The Airwave Health Monitoring Study (AHMS). An Occupational Cohort Study of the British Police Forces.

Lead Research Organisation: Imperial College London
Department Name: School of Public Health

Abstract

Police officers are among one of the occupational groups presenting with higher rates of ill health compared to other workers and are exposed to a wide range of chemical, physical and psychosocial risk factors that can affect their health and performance at work. This raises questions about how the risk factors they face at work affects their performance and ultimately their wellbeing and safety, as well as the safety of the public. Recent staff surveys and literature have indicated that mental health issues, such as anxiety and depression, are also a particular concern. Understanding these hazards and risks to police officer health and putting tailored safety and health promotion measures in place is an obvious solution. However, there is a lack of detailed information on the specific factors involved and the how these, individually or in combination, affect health. It is also likely that health outcomes vary according to workplace factors (e.g. region, rank, hours worked) but also vary according to individual make-up and sociodemographic characteristics. Therefore, understanding and quantifying risk factors to police officer health may impact on the health and wellbeing of the individual, their colleagues and families as well as on the health of the public.

The Airwave Health Monitoring Study (AHMS) was established to evaluate possible health risks associated with the use of the digital communication system used by the police forces and other emergency services. It is a large (over 50,000 participants) long-term study investigating the health of police officers and staff across Great Britain. Currently, follow-up measures are being undertaken in England only. Our objectives are both to extend the follow-up of the AHMS to Scotland and Wales, and to provide a resource for studying how gender, lifestyle, and occupational exposures interact with genetic and metabolic factors in relation to physical and mental health, in a comparatively young working population with a high representation of men.

Specifically we plan to:

i) follow-up the Scottish and Welsh AHMS participants who attended a baseline clinical assessment (N = 13,681) approximately 7.5 years later;
ii) develop a method to estimate exposures to a range of chemical, physical and psychosocial risk factors to health by combining group level data through a bespoke Job Exposure Matrix (JEM) and individual level data to refine and evaluate JEM performance.
iii) use mental health as an exemplar case study to examine the relationships between work-related risk factors and mental health difficulties, and identify the individual and/or workplace 'protective' factors that promote wellbeing within the workplace.

Our proposal has high policy relevance at the level of both government and employers. It represents a novel, cross-sectoral collaboration between academics across five UK leading universities and in partnership with police forces and the Police Federation (representing rank and file officers) across Great Britain. The application has wide support from our stakeholders who have been included in the project from the outset in order to ensure that the findings are translated into interventions that impact on health and wellbeing.

Technical Summary

The Airwave Health Monitoring Study (AHMS) is a long-term cohort study of the health of police officers and staff across Great Britain. With funding from Home Office (ends March 2018), it has recruited 53,280 individuals of whom 45,533 have had clinical and biological measurements collected as part of a baseline clinical assessment, with data linkage of the cohort to routine NHS records. The aim of the current proposal is to greatly augment the AHMS cohort through further face-to-face clinical follow-up in Scotland and Wales (follow-up in England is funded separately), and to provide a resource for studying how gender, lifestyle, and occupational exposures interact with genetic and metabolic factors in relation to physical and mental health. We will do this via: i) follow-up assessment at c. 7.5 years of Scottish and Welsh Airwave participants (N = 13,681) aiming for 40% participation rate based on extensive pilot studies; ii) development of a methodology for obtaining estimates of exposure to a range of chemical, physical and psychosocial risk factors that may be associated with chronic disease or reduced health and wellbeing, using a combination of estimates on group level through development of bespoke Job Exposure Matrices (JEMs), with self-reported and objective individual exposure measures (e.g. from analyses of available computerised records from the police TETRA radio system, which informs on individual shift work patterns); and iii) an exemplar case study to examine the reciprocal relationships between operational and organisational risk factors and mental health difficulties, and identify what factors promote resilience within the workplace. This proposal if funded will provide a unique resource for research on occupational health among a 'front-line' public-facing service and provide the evidence-base for interventions to improve health and well-being among the workforce.

