Sleep Quality and Dietary Patterns in an Occupational Cohort of Police Officers

We examined the association between self-reported sleep quality, sleep duration, and dietary patterns among police officers in the Buffalo Cardio-Metabolic Occupational Stress (BCOPS) study.422 police officers aged 21-74 (2004-2009).We used a cross-sectional study design and obtained sleep quality and duration from responses to the 19-item Pittsburgh Sleep Quality Index. Using 46 energy-adjusted food groups derived from a 125-item food frequency questionnaire, we identified dietary patterns using exploratory factor analysis. Multiple linear regression analysis was used to examine the associations of sleep quality and duration with the derived dietary patterns.We identified major dietary patterns: fruits and vegetables (FV), dairy products, starches and fried foods, and meat and eggs. Individuals with poor sleep quality had a lower average FV score than those with optimal sleep (β [SE] = -0.32 [0.13]; p = .01). Significant interactions were observed between sex and the FV and dairy products dietary patterns, where women with poor sleep quality had a lower mean FV score compared to women with optimal sleep quality (β [SE] = -0.81 [0.29]; p = .01). Women with < 6 hours sleep duration had a lower mean dairy score compared to women with ≥ 7 hours sleep duration (β [SE] = -0.69 [0.29]; p = .02). We did not observe these associations among men.Among women, good sleep quality and long sleep duration were associated with a dietary pattern high in consumption of both fruits and vegetables and dairy products.Abbreviations: BCOPS: Buffalo Cardio-Metabolic Occupational Stress study; BMI: body mass index; FFQ: food frequency questionnaire; FV: fruits and vegetables; KMO: Kaiser-Meyer-Olkin test; MET: metabolic equivalent of task score; PSQI: Pittsburgh Sleep Quality Index questionnaire.

Associations of adverse childhood experiences (ACEs) with sleep duration and quality: the BCOPS study

BACKGROUND

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

METHODS

ACEs (independent variable) was assessed using the ACE questionnaire. Sleep measures were assessed using the Pittsburgh Sleep Quality Index and actigraphy. ANOVA/ANCOVA were used to investigate associations between ACEs and sleep measures.

RESULTS

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

CONCLUSION

Exposure to ≥1 ACE was associated with worse sleep measures.

Adverse childhood experiences and police mental health

Purpose –

The purpose of this study is to examine cross-sectional associations between adverse childhood experiences (ACEs) and mental health among police officers.

Design/methodology/approach –

The sample was from the Buffalo Cardio-Metabolic Occupational Police Stress study data (132 male and 51 female officers). Standardized surveys were administered to participants. Regression coefficients were obtained from models adjusted for age, sex, race and alcohol intake. All statistical tests were performed using a statistical significance level at p < 0.05.

Findings –

Regression analyses showed significant positive associations between ACEs and mental health (Posttraumatic Stress Disorder [PTSD]: β = 1.70, p < 0.001 and depressive symptoms: β = 1.29, p < 0.001). Resiliency significantly modified the association between ACEs and PTSD. A positive and significant association was observed among officers with lower resiliency (β = 2.65, p < 0.001). The association between ACEs and PTSD was stronger among male officers compared to females (β = 2.66, p < 0.001 vs. β = 0.59, p ≤ 0.248, respectively).

Research limitations/implications –

Child abuse and development of PTSD or depression could not be traced through time as this was a cross-sectional study. Recall bias may affect results.

Practical implications –

PTSD and depression associated with ACEs can affect the interpretation of threat and can exacerbate emotional regulation in officers. An inquiry should be expanded regarding work assignments of victimized officers, such as child exploitation and pornography investigation.

Originality/value –

There are few studies on ACEs and the mental health of police officers. The present study is among the first to associate multiple police mental health issues with ACEs.

