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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.

Background The annual incidence rate of work-related upper extremity musculoskeletal disorders (WUEMSDs) is increasing in US workers according to the United States Bureau of Labor Statistics (BLS). However, the prevalence of WUEMSDs among US total workers has not been estimated. Objective We aimed to estimate the prevalence of WUEMSDs among US total workers and among each of major occupations and industries. Methods We analyzed data from the National Health Interview Survey Arthritis supplements (2006, 2009, and 2014) among 50,218 current workers (age ≥18 years) to estimate the 30-day prevalence of WUEMSDs and of WUEMSDs affecting work using the SAS-callable SUDAAN software. Results About 11.2 million workers reported WUEMSDs based on three surveys (2006, 2009, and 2014). The 30-day prevalence of WUEMSDs was 8.23% the prevalence of WUEMSDs affecting work was 1.24%. The Construction occupation and industry had the highest age- and sex-adjusted 30-day prevalence of WUEMSDs (10.98% for Construction occupation; 9.94% for Construction industry) and WUEMSDs affecting work (3.32% for Construction occupation; 2.31% Construction industry). Conclusions Our results show that construction workers had the highest prevalence of both WUEMSDs and WUEMSDs affecting work. They may be a priority group for interventions to reduce upper extremity musculoskeletal disorders.

Background: According to the US Bureau of Labor Statistics, musculoskeletal disorders (MSDs) accounted for 32% of all nonfatal injury and illness cases in 2014 among full-time workers. Our objective was to review and summarize the evidence linking occupational exposures to vibration and awkward posture with MSDs of the shoulder and neck. Methods: A literature search was conducted using the terms musculoskeletal disorders, vibration, and awkward posture. All types of observational epidemiologic studies, with the exception of case reports, published during 1998–2015 were included. Databases searched were MEDLINE (Ovid), Embase (Ovid), Scopus, Ergonomic Abstracts, NIOSHTIC-2, and Health and Safety Science Abstracts. Results: Occupational exposures to whole-body or hand–arm vibration were significantly associated with or resulted in MSDs of the shoulder and neck. Awkward postures while working were also associated with MSDs in these locations. These findings were consistent across study designs, populations, and countries. Conclusion: Occupational exposure to vibration and awkward posture are associated with shoulder and neck MSDs. Longitudinal studies are required to elucidate the mechanisms responsible for these associations, and intervention studies are warranted. Keywords: Awkward posture, Ergonomic exposures, Musculoskeletal disorders, Shoulder pain, Vibration

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

AIM In this study, we evaluated whether peritraumatic dissociation (PD) was associated with symptoms of depression and posttraumatic stress disorder (PTSD), and whether this association was modified by trauma prior to police work. METHOD Symptoms of depression, PTSD, peritraumatic dissociative experience (PDE), and trauma prior to police work were measured using the Center for Epidemiologic Studies Depression scale, PTSD Checklist-Civilian, PDE questionnaire, and the Brief Trauma questionnaire, respectively, in 328 police officers. Separate regression models were used to assess if either symptoms of depression or PTSD were associated with PD stratified by prior trauma. Means were adjusted for race, number of drinks per week, and smoking. RESULTS PD was associated with symptoms of PTSD and depression (β = 0.65, p < .001 and β = 0.27, p < .001, respectively). PD was positively associated with symptoms of PTSD regardless of prior trauma (β = 0.61, p < .001(without prior trauma), 0.75, p < .001 (with prior trauma). In contrast to PTSD, depression symptoms were significantly associated with PD scores in individuals with prior trauma (β = 0.47, p < .001), but not in individuals without prior trauma (β = 0.13, p = .165). LIMITATIONS This is a cross-sectional study. Outcomes were obtained via self-report and were not clinically diagnosed. Aspects of both the trauma event as well as the symptoms and severity of PD may have introduced recall bias. CONCLUSION These results add to the literature indicating that PD plays a role in symptoms of PTSD and depression and how prior trauma may modify this relationship. (PsycINFO Database Record

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.

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.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.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.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.