Planned Impact

The Airwave Health monitoring study (AHMS) is the only large-scale cohort study of police employees worldwide. It includes a group of younger men aged under 40 who are under-represented in the UK research portfolio. As it has proven difficult to interest this group in primary prevention and there is only limited routine contact with primary care, engaging with this demographic group helps fill a gap and boosts the value and impact of UK population cohorts as a whole.
Development of a set of Job Exposure Matrices (JEMs) to obtain greater understanding of workplace exposures experienced by Police Force employees would have wider applicability to other 'front-line' occupations, and would strengthen UK capability in this area of research.

The cohort has been richly phenotyped, flagged to routine records, and provides an excellent, unique resource to study the genetic, metabolic, occupational and lifestyle factors associated with physical and mental health, including cognitive performance, among a predominantly male and young adult workforce with a well-defined organisational hierarchy. Whilst the particular focus of the AHMS is the police force and related staff, the questions that can be asked of the resource can yield answers that are generalizable to workers in other occupational groups, especially those required to deal with stressful situations in high-demand, shift-based, structured work environments (e.g. health service, prison and fire services). The results therefore could have important impact on the working practices, and mental and physical health, of workers in a range of 'public facing' occupations.

The proposed research will address a number of areas and domains, where the findings could have important implications for working practice and lead to possible work-place interventions:

a. Studying how gender, lifestyle, and occupational exposures interact with genetic and metabolic factors in relation to the development of physical and mental health issues, will contribute to better understanding of risk factors for poor health, and possible remediation approaches
b. Gaining greater awareness of social differentials between job assignments and the impact of stress and job strain on health could have direct impact on day-to-day working arrangements, as well as the consequence of highly stressful events and shift working patterns
c. Absence from work through sickness constitutes a huge economic burden for the UK Police Force, and contributes to the poor productivity of the UK workforce in general. The AHMS has collected sickness absence records from participating police forces, and linked those data with clinical, lifestyle, genetic and metabolic information on a large sample of Police Force employees. Using this resource, the AHMS offers unique opportunity to gain much greater understanding of the drivers of absenteeism in the Police Force, with potential for substantial health and economic benefit if even a small downward shift in numbers of days absent could be achieved. By identifying and remediating the drivers of the large degree of absenteeism through sickness, there is potential to develop successful interventions targeting the most important modifiable determinants.
d. The AHMS participants have consented to recall into studies by genotype and/or phenotype. The cohort could become a rich source of participants for trials of behavioural and other interventions on mental health and other outcomes, potentially leading to new or improved treatments for these conditions in a work-place setting.

Publications

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Description The Airwave Health Monitoring Study (AHMS). An Occupational Cohort Study of the British Police Forces.
Amount £1,988,965 (GBP)
Funding ID MR/R023484/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 07/2018 
End 06/2023
 
Title Airwave Health Monitoring Study 
Description The Airwave Health Monitoring Study was established to evaluate possible health risks associated with the use of TETRA, a digital communication system used by the police forces and other emergency services in Great Britain since 2001. It is a long-term observational study following up the health of the police force with respect to TETRA exposure, and ability to monitor both cancer and non-cancer health outcomes. The Airwave Health Study Tissue Bank completed its recruitment in March 2015, thus establishing a "baseline" for the cohort. We are currently carrying out a programme of re-screening of existing cohort members that were already screened at baseline. 
Type Of Material Biological samples 
Year Produced 2015 
Provided To Others? No  
Impact We continue to collaborate with researchers both within Imperial College and external, sharing samples and data from our health screening. From June till December 2019, we completed 1,839 follow-up screens on 1,789 participants. As of 26th Feb 2020, the current number of active members of the Tissue Bank is 53,243, whose mean number of years of membership is 10.3. We have recently used 91 blood samples during the year for DNA extractions and genotyping, work on which is ongoing. More are planned for 2020. 
 