Effects of E-Cigarette Flavoring Chemicals on Human Macrophages and Bronchial Epithelial Cells

E-cigarettes utilize a wide range of flavoring chemicals with respiratory health effects that are not well understood. In this study, we used pulmonary-associated cell lines to assess the in vitro cytotoxic effects of 30 flavoring chemicals. Human bronchial epithelial cells (BEAS-2B) and both naïve and activated macrophages (THP-1) were treated with 10, 100, and 1000 µM of flavoring chemicals and analyzed for changes in viability, cell membrane damage, reactive oxygen species (ROS) production, and inflammatory cytokine release. Viability was unaffected for all chemicals at the 10 and 100 µM concentrations. At 1000 µM, the greatest reductions in viability were seen with decanal, hexanal, nonanal, cinnamaldehyde, eugenol, vanillin, alpha-pinene, and limonene. High amounts of ROS were elicited by vanillin, ethyl maltol, and the diketones (2,3-pentanedione, 2,3-heptanedione, and 2,3-hexanedione) from both cell lines. Naïve THP-1 cells produced significantly elevated levels of IL-1β, IL-8, and TNF-α when exposed to ethyl maltol and hexanal. Activated THP-1 cells released increased IL-1β and TNF-α when exposed to ethyl maltol, but many flavoring chemicals had an apparent suppressive effect on inflammatory cytokines released by activated macrophages, some with varying degrees of accompanying cytotoxicity. The diketones, L-carvone, and linalool suppressed cytokine release in the absence of cytotoxicity. These findings provide insight into lung cell cytotoxicity and inflammatory cytokine release in response to flavorings commonly used in e-cigarettes.

Associations of burnout with awakening and diurnal cortisol among police officers

The aim of this cross-sectional study was to assess the associations of burnout with cortisol parameters in 197 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (2010–2014). The Maslach Burnout Inventory-General Survey assessed depersonalization, exhaustion, and professional efficacy. Officers provided salivary cortisol samples collected upon awakening, and 15, 30, and 45 ​min thereafter as well as three additional samples at lunchtime, dinnertime, and bedtime. Total area under the curve with respect to increase (AUCW_I for waking and AUCD_I for diurnal), total area under the curve with respect to ground (AUCW_G for waking and AUCD_G for diurnal), and diurnal slope were determined and used in this study. Unadjusted and adjusted (age, sex, and race/ethnicity) associations were examined using linear regression. The mean age of the officers was 48 years and 72% were males. The depersonalization component of burnout was negatively associated with AUCD_G (β ​= ​−108.4; p ​= ​0.036). Similarly, as exhaustion increased, AUCW_I (β ​= ​−9.58, p ​= ​0.038), AUCD_G (β ​= ​−114.7, p ​= ​0.029) and the diurnal slope (β ​= ​−0.000038; p ​= ​0.017) decreased. The Professional efficacy was not associated with any of the cortisol parameters. These results suggest that certain characteristics of burnout may be associated with diminished cortisol secretion in this group of urban police officers. Our findings add to previous studies examining associations of burnout with the cortisol awakening response. Future longitudinal studies are needed to evaluate the temporal relationship between burnout and these cortisol parameters.

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Burnout component scores and cortisol parameter values did not differ significantly between male and female officers.

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Adjusted models demonstrated significant negative associations between the burnout components and cortisol parameters.

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As depersonalization increased, AUCD_G decreased.

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As exhaustion increased, AUCW_I, AUCD_G, and the diurnal slope decreased.

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Professional efficacy was not associated with either AUCW_I or AUCD_G.

Efficacy of an ambulance ventilation system in reducing EMS worker exposure to airborne particles from a patient cough aerosol simulator

The protection of emergency medical service (EMS) workers from airborne disease transmission is important during routine transport of patients with infectious respiratory illnesses and would be critical during a pandemic of a disease such as influenza. However, few studies have examined the effectiveness of ambulance ventilation systems at reducing EMS worker exposure to airborne particles (aerosols). In our study, a cough aerosol simulator mimicking a coughing patient with an infectious respiratory illness was placed on a patient cot in an ambulance. The concentration and dispersion of cough aerosol particles were measured for 15 min at locations corresponding to likely positions of an EMS worker treating the patient. Experiments were performed with the patient cot at an angle of 0° (horizontal), 30°, and 60°, and with the ambulance ventilation system set to 0, 5, and 12 air changes/hour (ACH). Our results showed that increasing the air change rate significantly reduced the airborne particle concentration (p < 0.001). Increasing the air change rate from 0 to 5 ACH reduced the mean aerosol concentration by 34% (SD = 19%) overall, while increasing it from 0 to 12 ACH reduced the concentration by 68% (SD = 9%). Changing the cot angle also affected the concentration (p < 0.001), but the effect was more modest, especially at 5 and 12 ACH. Contrary to our expectations, the aerosol concentrations at the different worker positions were not significantly different (p < 0.556). Flow visualization experiments showed that the ventilation system created a recirculation pattern which helped disperse the aerosol particles throughout the compartment, reducing the effectiveness of the system. Our findings indicate that the ambulance ventilation system reduced but did not eliminate worker exposure to infectious aerosol particles. Aerosol exposures were not significantly different at different locations within the compartment, including locations behind and beside the patient. Improved ventilation system designs with smoother and more unidirectional airflows could provide better worker protection.

