There are an estimated 623,000 sworn police officers employed in the United States, yet few studies of long term health risks have been conducted. It has been argued that police officers are at increased risk for mortality as a result of their occupation. The average age of death for police officer in our 40-year study was 66 years of age.

Our findings provide some insight on associations between police work and long term disease outcome. The police profession is portrayed as a job replete with psychological stress, danger, rotating shifts, family disruption, and exposure to noxious materials. Studies have suggested that the high psychological stress of police work may be one factor which plays a role in the etiology of disease. Some of our findings may hold true within the context of the stress-disease hypothesis. For example, younger officers under conditions of high stress and other risk factors may be at higher risk for arteriosclerotic heart disease.

Psychological stress may also be a catalyst for malignancy at selected sites. Stress is believed to be mediated immunologically and may lead to the onset of cancer. Our findings indicated a ,significantly elevated mortality risk for all malignant neoplasms in police officers. Specifically, we found a significantly increased risk of all digestive and hematopoietic cancers among officers employed 10-19 years. These findings are consistent with other studies of police mortality and with the hypotheses of a stress-cancer relationship. Interestingly, our previous research found that police officers between 10-19 years of service reported the highest stress scores.

Stress in police work may also lead to maladaptive behaviors which, it turn, may precipitate disease. Alcohol and tobacco use are examples. Twenty-five percent of police officers have been found to be dependent on alcohol, and a significantly strong positive relationship was found between stress and alcohol use among police. Alcohol is an important problem in police work, and may lead to other work problems such as high absenteeism, intoxication on duty, complaints by supervisors and citizens of misconduct on duty, traffic accidents, and an overall decrease in work performance. Alcohol use among police may be underestimated. Many officers, fearing departmental discipline, are unwilling to officially report their dependence. Other departments may "hide" problem drinkers in positions where they will not adversely affect police operations. In addition, approximately 40% of police officers smoke cigarettes. Our present findings indicated that officers have a significantly high mortality risk for esophageal cancer, which has been related to alcohol use and smoking. Also evident in our cohort was the significantly elevated risk of cirrhosis of the liver among officers, a disease which has been related to alcohol use. With the exception of 1-9 years of police service, cirrhosis of the liver was elevated across all years of service categories and had a 3.3-fold mortality risk for officers with over 30 years service.

Suicide is a disturbing maladaptive behavior which may be related to stress. The significantly high suicide risk among police officers in our study denotes the possibility that chronic job stress may lead to emotional numbing in officers and make death easier to accept as a coping solution. Other epidemiological studies which include police also point to a higher risk of suicide for officers. Several population studies have reported police suicide rates to be higher than other occupations. Another reason for the high suicide rate may be the availability and knowledge of firearms. Approximately 95% of all police suicide involve the use of a firearm. The police have a higher rate of firearm suicide than other groups who work with firearms. The military is one example. Although the most common method of suicide in the military is by firearm, approximately 59% of military personnel suicides compared to 95% of police officer suicides used a firearm. The police also have a higher rate of suicide by firearms than persons who possess guns in their home, where approximately 58% of all suicides were committed with a firearm. Alcohol use has also been found to be a factor in suicide, and police use of alcohol may be precipitated by stress. A Chicago police department study documented alcohol abuse in 60% of police officer suicides.

Psychological stress and its consequences may interact with other factors in police work. Shift work is one example. Since the early 1900’s, Buffalo police officers have engaged in a practice called "doubling back", in which officers work 16 hour shifts within a 24 hour period. Many officers then engage in extra jobs during their off-duty time. Such a rapid disruption of the Circadian cycle may add to the risk of arteriosclerotic heart disease risk in younger officers. In addition, there is significant inter-individual variation in the ability to adapt and deterioration with increasing age. Previous work has shown a relationship between shift work and heart disease.