Background Our objective was to assess the influence of shiftwork on change in endothelial function. Methods This longitudinal study was conducted in 188 police officers (78.2% men). Shiftwork status (day, afternoon, night) was assessed objectively using daily Buffalo, NY payroll work history records. Brachial artery flow-mediated dilation (FMD) was assessed using ultrasound. Mean change in FMD% between 2004–2009 and 2010–2015 was compared across shiftwork using analysis of variance/covariance. Results Overall, mean FMD% decreased from 5.74 ± 2.83 to 3.88 ± 2.11 over an average of 7 years among all officers; P

The aim of the study was to examine association of shift work with sleep quality in police officers.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.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.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

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 Osteoarthritis (OA) is a multifactorial disease with strong genetic and occupational components. Although published studies have described several risk factors for OA, very few studies have investigated the occupational and genetic factors that contribute to this debilitating condition. Objective To describe occupational and genetic factors that may contribute to the risk of developing (OA). Methods A literature search was conducted in PubMed using the search terms osteoarthritis, occupation, work, and genetics. Results Heavy physical work load was the most common occupational risk factor for OA in several anatomical locations. Other factors include kneeling and regular stair climbing, crawling, bending and whole body vibration, and repetitive movements. Numerous studies have also shown the influence of genetic variability in the pathogenesis of OA. Genetic variants of several groups of genes e.g., cartilage extracellular matrix structural genes and the genes related to bone density have been implicated in disease pathogenesis. Conclusion This review shows that occupational factors were extensively studied in knee OA unlike OA of other anatomical regions. Although genetic association studies performed to date identified a number of risk variants, some of these associations have not been consistently replicated across different studies and populations. Therefore, more research is needed.

Objective: Police officers in the New Orleans geographic area faced a number of challenges following Hurricane Katrina in 2005 . Design: This cross-sectional study examined gratitude, resilience, and satisfaction with life as mediators in the association between social support and post-traumatic stress disorder (PTSD) symptoms in 82 male and 31 female police officers. The Gratitude Questionnaire, Connor-Davidson Resilience Scale, Satisfaction with Life Scale, and the Interpersonal Support Evaluation List were used to measure gratitude, resilience, satisfaction with life, and social support, respectively. PTSD symptoms were measured using the PTSD Checklist-Civilian (PCL-C). Ordinary least square regression mediation analysis was used to estimate direct and indirect effects among gratitude, resilience, satisfaction with life, social support, and PTSD symptoms. All models were adjusted for age, alcohol, race, and previous military experience . Results: Mean PCL-C symptoms were 29.1 (standard deviation [SD] = 14.4) for females and 27.9 (SD = 12.1) for males. There was no direct relationship between social support and PTSD symptoms (c 9 = −0.041; 95% confidence interval [CI] = −0.199, 0.117) independent of the indirect effect through resilience (effect = −0.038; 95%CI = −0.099, −0.002). Neither gratitude (effect = −0.066; 95% CI = −0.203, 0.090) nor satisfaction with life (effect = −0.036, 95% CI = −0.131, 0.046) contribute to the indirect effect. Conclusions: These results indicate that resilience mediates the relationship between social support and symptoms of PTSD. Targeting social support and resilience in officers may facilitate reduction of PTSD symptoms .

Objective We examined prevalence, frequency, duration, and recency of injury leave and the association of duty-related injury with perceived stress in U.S. police officers. Methods This cross-sectional study contained 422 active duty police officers from a mid-sized urban police department. For each participating officer, work history records were used to assess on-duty injuries that lead to work absences. Linear regression analyses were used for analyses. Results Most participants had experienced at least one injury (62%), and among those injured, 67% experienced more than one duty-related injury. The average number of injuries per officer was three (range 1 to 12). There was a significant linear trend in mean perceived stress across injury count even after adjusting for age, rank, and sex (P = 0.025). Conclusion Findings suggest that work-related injury is common and repeated work-related injuries are psychologically distressing in U.S. police officers.