Police stress and depressive symptoms: role of coping and hardiness

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.

Shiftwork and Biomarkers of Subclinical Cardiovascular Disease: The BCOPS Study

OBJECTIVE

To assess the association of shiftwork 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 shiftworkers for leukocytes, tumor necrosis factor alpha, and homocysteine. After BMI stratification, higher c-reactive protein (CRP) levels were observed among evening shiftworkers with a BMI more than or equal to 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 shiftwork.

Influence of Work Characteristics on the Association Between Police Stress and Sleep Quality

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 (β = 0.17, p = 0.002). Only workload significantly modified this association (β = 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 (β = 0.13, p = 0.025). Only police rank significantly modified the association (β = 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.

Effort-Reward Imbalance and Overcommitment at Work: Associations With Police Burnout

The present study examined associations of effort-reward imbalance (ERI) and over-commitment at work with burnout among police officers using data from 200 (mean age = 46 years, 29% women) officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress Study. ERI and overcommitment were assessed using Siegrist's "effort/reward" questionnaire. The Maslach Burnout Inventory-General Survey was used to assess burnout and its three subscales (exhaustion, cynicism, and professional efficacy). Analysis of covariance was used to examine mean values of burnout scores across quartiles of ERI and overcommitment. Linear regression was used to test for linear trend. ERI and overcommitment were positively and significantly associated with cynicism and exhaustion (trend p value < .001), while professional efficacy showed an inverse association with overcommitment (p = .026). Cynicism and exhaustion scores were significantly higher in officers who reported both overcommitment and ERI compared with their counterparts (p < .001). The results suggest that ERI and overcommitment at work are determinants of higher cynicism and exhaustion. The inverse association of overcommitment with professional efficacy (an indicator of engagement at work) suggests that extreme involvement in work may negatively affect efficacy. Overcommitment may be related to a need for approval and inability of officers to withdraw from work, even in an off-duty status. Police agencies should consider organizational remedies to maintain acceptable levels of commitment by officers. In addition, there is a need to monitor and improve effort-reward imbalance experienced by officers.

Associations Between Police Work Stressors and Posttraumatic Stress Disorder Symptoms: Examining the Moderating Effects of Coping

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 <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 < 0.001; higher active coping, B = 3.33, p <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.

Effort-reward imbalance in police work: associations with the cortisol awakening response

PURPOSE

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

METHODS

176 police officers participated from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. ERI was the exposure variable. Outcome variables were saliva-based peak and mean cortisol values, total area under the curve ground (AUCG) and baseline (AUCI); linear regression line fitted to log-transformed cortisol. Regression analyses were used to examine linear trend between ERI and cortisol parameters. Repeated measures analysis examined whether the pattern of cortisol over time differed between low ERI (< median) and high ERI (≥ median).

RESULTS

Mean age was 46 years (SD = 6.6). After adjustment for potential confounders, there was a significant inverse association between ERI and peak cortisol (β = - 0.20, p = 0.009), average cortisol (β = - 0.23, p = 0.003), and total area under the curve (β = - 0.21, p = 0.009). ERI was not significantly associated with AUCI (β = - 0.11, p = 0.214); slope of the regression line fitted to the cortisol profile (β = - 0.009, p = 0.908). Repeated measures analyses showed that the cortisol pattern did not vary significantly between high and low ERI using the median as a cut point (interaction p value = 0.790).

CONCLUSIONS

ERI was inversely associated with the magnitude of awakening cortisol over time, indicating HPA axis dysregulation and potential future health outcomes.