Description Airwave & GRAPHIC research collaboration for Airwave study 
Organisation University of Leicester
Department Department of Cardiovascular Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Participant data from Airwave cohort study
Collaborator Contribution Participant data from GRAPHIC cohort study
Impact ongoing collaboration
Start Year 2019
 
Description Airwave - Police Federation of England and Wales 
Organisation Police Federation of England and Wales
Country United Kingdom 
Sector Public 
PI Contribution Scientific conduct of the study and close liaison with the Federation to ensure continuing support for participation
Collaborator Contribution Collaboration on the Airwave study steering committee and access committee - lay contribution to these committees and assistance with communication channels to police organisation contacts to improve effectiveness of study implementation.
Impact ongoing collaboration
Start Year 2018
 
Description Airwave Collaboration with the PGC 
Organisation Psychiatric Genomics Consortium (PGC)
Country Global 
Sector Learned Society 
PI Contribution The genetic data from the Airwave cohort is being incorporated into the forthcoming genome-wide association analyses of depression and anxiety disorders, in collaboration with the Psychiatric Genomics Consortium (PGC)
Collaborator Contribution The PGC will securely store the summary association statistics from Airwave and include it in a genome wide meta-analysis with other studies from around the world. They will also provide genetic risk scores for depression in all Airwave participants, allowing Airwave investigators to assess whether this predicts work place absenteeism and satisfaction in individuals with or without depression.
Impact No outputs so far
Start Year 2019
 
Description Airwave and CARDIA cohorts collaboration on metabolic pathways and blood pressure and body weight index 
Organisation University of North Carolina at Chapel Hill
Country United States 
Sector Academic/University 
PI Contribution Potentially we will contribute data from the Airwave cohort study to the proposed analysis, and expertise in data interpretation.
Collaborator Contribution Partner is sourcing funding for the proposed work and will bring data from the CARDIA cohort study to the project and expertise in nutrition and obesity.
Impact Data access applied for and grant application written and under consideration.
Start Year 2019
 
Description Airwave and CCACE - Centre for Cognitive Ageing and Cognitive Epidemiology 
Organisation University of Edinburgh
Department MRC Centre for Cognitive Ageing and Cognitive Epidemiology
Country United Kingdom 
Sector Academic/University 
PI Contribution Data collection, data quality control and analysis and database management
Collaborator Contribution Working with to enhancement baseline data collection with addition of questions on mental health and cognition to enable future analysis of work-related stressors
Impact ongoing collaboration
Start Year 2018
 
Description Airwave and MRC CSO Social and Public Health Sciences Unit 
Organisation University of Glasgow
Country United Kingdom 
Sector Academic/University 
PI Contribution Provision of Airwave study data and biosamples for analysis
Collaborator Contribution Expertise in occupational work exposures and evaluation of work place interventions for health promotion
Impact ongoing collaboration
Start Year 2018
 
Description Airwave and occupational exposure assessment 
Organisation University of Manchester
Country United Kingdom 
Sector Academic/University 
PI Contribution Airwave study data and biosamples
Collaborator Contribution Collaborating with the Centre for Occupational and Environmental Health with expertise in occupational exposure assessment. Obtaining expert advice on the formation and use of a job exposure metrix (JEM) for the study
Impact ongoing collaboration
Start Year 2019
 
Description Airwave collaboration with CIPHER 
Organisation Swansea University
Department Centre for Improvement in Population Health through E-records Research (CIPHER)
Country United Kingdom 
Sector Academic/University 
PI Contribution Airwave study participant data and database and expertise in secure database management
Collaborator Contribution Secure data linkage and expertise in e-records for health data
Impact ongoing collaboration
Start Year 2018
 
Description Airwave collaboration with DPUK - Dementia Platforms UK 
Organisation University of Oxford
Country United Kingdom 
Sector Academic/University 
PI Contribution Collection and provision of Airwave study data. Airwave data collected by the study team is being uploaded into the DPUK data portal so that it is available to other researchers. Collaboration with Prof Gallacher, PI of DPUK on pilot use of data including CSR pilot, collaborative grant applications and publications.
Collaborator Contribution DPUK portal coordination and data access procedures
Impact ongoing collaboration
Start Year 2018
 