Police officers work in an environment of chronic psychological stress which may be associated with sleep quality. Variation in sleep quality may be a result of how well officers cope with stress. The purpose of this study was to examine associations between police-specific stresses and sleep quality, and factors which may modify these associations. Participants were 356 police officers (256 men, 100 women) from the Buffalo Cardio-metabolic Occupational Police Stress (BCOPS) Study examined between 2004 and 2009. Stress in the past year, including organizational, physical and psychological danger and lack of support, was measured using the Spielberger Police Stress Survey. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Analysis of covariance was used to examine multivariable-adjusted sleep quality across police stress tertiles; p-values were obtained from linear regression. Adjustments were made for age, gender, race, education, marital and smoking status. Analyses were stratified by coping and depressive symptoms, potential moderators of the association of interest. Multivariable-adjusted global sleep and sleep disturbance scores increased significantly with increasing tertiles of police stress scores for the total and subscale scores (p

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.

To investigate associations of work hours, job control, job demands, job strain, and occupational category with brachial artery flow-mediated dilation (FMD) in 1499 Multi-Ethnic Study of Atherosclerosis participants.Flow-mediated dilation was obtained using high-resolution ultrasound. Mean values of FMD were examined across categories of occupation, work hours, and the other exposures using regression analyses.Occupational category was significantly associated with FMD overall, with blue-collar workers showing the lowest mean values-management/professional = 4.97 ± 0.22%; sales/office = 5.19 ± 0.28%; services = 4.73 ± 0.29%; and blue-collar workers = 4.01 ± 0.26% (adjusted P0.001). There was evidence of effect modification by sex (interaction P = 0.031)-significant associations were observed among women (adjusted P = 0.002) and nearly significant results among men (adjusted P = 0.087). Other exposures were not significantly associated with FMD.Differences in endothelial function may account for some of the variation in cardiovascular disease across occupational groups.

Chronic obstructive pulmonary disease (COPD) is a primary cause of morbidity and mortality globally.1 In the United States, COPD ranks third in causes of mortality with 100,000 deaths annually. An estimated 15 million people had health care provider diagnosed COPD in 2010, and an estimated 12 million potential cases remain undiagnosed.2–4 The estimated total annual cost of COPD for 2010 was $49.9 billion.5 The probability of being employed is reduced by 8.6% with COPD associated disability.4 Chronic obstructive pulmonary disease is a chronic disease, mostly affecting older adults.6, 7 Balmes et al8 concluded that 15% of COPD is attributable to occupational exposure. Furthermore, according to Bang et al,9 certain occupation groups have higher prevalence of COPD, especially among service occupations. Therefore, for this study we analyzed data for working adults aged 40 to 70 years by occupation. This study is based on National Health Interview Survey (NHIS) data (2004 to 2011) for COPD by occupation, representing a large sample of US working adults. The aim of this study was to (1) estimate the prevalence of COPD among older working adults in the United States by major occupational groups, and (2) provide prevalence odds ratios (PORs) of COPD by major occupational groups.

Objectives Police officers have a high prevalence of cardiovascular disease (CVD). Reduced heart rate variability (HRV) is known to increase CVD risk. Leptin and adiponectin may be related to CVD health. Therefore, our objective was to investigate the relationship between these variables and HRV. Methods Leptin and adiponectin levels were measured in 388 officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. HRV was assessed according to methods published by the Task Force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology for measurement and analysis of HRV. Mean values of high-frequency (HF) and low-frequency (LF) HRV were compared across tertiles of leptin and adiponectin using analysis of variance and analysis of covariance; trends were assessed using linear regression models. Results Leptin, but not adiponectin, was significantly and inversely associated with HRV. Body mass index (BMI) and percent body fat significantly modified the association between leptin and LF (but not HF) HRV. Among officers with BMI

