What is the focus of your research? What questions are you trying to answer? What problems are you attempting to solve?

The focus of my research includes cardiovascular disease (CVD) risk factors and morbidity in law enforcement officers. CVD is a serious public health issue and rates of CVD in this profession are frequently higher than that found in the general population. Law enforcement is unique regarding the frequency and type of critical incident and organizational stressors that agency members encounter consistently throughout their careers.

While my program of research began by employing primarily surveillance methods to study CVD risk and morbidity in police, the work has progressed to a mixed methods approach. Over the last 14 years, numerous interviews and focus groups have been analyzed to glean the perspectives of the target population regarding their views about issues that may impact health. Currently, my research includes more than 15 police agencies in the Midwest as well as a Pacific Islander population. 

Sophisticated measurement of stress mediators in police including cortisol, inflammatory marker C-reactive protein and pro- and anti-atherogenic inflammatory markers and determination of how various occupation-related stressors correlate with differences in these markers is facilitated by triangulation of data from many sources. Direct measurement of physical activity beyond self-report, e.g., energy expenditure, step counts and metabolic equivalents at work and on leisure days in police has contributed to better understanding of the types of activities innate in police work.

Even after 30 years of research in police, the problem remains that while we know traditional risk factors explain a portion of the increased morbidity from CVD in this profession; these factors alone do not fully explain why CVD manifests in police more often than counterparts in the general population. To this end, the study of sleep, depression, vital exhaustion and other understudied modifiable risk factors and their association with chronic diseases like CVD will likely inform interventions to increase the resilience of police in their personal and work lives throughout their careers.

What led to your interest in this topic?  

I began my career in nursing as a staff nurse in a large metropolitan coronary care unit (CCU). I was intrigued by the clients who returned to the CCU with exacerbated CVD despite cardiac rehabilitation programs and surgical intervention. I wanted to help people reduce the risk of CVD before chronic disease manifested. I experienced the indirect effects of CVD personally when my father had his first myocardial infarction before the age of 50; eventually CVD lead to his demise. This event further impacted my passion to help those at highest risk. Later, while pursing doctoral study, I became acquainted with an exercise physiologist at Iowa State University who studied CVD and risk in the Iowa State Patrol. Subsequently, my dissertation became one of the largest studies ever conducted in law enforcement, querying more than 4,000 officers in 15 State Departments of Public Safety. This initial work supported that the best predictor variables for CVD were perceived stress, time in the profession, and hypertension. Results of subsequent studies suggested officers with common CVD risk factors are also at an increased risk for nephrolithiasis and Native American police have a disproportionately higher prevalence of nephrolithiasis than do other ethnic groups. Also of concern is the finding that police retirees have almost three times higher prevalence of some risk factors than those of the same age in the general population.

What impact (on citizens, practice environment, educational opportunities, funding, etc.) do you predict coming from this research?

Heart disease is the number one killer of adults in our society. The long term goal of this work is to improve the health of police through development of effective interventions that decrease CVD risk and morbidity in law enforcement. The first step toward this end is already in place. Several large metropolitan police departments include my research in the annual in-service training sessions attended by all officers. This has proven to be an excellent opportunity to educate officers about the risk factors of CVD and increase awareness of specific risk factors that are prevalent in the profession. An example of how this opportunity is utilized is that recently, a large group of officers was queried as to how they would like to receive health information and what activities they would be most likely to engage in to improve their health. 

It is now recognized that the way police react to these stressors can be altered. While many of the sources of stress police encounter cannot be changed, empowering officers to modify psychological and physiological reactions to stress may reduce other risk factors, including overweight and obesity, blood pressure and cholesterol levels as well as improve recovery time after a stressful event. Improving the resilience of police may result in improvements in the officers overall health. A study funded for my research team is currently underway to evaluate the feasibility of an intervention employing:

• an education component
• bio-monitoring of heart rate via a small hand-held device
• measurement of heart rate variability in a large Midwestern police department

How does the research integrate into education/practice/service?

Society will be interested in this research for several reasons. More than 80,000 police agencies protect and serve communities in the United States. The number of officers employed by these agencies exceeds 700,000. Because of the general prevalence of CVD, almost everyone knows someone who has been affected by this disease. What the general public may not realize is that police work in the public domain and therefore their salaries, health care costs and benefits are supported with tax dollars. In the present economy with police departments and communities experiencing budget cuts, loss of officer positions and the expectation to do more with less, it makes perfect sense to keep officers healthy as they work longer into their careers. In the future, this work conducted in law enforcement may be utilized to help those employed in other high stress occupations.

For more Iowa Investigator features, click here [1]