88; 95% confidence interval [95% CI] = 1.02 to 3.45; OR = 2.17; 95% CI = 1.19 to 3.95; OR = 1.57; 95% CI = 0.85 to 2.88, respectively) compared with quartile 1. The glucose intolerance component of MetSyn was more prevalent among officers in DII quartile 4 than among those in quartile 1 (OR = 2.03; 95% CI = 1.08 to 3.82). CONCLUSIONS: A pro-inflammatory diet was associated with elevated CRP and with the glucose intolerance component of MetSyn.

BACKGROUND: We aimed to examine the association of objectively measured and self-reported sleep duration with carotid artery intima media thickness (IMT) among 257 police officers, a group at high risk for cardiovascular disease (CVD). METHODS: Sleep duration was estimated using actigraphic data and through self-reports. The mean maximum IMT was the average of the largest 12 values scanned bilaterally from three angles of the near and far wall of the common carotid, bulb, and internal carotid artery. Linear and quadratic regression models were used to assess the association of sleep duration with IMT. RESULTS: Officers who had fewer than 5 or 8 hr or more of objectively measured sleep duration had significantly higher maximum IMT values, independent of age. Self-reported sleep duration was not associated with either IMT measure. CONCLUSION: Attainment of sufficient sleep duration may be considered as a possible strategy for atherosclerosis prevention among police officers.

OBJECTIVE: Our previous work has suggested that the incidence of any occurrence of injury leave among police officers is higher on night shifts. In this study, we extended our inquiry to determine whether the incidence of long-term injury leave varies across shifts. METHODS: Police officers (N=419) from an urban department were included in the analysis. Daily payroll work history data from 1994-2010 was collected. Injury leave duration was examined ranging from ≥1≥90 days. Poisson regression models were used to compute incidence rates (IR) and incidence rate ratios (IRR) of long-term injury. RESULTS: Cumulative incidence of injury for different durations of leave defined as ≥1, ≥5, ≥10, ≥15, ≥30, and ≥90 days were 61.3%, 45.4%, 39.9%, 33.9%, 26.5%, and 9.6% respectively. Age-and gender adjusted IRR of long-term injury (≥90 days) for night versus day shifts was IRR 3.12, 95% confidence interval (95% CI) 1.35-7.21 and IRR 2.21, 95% CI 1.04-4.68, for night versus afternoon shifts. Among all durations examined, the largest IRR was for injury ≥90 days, night versus day shifts (IRR 3.12, 95% CI 1.35-7.21). CONCLUSIONS: Night shift work was significantly associated with long-term injury among police officers after adjustment for age and gender. Although type of injury was not available, it is possible that variation in injury type across shifts might account for some of this association.

Shiftwork, regarded as a significant occupational stressor, has become increasingly prevalent across a wide range of occupations. The adverse health outcomes associated with shiftwork are well documented. Shiftwork is an integral part of law enforcement, a high-stress occupation with elevated risks of chronic disease and mortality. Sickness absence is an important source of productivity loss and may also serve as an indirect measure of workers' morbidity. Prior studies of shiftwork and sickness absenteeism have yielded varying results and the association has not been examined specifically among police officers. The objective of this study was to compare the incidence rate of sick leave (any, ≥3 consecutive days) among day-, afternoon-, and night-shift workers in a cohort of police officers and also examine the role of lifestyle factors as potential moderators of the association. Participants (N = 464) from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study examined between 2004 and 2009 were used. Daily work history records that included the shift schedule, number of hours worked, and occurrence of sick leave were available for up to 15 yrs starting in 1994 to the date of the BCOPS study examination for each officer. Poisson regression analysis for ungrouped data was used to estimate incidence rates (IRs) of sick leave by shift, and comparison of IRs across shifts were made by computing incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). Sick leave occurred at a higher rate on the night shift (4.37 per 10 000 person-hours) compared with either day (1.55 per 10 000 person-hours) or afternoon (1.96 per 10 000 person-hours) shifts. The association between shiftwork and sickness absence depended on body mass index (BMI). For overweight individuals (BMI ≥ 25 kg/m(2)), the covariate-adjusted incidence rate of sick leave (≥1 day) was twice as large for night-shift officers compared with those working on the day (IRR = 2.29, 95% CI: 1.69-3.10) or afternoon (IRR = 1.74, 95% CI: 1.29-2.34) shift. The IR of three or more consecutive days of sick leave was 1.7 times larger for those working on night shift (IRR = 1.65, 95% CI: 1.17-2.31) and 1.5 times larger for those working on afternoon shift (IRR = 1.50, 95% CI: 1.08-2.08) compared with day shiftworkers. For subjects with normal BMI (<25 kg/m(2)), the incidence rates of sick leave did not differ significantly across shifts. In conclusion, shiftwork is independently associated with sickness absence, with officers who work the night shift having elevated incidence of sick leave. In addition, overweight officers who work the night shift may be at additional risk for sickness absence.