Stressful life events and posttraumatic growth among police officers: A cross-sectional study

Police officers often continue to face numerous threats and stressors in the aftermath of a disaster. To date, posttraumatic growth (PTG) has been studied primarily in the context of significant trauma; thus, it is not known whether stressful life events are associated with PTG. This study investigated the development of PTG among 113 police officers working in the New Orleans area following Hurricane Katrina. Hierarchical regression was used to evaluate if gratitude, social support, and satisfaction with life moderated the relationship between stressful life events (as measured by the total life stress score) and PTG, after adjustment for age, sex, race, level of involvement in Hurricane Katrina, and alcohol intake. Results indicate that stressful life events are independently associated with PTG. Gratitude, satisfaction with life, and social support were seen to moderate this relationship; as stressful life events increased so too did PTG-particularly among officers with higher levels of gratitude (B = 0.002, p ≤ .05), satisfaction with life (B = 0.002, p ≤ .05), and social support (B = 0.001, p ≤ .05). These findings suggest that promoting satisfaction with life, interpersonal support, and gratitude may be beneficial to those who are regularly at risk of trauma exposure.

Social avoidance in policing: Associations with cardiovascular disease and the role of social support

PURPOSE

The purpose of this paper is to examine the association of social avoidance among police, cardiovascular disease (CVD) (metabolic syndrome (MetSyn)), and social support.

DESIGN/METHODOLOGY/APPROACH

Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress study (n = 289). Social avoidance (defined as the tendency to avoid social contact) and other subscales from the Cook-Medley Hostility Scale were analyzed. The mean number of MetSyn components across tertiles of the Cook-Medley scales was computed using analysis of variance and analysis of covariance. Social support was measured with the Social Provisions Scale, categorized as high or low based on the median.

FINDINGS

The mean number of MetSyn components increased significantly across tertiles of social avoidance (1.51 ± 0.18, 1.52 ± 0.12, and 1.81 ± 0.12); the only Cook-Medley subscale that remained significantly associated with MetSyn following adjustment for age and gender. Participants high in social avoidance reported significantly lower social support (79.9 ± 8.5 vs 85.8 ± 8.6; p = 0.001).

RESEARCH LIMITATIONS/IMPLICATIONS

The study is cross-sectional and therefore precludes causality. The authors were unable to determine the direction of associations between social avoidance and MetSyn. The measure of social support was unidimensional, including only perceived support; additional types of social support measures would be helpful.

PRACTICAL IMPLICATIONS

This study suggests that occupational-based police social isolation is associated with health outcomes and lower support. Several suggestions are made which will help to improve communication between the police and public. Examples are the use of social media, training in communication techniques, and changing the police role to one of public guardians.

ORIGINALITY/VALUE

Social avoidance is the least studied the Cook-Medley subscale associated with CVD. It is important for the health of officers to maintain a social connection with others.

Police work stressors and cardiac vagal control

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 β = -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.

Police work stressors and cardiac vagal control

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 β = -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.

Law Enforcement Officers' Involvement Level in Hurricane Katrina and Alcohol Use

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; p<0.05), indicating higher levels of hazardous alcohol use. Contrary to original hypotheses, marital status and military training were not protective against alcohol use (p>0.05). 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.

Correlates of hopelessness in the high suicide risk police occupation

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.

Positive Psychological Factors are Associated with Lower PTSD Symptoms among Police Officers: Post Hurricane Katrina

Following Hurricane Katrina, police officers in the New Orleans geographic area faced a number of challenges. This cross-sectional study examined the association between resilience, satisfaction with life, gratitude, posttraumatic growth, and symptoms of posttraumatic stress disorder in 84 male and 30 female police officers from Louisiana. Protective factors were measured using the Connor-Davidson Resilience scale, Satisfaction with Life Scale, the Gratitude Questionnaire, and the Posttraumatic Growth inventory. Symptoms of posttraumatic stress disorder were measured using the Posttraumatic Stress Disorder Checklist--Civilian (PCL-C). Potential associations were measured using linear regression and analysis of variance. Models were adjusted for age, sex, race, education, and alcohol. Mean PCL-C symptoms were 29.5 ± 14.5 for females and 27.8 ± 12.1 for males. Adjusted mean levels of PCL-C symptoms significantly decreased as quartiles of resilience (p < .001), satisfaction with life (p < .001), and gratitude (p < .001) increased. In contrast, PCL-C symptoms were not associated with posttraumatic growth in this sample. These results indicate that positive factors such as resilience, satisfaction with life, and gratitude may help mitigate symptoms of posttraumatic stress disorder. To further explore these relationships, longitudinal follow-up in a larger population would be of interest.