Description Airwave collaboration with DPUK - Great Minds pilot study 
Organisation MRC Dementias Platform UK
Country United Kingdom 
Sector Academic/University 
PI Contribution Collaboration with DPUK to invite Airwave study participants to take part in the Great Minds pilot study. Facilitated contact with study participants.
Collaborator Contribution Coordination of Great Minds pilot study
Impact new collaboration - ongoing
Start Year 2019
 
Description Airwave collaboration with DPUK and SAIL 
Organisation Swansea University
Country United Kingdom 
Sector Academic/University 
PI Contribution Provision of Airwave study data and expertise in database management and health data linkage
Collaborator Contribution SAIL Databank is being used as a means of secure data processing and storage for study data
Impact ongoing collaboration
Start Year 2018
 
Description Airwave collaboration with UK Biobank 
Organisation UK Biobank
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution We have initiated an amendment to UK Biobank project 4844 to allow Airwave to be linked to UK Biobank using genetic checksums, allowing overlapping individuals to be removed from analyses that utilise both datasets
Collaborator Contribution UK Biobank have provided genetic data and information on depression and anxiety to facilitate this collaboration
Impact None so far
Start Year 2019
 
Description Cardiovascular health and Airwave collaboration - Glasgow 
Organisation Glasgow Royal Infirmary
Country United Kingdom 
Sector Hospitals 
PI Contribution Contributing data from the Airwave cohort study and ECG trace data
Collaborator Contribution Expertise in analysis of ECG trace data and data interpretation in relation to cardiovascular health and wellbeing.
Impact ongoing collaboration
Start Year 2019
 
Description DPUK data portal pilot study - Airwave 
Organisation MRC Dementias Platform UK
Country United Kingdom 
Sector Academic/University 
PI Contribution Airwave cohort study data is being uploaded into the national DPUK data portal and the study was selected to take part in the pilot launch of the data platform.
Collaborator Contribution Facilitated inclusion of the cohort data into the data platform with potential to share anonymised data with research partners.
Impact Scientific paper submitted for publication
Start Year 2019
 
Description DPUK data portal pilot study - Airwave 
Organisation Swansea University
Department Swansea University Medical School
Country United Kingdom 
Sector Academic/University 
PI Contribution Airwave cohort study data is being uploaded into the national DPUK data portal and the study was selected to take part in the pilot launch of the data platform.
Collaborator Contribution Facilitated inclusion of the cohort data into the data platform with potential to share anonymised data with research partners.
Impact Scientific paper submitted for publication
Start Year 2019
 
Description DPUK data portal pilot study - Airwave 
Organisation University of Oxford
Department Department of Psychiatry
Country United Kingdom 
Sector Academic/University 
PI Contribution Airwave cohort study data is being uploaded into the national DPUK data portal and the study was selected to take part in the pilot launch of the data platform.
Collaborator Contribution Facilitated inclusion of the cohort data into the data platform with potential to share anonymised data with research partners.
Impact Scientific paper submitted for publication
Start Year 2019
 
Description Mental health in the police force and Airwave collaboration 
Organisation King's College London
Department King's Centre for Military Health Research
Country United Kingdom 
Sector Public 
PI Contribution Data from the Airwave cohort study and epidemiological expertise in data interpretation
Collaborator Contribution Expertise in assessment of mental health status and trauma exposure.
Impact Scientific paper submitted and under consideration for publication.
Start Year 2019
 
Description The Consortium of Metabolomics Studies (COMETS) and Airwave 
Organisation Brigham and Women's Hospital
Country United States 
Sector Hospitals 
PI Contribution Contributing data from the Airwave cohort to this consortium of 47+ international cohorts
Collaborator Contribution Platform for sharing data to facilitate large-scale collaborative research e.g. meta-analysis and GWAS on the human metabolome
Impact Publication Yu et al Am J Epidemiol 2019 https://doi.org/10.1093/aje/kwz028 .
Start Year 2019
 
