Officer Health July 2013 Voiceover: Beat Intro 00:00 This is the Beat—a podcast series that keeps you in the know about the latest community policing topics facing our nation. Mora Fiedler 00:08 Hello and welcome. My name is Mora Fiedler and on behalf of the COPS Office I’d like to introduce to you Dr. Sandra Ramey, assistant professor at the University of Iowa, who specializes in studying the prevalence and risk of morbidity from cardiovascular disease in law enforcement. Dr. Ramey has spent 14 years working with law enforcement agencies in studying and developing successful interventions to improve the health of those who work in high-stress environments. Dr. Ramey, can you please provide a brief background on the risk factors of cardiovascular disease? Dr. Sandra Ramey 00:46 Thank you, Mora. Traditional cardiovascular disease risk factors include diabetes, cholesterol— cholesterol has several components, but particularly when you have high low-density lipoprotein, that’s a risk factor. If your HDL—that’s the counterpart of that—is low, that’s a risk factor as well. Age is certainly a risk factor. High-blood pressure, smoking, overweight and obesity, and physical inactivity are among the others, and also familial history. Now we have some newer risk factors, according to the American Heart Association, that some of you may not know about. One of them is stress. The other is depression. There’s something called vital exhaustion. Vital exhaustion is when you become that deep fatigue where you feel demoralized and irritable, usually from exposure to chronic stress. The good news is that most of these risk factors are modifiable. There are some that aren’t—of course you can’t modify your age or your genetics—but the others you can pay attention to and do some things to reduce. Mora 01:47 Do these risk factors differ for law enforcement officers? If so, what is the difference in the general population and law enforcement? Sandra 01:55 They actually do differ, Mora. One thing law enforcement officers need to know is that when they have multiple risk factors present, the risk is actually magnified. That’s called metabolic syndrome— some people may have read about that. They also need to know that stress affects cardiovascular disease in two ways. First it directly affects the disease; it increases inflammatory markers and has direct effects on the workload of your heart. Also, it indirectly is related to disease because it increases your blood pressure, your cholesterol, and can cause physical inactivity. For law enforcement, most often what we see are increased cholesterol levels, hypertension, and overweight and obesity. Usually when we begin to do a health risk assessment in law enforcement agencies, what we usually see is higher prevalence of these risk factors when you compare with counterparts in the general population. However, one noteworthy thing is that, when it comes to looking at the actual presence of cardiovascular disease, we usually see equal or fewer cases in the working law enforcement officers. We believe that this is due to the Healthy Worker Effect. What that means is if officers become ill with CVD, they select out of the sample by taking disability, or dying, or retiring. To look at that, we looked at retirees in the Milwaukee Police Department, about 305 of them. What we found were the rates of these risk factors, once people entered retirement, were much higher for police than in the general population as the CVD morbidity was also increased in retirement. That leads us to think that either people don’t know they have heart disease, or they have self- selected out of the sample, or that the disease manifests in the retirement period. Mora 03:35 What are the specific cardiovascular risk factors for law enforcement? Sandra 03:40 I would say the biggest one and the most obvious one is stress, but not necessarily from the type of stress that you would expect. What officers have told me over the decades is that they expect when they entered the profession to be in traffic control, to be in horrendous situations, to see people at their worst, and their best, sometimes. But the organizational factors like shift work and the toll that less than six hours of sleep a night can take on them, and the excessive fatigue—mainly vital exhaustion, and excessive overtime—are things that they really didn’t expect and were not prepared for in the profession. We did a study recently with three police departments that showed that people that work a nine-day shift are 14 times more likely to sleep less than six hours. They also were two times more likely to have poor sleep, and this is also a risk factor for cardiovascular disease—if you get less than six hours sleep on a regular basis. The other thing that we see, specific to law enforcement, is obesity and overweight individuals. The prevalence of that is much higher than the general population. This can be related to emotional eating that comes with stress, but a cascade of events starts with obesity and overweight when you eat from emotional eating. Your blood pressure can go up when your weight goes up. You become more physically inactive. It kind of has a detrimental effect on officers. We also have looked at the fact that they are more physically inactive than other people in the general population. What we found recently too, by using actographs to measure physical activity, was that most officers expend more energy and go more steps and have a higher metabolic rate on their off days. Now that’s good news because we also know that if you exercise, even just on the weekend, you can almost cut your cardiovascular disease risk in half for that. Mora 05:28 What are effective strategies for reducing cardiovascular risk factors for law enforcement? Sandra 05:34 Well the first one is really very simple and I would just say, “just move.” Even when you exercise on the weekend, as I said, you can cut your risk in half. Even if you can just be aware of the fact that the profession is really primarily sedentary, and by that I mean with bursts of excessive energy but a lot of time sitting, filling out paperwork, time in a vehicle, or time at a desk. The next one is awareness. That’s a very powerful intervention that really doesn’t cost anything to execute. Officers need to know what they’re at risk for and be aware of what might happen and, most importantly, how you can modify your own stress. A lot of stressors that you come in contact with you can’t modify, but you can control how you react to stress. You also need to know that, although officers have this really high cholesterol prevalence that I talked about, at least half of those officers have not sought treatment for that. There are a lot of things you can do for your cholesterol level that don’t involve medication: exercise and diet. But if you have a positive familial history of high cholesterol, you probably should talk to your physician about possible medication. Mora 06:39 In closing, what recommendations would you give law enforcement in how to best support officers with cardiovascular risk factors or heart disease. Sandra 06:48 Well, the first one is also very easy and really doesn’t cost any money and that’s to increase the awareness. Begin in the academy and educate the officers about what they might expect from the profession, especially as far as the organizational stressors and the sleep issue and shift work. Stress management is also something that I believe should be taught at the academy, but also in- service time can be used to impart some of these things that we’re talking about. Mentorship with…Senior employees in the law enforcement agencies should fellow with younger officers, so that they can share their experiences and hopefully be able to recognize some of the signs of stress in younger officers. This will hopefully begin to change the culture in police agencies to one that’s more protective and values health and wellness. Everybody has to take responsibility for their own health. A good way to find out where an agency is is to do a simple health risk assessment, but most importantly—to give feedback to the officers about what this shows and increase awareness. Particularly academia is a good place to partner because that’s a win-win situation, because we can obtain grant money, we have the skills to know what to do with the data, and that’s a really nice relationship to develop if you really are serious about doing this. Most of all, you need to let the public know what you’re doing. Use any media that you can to make the public aware that you care about these issues and you’re trying to make them better. Mora 08:10 Thank you. Sandra 08:12 Thank you. Voiceover: Beat Exit 08:14 The Beat was brought to you by the United States Department of Justice COPS Office. The COPS Office helps to keep our nation’s communities safe by giving grants to law enforcement agencies, developing community policing publications, developing partnerships, and solving problems. Voiceover: Disclaimer 08:30 The opinions contained herein are those of the authors and do not necessarily represent the official position or polices of the U.S. Department of Justice. References to specific agencies, companies, products, or services should not be considered an endorsement by the authors or the U.S. Department of Justice. Rather, the references are illustrations to supplement discussion of the issues.