Association Between Police-Specific Stressors and Sleep Quality: Influence of Coping and Depressive Symptoms

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<0.005). The association with global sleep was significant for those who used more passive coping strategies (p<0.007). The association with sleep disturbances was significant for those with higher levels of depressive symptoms (p<0.003) and passive coping (p<0.001). These findings demonstrate that different types of police stress may adversely affect sleep quality, and those who use passive coping strategies, such as self-blame or denial, and those with higher depressive symptoms may be more adversely affected by police stress.

Associations of objectively measured and self-reported sleep duration with carotid artery intima media thickness among police officers

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.

Associations between insulin and heart rate variability in police officers

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 (ms(2)) 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/m(2), with ≥ 25.5% body fat, and among those who reported low (<median) physical activity scores.

CONCLUSIONS

In this cohort, insulin levels were inversely and significantly associated with both HF and LF HRV, especially among those with higher levels of obesity and lower levels of physical activity, suggesting associations with autonomic nervous system function. Prospective studies of this association in other populations are warranted.

Parental occupational exposures and autism spectrum disorder

Both self-report and industrial hygienist (IH) assessed parental occupational information were used in this pilot study in which 174 families (93 children with ASD and 81 unaffected children) enrolled in the Childhood Autism Risks from Genetics and Environment study participated. IH results indicated exposures to lacquer, varnish, and xylene occurred more often in the parents of children with ASD compared to the parents of unaffected children. Parents of children with ASD were more likely to report exposures to asphalt and solvents compared to parents of unaffected children. This study was limited by the small sample size, but results suggest that workplace exposures to some chemicals may be important in the etiology of ASD and deserve further investigation.

Adiposity, muscle, and physical activity: predictors of perturbations in heart rate variability

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.

Military experience and levels of stress and coping in police officers

Policing is a stressful occupation and working in this environment may make officers more vulnerable to adverse psychological and physiological outcomes. The impact of prior military experience on work stress and coping strategies has not been well-studied in police. The purpose of this cross-sectional study was to examine differences in levels of police-related stress and coping in officers with and without military experience. Participants were 452 police officers from the Buffalo Cardio-metabolic Occupational Police Stress Study Officers were categorized into three groups: non-military (n = 334), non-combat military (n = 84), and military with combat (n = 34). Age, sex and education adjusted levels of psychological stress and coping measures were compared across the three groups using ANCOVA. P-values were derived from post-hoc comparisons. Non-military police officers had significantly higher stress levels for physically and psychological threatening events compared to non-combat officers (p = 0.019). Non-military officers also reported experiencing significantly more organizational stressors and physically and psychologically threatening events in the past year than combat and non-combat officers (p < 0.05). Combat officers had significantly lower levels of planning and active coping styles compared to non-combat officers (p = 0.026, p = 0.032, respectively) and non-military officers (p = 0.010, p = 0.005, respectively). In summary, police officers without military experience reported experiencing more organizational and life-threatening events than officers who served in the military. Yet combat officers were less likely to utilize positive coping than non-combat and non-military officers. These findings demonstrate the potential positive influence of military experience on police stress. Further research is needed as military veterans return to police work.

Associations between protective factors and psychological distress vary by gender: the Buffalo Cardio-Metabolic Occupational Police Stress Study

Previous research by this group identified gender interactions between some protective factors and psychological distress in police officers. This study extends this result to include a larger sample of police officers and a more comprehensive list of protective factors. These results confirm the conclusion that the commitment dimension of hardiness appears to have a stronger protective association with psychological distress among women. Furthermore, an avoidant coping style appears to be somewhat more positively associated with psychological distress among women. The personality trait of openness was also positively associated more strongly with PTSD symptoms in women than in men, while the trait of agreeableness was significantly protective in women and not in men. Hostility was generally positively associated with psychological distress with stronger association for PTSD symptoms and hostility in women.

Behind the blue shadow: a theoretical perspective for detecting police suicide

Police officers are at increased risk for suicide. Reluctance by this population to self-report suicidal thoughts requires detection on a different level. Based on existing theory, this paper discusses a possible alternative method for detecting suicidal tendencies among police officers: the suicide Implicit Association Test (IAT). The IAT measures the implicit strength of cognitive identification with death opposed to life. Previous work has demonstrated that a cognitive identification with death over life is associated with both suicide attempts and completions. The clinical application of implicit cognitions, along with other proven clinical measures, may be of value in detecting suicide ideation in police officers or other high suicide risk groups who are hesitant to explicitly report suicidal thoughts. More research is needed to help clarify the clinical usefulness of the IAT and its validity over time.