Background: Shift work has been associated with occupational stress in health providers and in those working in some industrial companies. The association is not well established in the law enforcement workforce. Our objective was to examine the association between shift work and police work-related stress. Methods: The number of stressful events that occurred in the previous month and year was obtained using the Spielberger Police Stress Survey among 365 police officers aged 27–66 years. Work hours were derived from daily payroll records. A dominant shift (day, afternoon, or night) was defined for each participant as the shift with the largest percentage of total time a participant worked (starting time from 4:00 AM to 11:59 AM, from 12 PM to 7:59 PM, and from 8:00 PM to 3:59 AM for day, afternoon, and night shift, respectively) in the previous month or year. Analysis of variance and covariance were used to examine the number of total and subscale (administrative/professional pressure, physical/psychological danger, or organizational support) stressful events across the shift. Results: During the previous month and year, officers working the afternoon and night shifts reported more stressful events than day shift officers for total stress, administrative/professional pressure, and physical/psychological danger (p

This study examined: (a) differences in lung function between current and non current smokers who had sedentary lifestyles and non sedentary lifestyles and (b) the mediating effect of sedentary lifestyle on the association between smoking and lung function in African Americans. Sedentary lifestyle was defined as the lowest quartile of the total physical activity score. The results of linear and logistic regression analyses revealed that non smokers with non sedentary lifestyles had the highest level of lung function, and smokers with sedentary lifestyles had the lowest level. The female non-smokers with sedentary lifestyles had a significantly higher FEV1% predicted and FVC% predicted than smokers with non sedentary lifestyles (93.3% vs. 88.6%; p = 0.0102 and 92.1% vs. 86.9%; p = 0.0055 respectively). FEV1/FVC ratio for men was higher in non smokers with sedentary lifestyles than in smokers with non sedentary lifestyles (80.9 vs. 78.1; p = 0.0048). Though smoking is inversely associated with lung function, it seems to have a more deleterious effect than sedentary lifestyle on lung function. Physically active smokers had higher lung function than their non physically active counterparts.

To investigate associations between shiftwork and glomerular filtration rate among white/Hispanic (n = 273) and African American (n = 81) police officers.Analysis of variance/analysis of variance was utilized to compare mean values of estimated glomerular filtration rate (eGFR) across shiftwork categories.Shiftwork was significantly associated with eGFR among white/Hispanic officers only: day (88.6 ± 2.8), afternoon (90.6 ± 2.9), and night shift (83.1 ± 3.1 mL/min/1.73 m); afternoon versus night, P = 0.007. Percentage of hours worked on the night shift was inversely associated with mean levels of eGFR, trend P = 0.001. Body mass index modified the association between shiftwork and eGFR (interaction P = 0.038). Among officers with body mass index 25 kg/m or higher, those who worked the night shift had the lowest mean eGFR (afternoon vs night, P = 0.012; day vs night, P = 0.029).Night-shift work was associated with decreased kidney function among white/Hispanic officers. Longitudinal studies are warranted among all races.

Objective Low heart rate variability (HRV) has been linked to cardiovascular disease. Our objective was to examine the cross-sectional association between insulin and HRV. Methods Insulin levels were measured in 355 nondiabetic officers from the BCOPS study, following a 12 h fast. HRV was performed according to methods published by the task force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology for measurement and analysis of HRV. Mean values of high (HF) and low frequency (LF) HRV were compared across tertiles of insulin using ANOVA and ANCOVA; p-values were obtained from linear regression models. Results Higher mean levels of insulin were significantly associated with lower (i.e., worse) mean levels of HRV before and after risk-factor adjustment. The results for HF HRV (ms2) were as follows: 1st insulin (µU/ml) tertile (156.3; 95% confidence interval (CI) = 128.6–189.9); 2nd tertile (154.3; 95% CI = 124.3–191.5); 3rd tertile (127.9; 95% CI = 105.0–155.8), p for trend = 0.017. Results with LF HRV were similar to HF HRV. Insulin was also inversely and significantly associated with HRV among officers with BMI ≥25 kg/m2, with ≥25.5% body fat, and among those who reported low (