Shift work may also affect officer’s dietary and exercise habits. The general nutrition of police officers in poor, lacking many of the nutrients found in fruits and vegetables. Officers have a tendency to consume high-fat "fast food" meals, and generally eat them unscheduled, sometimes between high stress police calls. During shifts, officers may not eat at all or eat at takeout restaurants. The lack of meaningful exercise is evident among police officers , and they have been found to have a high prevalence of arteriosclerotic heart disease risk due to poor physical fitness. In one study, 76% of officers had elevated cholesterol, 26% had elevated triglycerides, and 60% had elevated body fat. Other studies have shown that only police officers who exercised regularly had a lower 10-year risk of heart disease and were absent less from work. The present findings of significantly elevated colon cancer risk may also be the result of a complex interaction of stress, shift work, lack of exercise and poor dietary habits.

Our present findings of increased risk of lymphatic and hematopoietic cancers , especially Hodgkin’s disease and leukemia, suggest additional risk factors in police work. Psychological stress has been suggested as a risk factor in hematopoietic cancer , as well as exposure to chemical substances in the workplace. A study of Hodgkin’s disease in the U.S. Navy consisting of 2.3 million person-years reported that probable exposure to solvents and ionizing radiation may increase risk. Leukemia mortality risk has also been associated with occupational exposures to diesel fuels, benzene, and lead. Police officers are exposed on a daily basis to carbon monoxide from motor vehicles and chemicals on the highway and gun cleaning solvents which may contribute to arteriosclerotic heart and renal diseases. Exposure to lead has been implicated in cerebrovascular and other diseases, and high levels of lead in the blood have been found in police officers exposed to firearms, ammunition, and fingerprint powder. Cancer of the kidney also showed a significantly high risk in our present study. A study of urban policemen in Rome found a high risk of kidney cancer among motorcycle officers, and additional studies have found associations between occupational chemical exposure and kidney cancer.

Increased risk of hematopoietic and brain cancers found in the present study may be in part be a result of electromagnetic field exposure in police work. It is probable, however, that EMF exposure and several environmental carcinogens working together may lead to promotion of these cancers. Most police agencies engage in the widespread use of radio transmissions and radar. Police speed enforcement radar devices generate a continuous wave (CW) reference frequency in either X-band (10.525 Ghz) or in K-band (24.150 Ghz) and transmit nonionizing electromagnetic frequency. Davis and Mostifi found a significant increased risk for testicular cancer among police officers who reported use of hand-held radar units inside of the police vehicle. Violanti (unpublished study) found a 68% increased probability of cancer with increased exposure time to police radar . Officers were, on average, exposed to radar 74% of the time that they were enforcing speeding laws. Hand-held radar units (used inside the police vehicle) had significant associations with self-reported testicle, breast, and prostrate cancer.

Although it is not possible to change the dangers inherent in police work, it is possible to change aspects which affect the long term health of officers. The present findings suggest that police officers are at significantly elevated risks for a number of diseases and appropriate interventions should be instituted. Elevated mortality risk of colon cancer and other digestive cancers , for example, indicates a need for earlier detection with stool tests or frequent medical examinations. Such medical examinations are lacking as part of work benefits in most police agencies. Elevated risk for cirrhosis, arteriosclerotic heart disease, and all malignant neoplasms combined are also diseases of concern. Prevention should emphasize management programs which include health education, physical exercise , smoking abatement, and dangers of alcohol use. The elevated risk of suicide among police officers in present study indicates the effect of a high stress work environment and perhaps the officer’s inability to adequately cope with stress. In addition to stress management and suicide awareness education, police officers should have confidential psychological services available to help them deal with such difficulties. Only one of five police agencies presently have such programs. Shift work is another possible factor related to long term health problems. Departments should consider arranging work shifts to optimally benefit officers in terms of proper sleep. Shifts, for example, should not be changed for at least 4-6 weeks at a time, as rapid shift changes exacerbate strain on the body. Lastly, there is need for police departments to consider alternatives to police organizational structure which can produce much of the stress experienced by police officers. Officers report that approximately 90% of stress in their work is a result of a highly structured, unresponsive, uncaring administration. Changes should include allowing officers the opportunity to participate in decisions affecting their work, and a greater organizational awareness of problems at the street level.

No simple answers exist for prevention of disease in police work. The present study may help to understand correlates of the long term health effects of this occupation and provide a basis for future work.