Police suicide in small departments: a comparative analysis

The majority of police suicide research has focused on larger police departments. Very little research has been done within small departments. The present study compared suicide rates between small and larger police departments. Two Hundred ninty-eight departments were drawn from the U.S. Public Safety Officer Benefits database totaling 119,624 officers. Annual suicide rates were calculated per 100,000 for each of four category (by size of department) and p-values from Chi-square tests were employed to assess differences in rates across categories. The annual suicide rate varied significantly across departments. Smaller police departments had a significantly higher suicide rate than large departments. Possible reasons include lack of availability for mental health assistance, increased workload and danger and community visibility.

C-reactive protein, interleukin-6, and posttraumatic stress disorder symptomology in urban police officers

Our aim was to examine the relationship between the level of the inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), and posttraumatic stress disorder (PTSD) symptomology in a random sample of 115 police officers. CRP was measured in citrated plasma using a particle enhanced immunonepholometric assay and IL-6 was measured in serum with a solid-phase quantitative sandwich ELISA. The presence of high PTSD symptomology was defined as having an Impact of Event Scale score (IES) of ≥ 26 compared to<26 (low PTSD symptomology). 28% of the officers had high PTSD symptomology. Mean levels of CRP and IL-6 did not differ significantly between officers with high PTSD symptomology and those with low symptomology (CRP: 0.76 mg/l vs. 0.97 mg/l; IL-6: 2.03 pg/ml vs. 1.74 pg/ml). We found no association of CRP and IL-6 levels with PTSD symptomology. This study was limited by sample size and its cross-sectional study design. A lack of association may occur if either CRP or IL-6 is elevated only at the onset of PTSD symptomology, or if inflammation is related to specific key components that define PTSD. Further research examining these relationships in a larger population may be worthwhile.

Association of perceived stress with sleep duration and sleep quality in police officers

The objective was to investigate associations ofperceived stress with sleep duration and quality among 430 police officers. Perceived stress was assessed using the perceived stress scale. Sleep duration and quality were assessed using the Pittsburg sleep quality index questionnaire. Mean hours of sleep were determined across quartiles of perceived stress using ANOVA/ANCOVA. Logistic regression was used to obtain odds ratios and 95% confidence intervals for poor sleep quality across perceived stress quartiles. Mean age was 42.1 years. Perceived stress was inversely associated with sleep duration among certain groups: men (p = 0.004), higher-ranked officers (p = 0.002), those with higher depressive symptoms (p 0.097), no military experience (p = 0.006), and higher workload (p = 0.003). Gender, police rank, depressive symptoms, and workload each significantly modified the association between stress and sleep duration. Prevalence of poor sleep quality increased with higher levels of perceived stress; the trend was significant among men only (p < 0.0001), and gender significantly modified this association (interaction p = 0.015). Compared to those in the first quartile of perceived stress, women in the fourth quartile were almost four times and men almost six times more likely to have poor sleep quality. Perceived stress was inversely associated with sleep duration and positively associated with poor sleep quality.

Association of sleep quality with depression in police officers

Poor sleep quality has been shown to adversely affect neurobehavior including an increase in depression symptoms. Police officers are at increased risk of poor sleep quality due to occupational factors. This study analyzed self-reported sleep and depression data from police officers; 391 police officers from Buffalo, New York reported on sleep and depression by completing the Pittsburgh Sleep Quality Index (PSQI) and the Center for Epidemiological Studies Depression (CES-D) questionnaires. Mean CES-D scores were assessed across quintiles of PSQI. As PSQI scores increased, reflecting poorer sleep quality, CES-D scores also increased significantly indicating an increase in depression symptoms as sleep quality worsens. This trend held for both male and female officers. Mean CES-D scores across quintiles ranged from 4.72 to 12.65 in men and from 5.53 to 12.63 in women. Multivariate adjustment only very slightly attenuated the association in female officers. After adjustmnent, five of the seven PSQI components showed statistically significant associations with CES-D scores in male officers and two in female officers. Sleep quality was significantly and independently associated with depressive symnptoms as evidenced by a trend of increasing depressive symptom scores with decreasing sleep quality in both male and female officers.