Chronic lung disease is exacerbated by comorbid psychiatric issues and treatment of depression may improve disease symptoms. We sought to add to the literature as to whether depression is associated with pulmonary function in healthy adults.In 2551 healthy adults from New York State, we studied the association of depression via the Center for Epidemiologic Studies Depression scale (CES-D) scale score and forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) using general linear models and a cross-sectional design.We identified statistically significant inverse trends in FEV1, FVC, FEV1%, and FVC% by CES-D category, especially in ever-smokers and men. When adjusted for covariates, the difference in FEV1 and FEV1% for smokers with more than 18.5 lifetime pack-years from CES-D scores 0 to 3 to 16 or more (depressed) is approximately 0.25 l and 5.0% (adjusted p values for trend are.001 and .019, respectively). In men, we also observed statistically significant inverse trends in pulmonary function with increasing CES-D.We identified an inverse association of depressive symptoms and pulmonary function in healthy adults, especially in men and individuals with a heavy smoking history. Further studies of these associations are essential for the development and tailoring of interventions for the prevention and treatment of chronic lung disease.

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 10000 person-hours) or afternoon (1.96 per 10000 person-hours) shifts. The association between shiftwork and sickness absence depended on body mass index (BMI). For overweight individuals (BMI ≥ 25 kg/m2), 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 (

Objectives Chronic stress, characteristic of police work, affects the hypothalamic-pituitary-adrenal axis' control of cortisol production. Capacity to vary cortisol may be the appropriate measurement to interpret associations with chronic diseases, including obesity, best measured by variability within a person, not central tendency. Methods On each of 217 policemen, 18 saliva specimens were obtained for cortisol. Statistical models examined the associations of within-subjects (W-S) cortisol standard deviation (SD) and W-S cortisol mean with waist circumference and four body composition indexes: BMI, and three derived from DEXA: fat-mass, and trunk and extremities lean-mass. Explained variance and the functional nature of associations are reported. Results Associations of anthropometrics with W-S cortisol mean were not statistically significant at P

Objectives This study examines cross-sectional associations of indices of adiposity, lean body mass, and physical activity, with heart rate variability (HRV), a marker for parasympathetic cardiac vagal control. Methods The study population consists of 360 officers from the Buffalo New York Police Department. Indices of adiposity include body mass index, waist circumference, and a fat-mass index taken from dual-energy X-ray absorptiometry (DEXA) measurements. Lean body mass indices were derived from DEXA measurements of trunk mass and extremity lean mass. Physical activity was measured using a 7-day self-report questionnaire. HRV was obtained from 5-min electrocardiogram measurements by means of parametric spectral analysis resulting in estimates for high-frequency (HF) and low-frequency (LF) HRV. Results Both HF and LF HRV were significantly associated with markers for adiposity, two components of lean mass and physical activity with all associations being in the expected direction except that for trunk lean mass. This unexpected result is explained by the possibility that trunk mass is a marker for visceral adiposity rather than lean mass. Body mass index did not explain any additional variance in HRV above and beyond waist circumference and the DEXA indices. Conclusions Higher levels of physical activity, lower levels of markers for central adiposity and higher lean mass in the extremities predict higher levels of HRV in this population of police officers. This association between modifiable risk factors and markers for autonomic function suggest possible interventions that may improve health and performance. Am. J. Hum. Biol. 25:370–377, 2013. © 2013 Wiley Periodicals, Inc.

Objectives: Mental health has been shown to be linked with certain underlying physiological mechanisms. The objective of this cross sectional study was to investigate the relationship between depressive symptoms and brachial artery reactivity (BAR) in an understudied population: police officers. Methods: Participants were 351 police officers who were clinically examined in the Buffalo Cardio-Metabolic Police Stress (BCOPS) study. BAR was performed using standard B-Mode ultrasound procedures. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D) scale. Mean values of the difference between the baseline and maximum diameters of the brachial artery were determined across three categories of CES-D score using the analysis of variance and the analysis of covariance. p-values for linear trends were obtained from linear regression models. Results: The mean age (± standard deviation) of all officers was 40.9 ± 7.2 years. Women had a slightly higher mean CES-D score than men (8.9 ± 8.9 vs. 7.4 ± 6.4) and a slightly higher percentage increase of BAR than men (6.90 vs. 5.26%). Smoking status significantly modified the associations between depressive symptoms and BAR. Among current smokers, mean absolute values of BAR significantly decreased as depressive symptoms increased after adjustment for age, gender, race/ethnicity, hypertension, and diabetes; the multivariate-adjusted p-values were 0.033 (absolute) and 0.040 (%). Associations between depressive symptoms and BAR were not statistically significant among former smokers or never smokers. Conclusion: Depressive symptoms were inversely associated with BAR among police officers who were current smokers and together may be considered a risk factor for cardiovascular disease among police officers. Further prospective research is warranted.