The objective of this study was to evaluate whether long-term shift work is associated with both the total hormonal secretion after awakening and the pattern of the cortisol levels during the first hour following awakening, among 65 randomly selected police officers who represent a high stress occupation. Dominant shift (Day, Afternoon, or Midnight) was ascertained using daily payroll records of each participant's work activities during the 6-8 prior to saliva sampling. Four salivary samples were collected at 15 minute intervals upon first awakening. After accounting for potential confounders, salivary cortisol concentrations averaged across all four time points and total area under the curve differed significantly across shift with midnight shift workers showing suppressed awakening cortisol response relative to the afternoon and day shift. The percent of hours worked on midnight shift was inversely correlated with total awakening cortisol output. In contrast, the pattern of cortisol secretion during the first hour following waking appeared not to be affected as no significant interaction effect was found between time since awakening and shift work. The results show that long-term midnight shift work is associated with decreased absolute mean level and total volume of cortisol released over the waking period.

The Buffalo Cardio-metabolic Occupational Police Stress study, an occupational cohort study of police officers, was conducted to evaluate physiologic and stress measures in a high-risk occupation where occupational exposure to difficult criminal situations can lead to physiologic and psychological health consequences among those who enforce the law. The chronic exposure to human tragedy may place police officers at special risk for mental health disorders and the potential for misuse of alcohol or drugs. While exact etiologies of post-traumatic stress were not determined by this study, overall post-traumatic stress (PTS) prevalence rates among the police officers was 35%, with 10% of individuals demonstrating severe PTS symptomatology. Waking cortisol measures tended to be higher among officers with more PTS symptomatology, with some gender related differences noted. Given the increase in incarcerations for addictions related offenses over the past 20 years and the chronic exposure to human suffering and tragedy, early recognition of PTS symptoms is essential in making the diagnosis of post-traumatic stress in high-risk occupational cohorts. Providing early entry into treatment and subsequently attempting to eliminate or minimize long-term consequences of post-traumatic stress can have a significant impact on the prevention of long term sequelae of chronic stress, such as the use or misuse of drugs or alcohol.

BACKGROUND: Police officers may be injury prone due to fatigue, erratic work hours, and insufficient sleep. This study explored injury incidence among police officers across shifts. METHODS: Day-to-day shift data from computerized payroll records (1994-2010) were available from a mid-sized urban police department (n=430). Sleep duration, shift activity level, returning to work after days off, and injury incidence over time were also examined. RESULTS: Age-adjusted incidence rate ratio (IRR) for injury on the midnight shift was 72% larger than the day shift (IRR=1.72; 95% CI=1.26-2.36) and 66% larger than the afternoon shift (IRR=1.66; 95% CI=1.23-2.25). Injury incidence for the first day back on the midnight shift was 69% larger than day shift (IRR=1.69; 95% CI=1.23-2.32) and 54% larger than the afternoon shift (IRR=1.54; 95% CI=1.36-1.76). High activity level combined with midnight shift work put officers at increased injury risk (IRR=2.31; P=0.0003). Probability of remaining free of injury was significantly higher for day shift than midnight shift (P< 0.0001). CONCLUSIONS: Higher injury risk was associated with night shift work in police officers. Night shift combined with high work activity was strongly associated with injury risk. There was a significantly higher probability of not being injured on day compared to midnight or afternoon shifts. (Am. J. Ind. Med. 55:217-227, 2012. (c) 2011 Wiley Periodicals, Inc.)

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.

OBJECTIVE: To examine the association between metabolic syndrome (MetSyn) and carotid intima media thickness (IMT) separately in male and female police officers. METHODS: MetSyn was defined using 2005 guidelines. B-mode ultrasound was used to measure mean and maximum (12 and 36 segments) carotid artery thickness. Analysis of covariance was used to compare mean IMT values across individuals categorized by number of MetSyn components. Adjustments were made for age, smoking status, and low-density lipoprotein cholesterol. RESULTS: Among 106 women, the adjusted mean common and maximum(36) carotid IMT were significantly and positively associated with number of MetSyn components. No associations were found in men (n = 304). Adjusted carotid IMT values were inversely associated with low high-density lipoprotein cholesterol and directly with hypertension in women. CONCLUSIONS: Number of MetSyn components was significantly associated with carotid IMT in female but not in male officers.