Description The Consortium of Metabolomics Studies (COMETS) and Airwave 
Organisation National Cancer Institute
Country Lithuania 
Sector Hospitals 
PI Contribution Contributing data from the Airwave cohort to this consortium of 47+ international cohorts
Collaborator Contribution Platform for sharing data to facilitate large-scale collaborative research e.g. meta-analysis and GWAS on the human metabolome
Impact Publication Yu et al Am J Epidemiol 2019 https://doi.org/10.1093/aje/kwz028 .
Start Year 2019
 
Description Law Enforcement and Public Health (LEPH) conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact On the 21-23rd October 2019, we presented a poster at the Law Enforcement and Public Health (LEPH) conference in Edinburgh, Scotland. This is a biennial conference exploring the complex and diverse intersections of law enforcement and public health, involving practitioners, policy makers and researchers from these and other related sectors.
Year(s) Of Engagement Activity 2019
 
Description British APCO - Presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact In March 2019, our research fellow, Dr He Gao, presented a lay summary of the recent research results of the Airwave Study at BAPCO, "the leading UK based Association for all professionals using or developing Public Safety technology."
Year(s) Of Engagement Activity 2019
 
Description National Institute for Health research (NIHR) Imperial Research open day 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact To enrich or public engagement activities we took part in the National Institute for Health research (NIHR) Imperial Research open day on the 15th November 2019 at the W12 conferences in Hammersmith Hospital. The aim was to promote meaningful conversations about the work we do to a wide audience consisting of carers, patients, research and healthcare professionals as well as members of the public.
Year(s) Of Engagement Activity 2019
 
Description Newsletters to Airwave Health Monitoring Study participants 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Study participants or study members
Results and Impact Jointly with our collaborators at DPUK, we sent a newsletter to all members of the cohort. This highlighted the recently completed research relating to Airwave usage, promoted the revised and expanded research objectives of the Tissue Bank, and provided a channel by which DPUK could explain how they are addressing their dementia-focussed research objectives and how their collaboration with the Airwave Tissue Bank may provide opportunities for joining research studies they are supporting.
Year(s) Of Engagement Activity 2019
 
Description Oral presentation to 5th International Conference on Law Enforcement & Public Health LEPH2019, Edinburgh, Oct 2019 on Airwave Occupational Cohort Study 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited oral presentation to biennial national conference with aim of exploring and debating the intersections between law enforcement and public health involves. Audience included practitioners, policy makers and researchers from these and other related sectors. Aims of the study were presented and basic results and plans for future participant involvement. Opportunity to promote the study and engage with police and law enforcement agencies.
Year(s) Of Engagement Activity 2019
URL https://leph2019edinburgh.com/
 
Description Oral presentation to British APCO annual conference 13 March 2019 on Personal radio use and cancer risks among police officers and staff from the Airwave Health Monitoring Study 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited oral presentation by research team member to the British Association of Public Safety Communications Officials (BAPCO) annual meeting to present the aims of the study, how researchers are following up participant data and what the study has found in relation to risks of development of any diseases including cancers (ref: paper recently published in BJC). Airwave is investigating any effect of use of the TETRA radio technology on police officers and staff.
Year(s) Of Engagement Activity 2019
 
Description Presentation to 15th Annual Conference of The Metabolomics Society, The Hague, The Netherlands, June 23-27, 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented methods and results of work on a metabolomics analysis to identify and characterise metabolomic signatures associated with risk variants for coronary artery disease using samples from MESA, Rotterdam and Airwave cohort studies with the aim of producing new knowledge on the causal pathways linking genes to CVD.
a new cross-cohort matching in untargeted metabolomics to generate accurate within-dataset feature matching across multiple cohorts.
Year(s) Of Engagement Activity 2019
URL http://metabolomics2019.org/images/2019-Metabolomics_Abstract_9.pdf