Objectives: To investigate the association between psychological distress and obesity among law enforcement officers (LEOs) in the United States. Methods: Self-reported data on psychological distress based on six key questions were obtained from LEOs who participated in the National Health Interview Survey (2004-2010). We used Prochaska's cut-point of a Kessler 6 score ≥ 5 for moderate/high mental distress in our analysis. Mean levels of body mass index (BMI) were compared across three levels of psychological distress. Results: The average age of LEOs (n = 929) was 39.3 years; 25% were female. Overall, 8.1% of LEOs had moderate or high psychological distress; 37.5% were obese (BMI ≥ 30). Mean BMI increased with increasing psychological distress (no distress, BMI = 27.2 kg/m 2 ; mild distress, 27.6 kg/m 2 ; and moderate/high distress, 33.1 kg/m 2 ; p = 0.016) after adjustment for age, race, income, and education level among female officers only. Physical activity modified the association between psychological distress and BMI but only among male LEOs (interaction p = 0.002). Among male LEOs reporting low physical activity, psychological distress was positively associated with BMI (30.3 kg/m 2 for no distress, 30.7 for mild distress, 31.8 for moderate/high distress; p = 0.179) after adjustment, but not significantly. This association was not significant among males reporting high physical activity. Conclusion: Mean BMI significantly increased as psychological distress increased among female LEOs. A longitudinal study design may reveal the directionality of this association as well as the potential role that physical activity might play in this association.

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 45 min 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.

Introduction: Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers. Methods: Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004–2012. Participants were categorized as normal weight (BMI: 18.5–24.9 kg/m2), overweight (BMI: 25.0–29.9), obese I (BMI: 30.0–34.9), and obese II (BMI: 35 +). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software. Results: During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000 ± 1.2), fingers (11.5 ± 1.3), and knees (7.1 ± 0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR = 1.25 (95% CI = 1.04–1.52); obese I: 1.41 (1.14–1.74); obese II: 1.68 (1.32–2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR = 1.48, (95% CI = 1.03–2.13); obese I: 1.70 (1.13–2.55); obese II: 2.91 (1.91–4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR = 1.73 (95% CI = 1.29–2.31); obese I: PR = 2.24 (1.64–3.06); obese II: PR = 2.95 (2.04–4.26)]. Conclusions: Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers. Practical applications: Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.

To investigate associations between shiftwork and diurnal salivary cortisol among 319 police officers (77.7% men).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).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.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.

OBJECTIVES: The aim of this study was to estimate prevalence of injury by occupation and industry and obesity's role. METHODS: Self-reported injuries were collected annually for US workers during 2004 to 2013. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were obtained from fitted logistic regression models. RESULTS: Overall weighted injury prevalence during the previous three months was 77 per 10,000 workers. Age-adjusted injury prevalence was greatest for Construction and Extraction workers (169.7/10,000) followed by Production (160.6) among occupations, while workers in the Construction industry sector (147.9) had the highest injury prevalence followed by the Agriculture/Forestry/Fishing/Mining/Utilities sector (122.1). Overweight and obese workers were 26% to 45% more likely to experience injuries than normal-weight workers. CONCLUSION: The prevalence of injury, highest for Construction workers, gradually increased as body mass index levels increased in most occupational and industry groups. Language: en