Atypical work hours and metabolic syndrome among police officers

This study examined whether atypical work hours are associated with metabolic syndrome among a random sample of 98 police officers. Shift work and overtime data from daily payroll records and reported sleep duration were obtained. Metabolic syndrome was defined as elevated waist circumference and triglycerides, low HDL cholesterol, hypertension, and glucose intolerance. Multivariate analysis of variance and analysis of covariance models were used for analyses. Officers working midnight shifts were on average younger and had a slightly higher mean number of metabolic syndrome components. Stratification on sleep duration and overtime revealed significant associations between midnight shifts and the mean number of metabolic syndrome components among officers with less sleep (p = .013) and more overtime (p = .007). Results suggest shorter sleep duration and more overtime combined with midnight shift work may be important contributors to the metabolic syndrome.

Shift-work and suicide ideation among police officers

BACKGROUND

This cross-sectional study assessed the association of shift work with suicide ideation among police officers.

METHODS

Shift work was based on daily payroll records over 5 years (41 women, 70 men). Standardized psychological measures were employed. ANOVA and Poisson regression were used to evaluate associations.

RESULTS

Among policewomen with increased depressive symptoms, prevalence of suicide ideation increased by 116% for every 10-unit increase in percentage of hours worked on day shift (prevalence ratio (PR) = 2.16; 95% confidence interval (CI) = 1.22-3.71). Among policemen with higher (but not lower) posttraumatic stress disorder (PTSD) symptoms, prevalence of suicide ideation increased by 13% with every 10-unit increase in the percentage of hours worked on afternoon shift (PR = 1.13; 95% CI = 1.00-1.22).

CONCLUSION

Prevalence of suicide ideation significantly increased among policewomen with higher depressive symptoms and increasing day shift hours, and among policemen with higher PTSD symptoms with increasing afternoon shift hours.

Dimensional analysis of actigraphic derived sleep data

Nonlinear dimensional analyses can be a useful tool in understanding the underlying behavior of dynamical systems, including biological systems. Many biological functions can be modeled as chaotic processes, including sleep. Sleep data can be obtained from several methods, such as electroencephalograms, polysomnography, and actigraph. Actigraphy, because of its low level of invasiveness, is an increasingly popular method of obtaining sleep data. This study analyzed actigraphy data with nonlinear dimensional analyses to determine if such analytic methods would be useful in sleep studies. Participants wore actigraphs on their wrists, which recorded movement for several days. Several sleep quality variables, such as movement during sleep and total sleep time, were derived from these sleep data. These variables were used to determine whether the quality of sleep was good or poor. Lagged phase space plots were graphed and nonlinear parameters for the fractal dimension and the correlation dimension were computed for each participant. Descriptive and inferential statistics were performed to determine if the nonlinear parameters showed significant differences with respect to sleep quality.

Police trauma and cardiovascular disease: association between PTSD symptoms and metabolic syndrome

Although prior evidence exists concerning the association between posttraumatic stress disorder (PTSD) and cardiovascular disease, few studies have examined associations of PTSD symptomatology and the metabolic syndrome in the high stress occupation of police work. The metabolic syndrome is a clustering of cardiovascular disease risk factors that have also been independently associated with psychological conditions. The aim of this study was to examine associations between the PTSD symptoms and metabolic syndrome in police officers. A stratified sample of 115 police officers was randomly selected from the Buffalo, NY Police Department. PTSD symptoms were measured with the Impact of Event scale (IES), divided into categories of subclinical, mild, moderate and severe symptom levels. The metabolic syndrome was considered present if three or more of its component parameters (obesity, elevated blood pressure, reduced high density lipoprotein (HDL) cholesterol, elevated triglycerides, and abnormal glucose levels) were present in each officer. Results indicated a significantly increased prevalence of the metabolic syndrome among those officers in the severe PTSD symptom category compared with the lowest PTSD severity category (prevalence ratio (PR) = 3.31, 95% C.I. = 1.19 - 9.22). Adjustment for age did not alter the association appreciably (PR = 3.12, 95% C.I. = 1.15 - 8.50). Adjustment for several demographic and lifestyle factors (age, education, smoking, alcohol intake) reduced the magnitude of the prevalence ratio slightly for the severe versus subclinical PTSD category (PR = 2.69, 95% C.I. = 0. 79 - 9.13), with adjustment for age and education accounting for most of the attenuation (PR = 2.71, 95% C.I. = 0.99 - 7.37). Thus, officers with severe PTSD symptoms were approximately three times more likely to have the metabolic syndrome and education may account for some of this association.