UNCORRECTED PROOF 1 Q1 Fatigue and on-duty injury among police officers: The BCOPS study 2 Q2 Desta Fekedulegn, a, ⁎ Cecil M. Burchfiel, a Claudia C. Ma, a Michael E. Andrew, a Tara A. Hartley, a 3 Luenda E. Charles, a Ja K. Gu, a John M. Violanti, b 4 a Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, 5 WV, USA 6 b Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY, USA 7 abstract 8 article info 9 Article history: 10 Received 21 March 2016 11 Received in revised form 14 June 2016 12 Accepted 30 November 2016 13 Available online xxxx 14 19 Introduction: Q4 Policing involves inherent physical and psychological dangers as well as occupational stressors that 20 could lead to chronic fatigue. Although accounts of adverse events associated with police fatigue are not scarce, 21 scientific literature on the association between chronic fatigue and on-duty injury are limited. Methods: Partici- 22 pants were officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. A 10-item 23 questionnaire was administered to assess how tired or energetic the officers generally felt irrespective of sleep 24 hours or workload. The questionnaire consisted of five positively worded and five negatively phrased items 25 that measured feelings of vigor/energy and tiredness, respectively. Total as well as separate scores for positive 26 and negative items were computed by summing scores of individual items. Payroll records documenting each 27 officer's work history were used to assess occurrence of injury. Poisson regression was used to estimate preva- 28 lence ratios (PR) of injury associated with fatigue score. Results: Nearly 40% of officers reported feeling drained. 29 The overall prevalence of on-duty injury during the past year was 23.9%. Injury prevalence showed a significant in- 30 creasing trend across tertiles of total fatigue score: 19.6, 21.7, and 30.8% for lowest, middle and highest tertiles, 31 respectively (trend p-value = 0.037). After controlling for potential confounders, a 5-unit increase in total fatigue 32 score was associated with a 12% increase in prevalence of injury which was marginally significant (p = 0.075). 33 A 5-unit increase in fatigue score of the positively worded items was associated with a 33% increase in prevalence 34 of injury (PR = 1.33, 95% CI: 1.04–1.70, p = 0.022). Conclusion: Officers who do not feel active, full of vigor, alert, 35 or lively had a significantly higher prevalence of non-fatal work place injury compared to their counter parts. 36 Practical applications: With additional prospective evidence, workplace interventions designed to enhance level 37 of energy may reduce feelings of tiredness and hence may prevent workplace injury. 38 Published by Elsevier Ltd. 39 Keywords: 40 Non-fatal injuries 41 Chronic tiredness 42 Law enforcement 43 Work history 48 1. Introduction 49 Fatigue, broadly defined as “a feeling of weariness, tiredness, or lack 50 of energy,” is a frequently cited complaint among the U.S. workforce 51 with reported prevalence of 38% (Ricci, Chee, Lorandeau, & Berger, 52 2007). It is an especially serious concern among police officers who 53 are overly fatigued because of long and irregular work hours, shift 54 work, sleep deprivation, and the inherent physical and psychosocial 55 danger associated with the job (Vila, 2006; Vila & Kenney, 2002). Law 56 enforcement is also one of six occupations with the highest incidence 57 rates of nonfatal occupational injuries. The most recent data provided 58 by U.S. Bureau of Labor Statistics (BLS) indicated that, in 2014, 59 police and Sheriffs patrol officers had one of the highest days away 60 from work (DAFW) nonfatal injury rates (485.8 per 10,000 full-time 61 workers) among all occupations (107.1 per 10,000 full-time workers) 62 and incurred the highest number of injuries among local government 63 and second highest among state government employees (BLS, 2014). 64 Fatigue in police officers impairs vigilance, reaction time, and perfor- 65 mance thereby elevating the risk for fatal and non-fatal injuries 66 to both the officers and the general public (Garbarino et al., 2007; 67 Rajaratnam et al., 2011; Vila, 2006; Vila & Kenney, 2002; Waggoner, 68 Grant, Van Dongen, Belenky, & Vila, 2012). 69 While considerable attention has been placed on the psychosocial 70 and cardio-metabolic health of police officers (Violanti et al., 2006), 71 scientific research on occupational injury of officers is limited, and sta- 72 tistics for injuries are less readily available (LaTourrette, 2011). In 73 2009, the National Public Safety Agenda, which is part of the National 74 Occupational Research Agenda (NORA) for occupational safety and 75 health research and practice in the United States, recognized that data 76 on occupational injuries and illness among law enforcement personnel 77 are not sufficient (NORA, 2009). Fatigue is a well-known risk factor for 78 injury, yet the scientific literature documenting the prevalence of fa- 79 tigue among police officers, particularly its association with non-fatal 80 on-duty injury, is limited (James & Vila, 2015). Journal of Safety Research xxx (2016) xxx–xxx ⁎ Corresponding author at: National Institute for Occupational Safety and Health, HELD/BEB, MS L-4050, 1095 Willowdale Rd., Morgantown, WV 26505-2888, USA. E-mail address: bdesta827@gmail.com Q3 (D. Fekedulegn). JSR-01357; No of Pages 9 http://dx.doi.org/10.1016/j.jsr.2016.11.006 0022-4375/Published by Elsevier Ltd. Contents lists available at ScienceDirect Journal of Safety Research journal homepage: www.elsevier.com/locate/jsr Please cite this article as: Fekedulegn, D., et al., Fatigue and on-duty injury among police officers: The BCOPS study, Journal of Safety Research (2016), http://dx.doi.org/10.1016/j.jsr.2016.11.006