To investigate the associations between long work hours and adiposity measures in police officers.Participants included 408 officers from the Buffalo Cardio-Metabolic Occupational Police Stress study who were examined between 2004 and 2009. Total work hours were abstracted from payroll records and questionnaires. Analysis of variance and covariance models were used.Among male officers who worked the midnight shift, mean values of waist circumference and body mass index increased with longer work hours after adjustment for age, physical activity, energy intake, sleep duration, smoking status, police rank, activities after work (eg, child/family care, sports), and household income. Adiposity measures were not associated with work hours among women on any shift.Working longer hours was significantly associated with larger waist circumferences and higher body mass index among male police officers working the midnight shift.

Long working hours may be associated with cardiovascular disease (CVD). The objective was to investigate cross-sectional associations of work hours with carotid intima-media thickness (CIMT) and ankle-brachial index (ABI).Participants were 1694 women and 1868 men from the Multi-Ethnic Study of Atherosclerosis. CIMT and ABI were measured using standard protocols. Information on work hours was obtained from questionnaires. Mean values of CIMT and ABI were examined across five categories of hours worked per week (≤20, 21-39, 40, 41-50 and50) using analysis of variance/analysis of covariance. p Values for trend were obtained from linear regression models.Mean age of participants was 56.9±8.4 years; 52.4% were men. Distinct patterns of association between work hours and the subclinical CVD biomarkers were found for women and men, although this heterogeneity by gender was not statistically significant. Among women only, work hours were positively associated with common (but not internal) CIMT (p=0.073) after full risk factor adjustment. Compared with women working 40 h, those working50 h were more likely to have an ABI1 (vs 1-1.4) (OR=1.85, 95% CI 1.01 to 3.38). In men, work hours and ABI were inversely associated (p=0.046). There was some evidence that the association between work hours and ABI was modified by occupational category (interaction p=0.061). Among persons classified as management/professionals, longer work hours was associated with lower ABI (p=0.015). No significant associations were observed among other occupational groups.Working longer hours may be associated with subclinical CVD. These associations should be investigated using longitudinal studies.

Glioblastoma multiforme (GBM) is the most common adult primary malignant brain tumor. Ninety percent of adult GBM patients die within 24 months after diagnosis. The etiology of GBM is unknown. The Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS) are prospective, cohort studies of cardiovascular and neurodegenerative disease based on 8,006 Japanese-American men followed since 1965. The Japan Hawaii Cancer Study provides data on incident cancer cases in the HHP/HAAS cohort. We used data from these studies to obtain epidemiologic information about GBM. GBM cases were identified by searching the 1965-1998 databases using International Classification of Diseases (ICD-9) codes. Nine histologically confirmed GBM cases, 58-80 years old, were identified. The incidence rate was 6.2/100,000 person-years. Records of each case were reviewed. Selected variables from the first three examinations (1965-1968; 1968-1970; 1971-1974) were used to identify potential candidate GBM risk factors. A multivariate Cox proportional hazards model showed sugar intake and occupational exposure to carbon tetrachloride were independently and significantly associated with development of GBM.

Objectives: The body mass index (BMI), a ratio of weight/height2, dominates estimation of adiposity in population studies. BMI, however, does not distinguish among fat, muscle, or bone mass. Accordingly, its usage to assess and manage obesity in the population is limited. This study compares the use of BMI with direct measures of fat- and lean-mass to predict established cardiovascular and diabetes risk factors: blood pressure, lipids, and glucose. Methods: The entire Buffalo Police Department was the object of recruitment to a baseline study of physiological and psychological stress. Four hundred nine officers constitute the sample for this analysis. Regression methods focusing on explained variance in blood pressure, high density lipoprotein (HDL) cholesterol, and blood glucose compare the use of BMI to that of fat- and lean-mass indexes derived from dual energy X-ray absorptiometry (DEXA). Results: DEXA indexes explain 1.6%–3.3% (P < 0.05, all risk factors) more variance than BMI. Fat mass drives the association for blood pressure, trunk lean mass for HDL cholesterol, and both for blood glucose. High degrees of multicollinearity complicate interpretation of predictive models jointly containing BMI and DEXA indexes. Conclusions: In police officers, DEXA indexes are better predictors of cardiovascular disease and diabetes risk factors. However, populations with different distributions of fitness, diet, and health conditions may demonstrate differentfeatures. In contrast to BMI, DEXA-derived measurements suggest avenues to explore metabolic processes, which relate to an index's underlying association with risk and may suggest more effective intervention strategies. © 2012 Wiley Periodicals, Inc.

