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

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.

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.

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.