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.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.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 (P0.0001).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.

Police work is a high stress occupation and stress has been implicated in work absence. The present study examined (1) associations between specific types of police stress and work absences, (2) distinctions between “voluntary” (1-day) and “involuntary” (> 3-days) absences; and (3) the modifying effect of resiliency. Officers (n=337) from the Buffalo Cardio-Metabolic Occupational Police Stress study were included in the present study. The sample was 72% male, 77% Caucasian, 73% married, and 75% patrol officers. Mean age was 41 years (SD=6.4). Measures included: the Spielberger Police Stress Survey, 1-year payroll absence data, and the Dispositional Resilience Scale. The negative binomial regression was used to estimate rate ratios (RR) of 1-day and >3-days work absences for increasing stress scores. Models were adjusted for age, race/ethnicity, rank, smoking status, alcohol intake, and sleep duration. For one-unit increase in stress scores, the covariate adjusted RRs for one-day work absences were: total stress score (RR=1.19, 95% CI: 1.04–1.36); administrative stress (RR=1.52, 95% CI: 1.05–2.18); physical/psychological stress (RR=1.54, 95% CI: 1.14–2.07); and lack of support (RR=1.75, 95% CI: 1.01–3.05). Results suggest that officers were more likely to take voluntary 1-day absences due to specific types of stress at work. When the entire sample was considered, there was no significant association between police specific stress and episodes of work absence lasting at least three consecutive days. Hardy individuals, including those with high scores on the challenge sub-score, may use 1-day absences as a positive coping strategy.

The authors conducted a retrospective cohort mortality study on police officers from 1950-2005.Standardized Mortality Ratio (SMR) analyses were conducted separately for white male (n=2761), black (n=286), and female (n=259) officers.Mortality from all causes of death combined for white male officers was significantly higher than expected (SMR=1.20; 95% confidence interval (CI) =1.14-1.26). Increased mortality was also seen for all malignant neoplasms combined (SMR=1.32; 1.19-1.46), all benign neoplasms combined (SMR=2.50; 1.08-4.93), and all diseases of the circulatory system combined (SMR=1.11; 1.02-1.19). The elevated mortality for all malignant neoplasms was primarily due to statistically significant excesses in cancers of the esophagus, colon, respiratory system, Hodgkin's disease and leukemia. Black officers had lower than expected mortality from all causes (SMR=0.45; 0.18-0.92) while female officers had elevated all-cause mortality (SMR=2.17; 1.12-3.79).Findings of increased risk for malignant neoplasms should be replicated and studied in relation to measured risk factors.

The purpose of this work is to examine the relationship between alcohol use and level of involvement during Hurricane Katrina among law enforcement officers, and to investigate whether marital status or previous military training offer resilience against negative outcomes. Officers in the immediate New Orleans geographic area completed surveys that assessed their involvement in Hurricane Katrina and alcohol use (Alcohol Use and Disorders Identification Test (AUDIT) score). Negative binomial regression models were used to analyze level of hazardous alcohol use; interactions were tested to examine protective influences of marriage and prior military training (controlling for age and gender). There was a significant association between heavy involvement in Hurricane Katrina and having a greater AUDIT score (exp(β)[EB]=1.81; 95% CI: 1.03, 3.17; p0.05). These results illustrate an association between law enforcement officers' heavy involvement during Hurricane Katrina and greater levels of hazardous alcohol use when compared to officers with low or moderate involvement. This has important treatment implications for those with high involvement in disasters as they may require targeted interventions to overcome the stress of such experiences.