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APPLIED SCIENCES

Obesity Prevalence and Musculoskeletal Injury History in Probation Officers

MOTA, JACOB A.1,2; KERR, ZACHARY Y.1,3,4; GERSTNER, GENA R.1,2; GIULIANI, HAYDEN K.1,2; RYAN, ERIC D.1,2,5

Author Information
Medicine & Science in Sports & Exercise: September 2019 - Volume 51 - Issue 9 - p 1860-1865
doi: 10.1249/MSS.0000000000001996
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Abstract

Probation officers are a subset of law enforcement officers who contribute to public safety by supervising offenders on probation (a period of court ordered supervision), monitoring the compliance of offenders, and addressing those who violate their terms of probation. Despite similar public safety occupations (i.e., firefighters, police officers) having seen a rise in research recently (1–6), probation officers remain significantly understudied. Furthermore, given that probation officers have similar job demands (i.e., unpredictable bursts of strenuous activity) and experience similar work-related events (i.e., witnessing or experiencing violent acts) as traditional police officers, it is possible they may also have very poor health profiles as seen in police officers (7).

Obesity (body mass index [BMI] ≥ 30.0 kg·m−2) is a disease and remains a significant public health concern which is associated with numerous health issues (e.g., cardiovascular disease, diabetes mellitus) (8–10). Furthermore, the influence of obesity in the workplace has grown (11), with previous studies indicating obese workers miss more work days (absenteeism) compared with their normal weight colleagues, incurring a substantial financial burden on the employer (5). Although select public safety personnel (i.e., firefighters, law enforcement officers) are expected to perform strenuous duties, the prevalence of overweight and obesity in these occupational groups is higher than the general public (7) and has been shown to negatively impact occupational performance (12). Although the contributors to obesity are multifaceted (11), physical activity (PA) status is consistently cited as a key contributor (13,14). Thus, future studies are needed to determine the prevalence of overweight and obesity in probation officers, in addition to their current PA status.

Public safety occupations have one of the highest rates of work-related musculoskeletal injuries (15). Although some injury risk factors are inherent to all public safety personnel, each public safety profession may have unique risk factors (16). For example, probation officer duties are unique and include both law enforcement (i.e., arresting offenders) and social work (i.e., counseling offenders) responsibilities, which may influence injury patterns. However, we are aware of no previous studies investigating factors contributing to work-related musculoskeletal injury history in probation officers. The goal of the current study is to characterize the current health status of probation officers which may help to inform future worksite health-related decisions for public safety administrators. Thus, the purpose of the present investigation was to identify 1) the prevalence of overweight and obesity and 2) factors associated with previous work-related musculoskeletal injury and PA levels in North Carolina probation officers.

METHODS

Sample and data collection

The current study used a questionnaire administered to all North Carolina probation officers in 2015 (N = 1866). The questionnaire collected information regarding a variety of factors related to general health history and job-related tasks. Probation officers were sent an email with a link to the questionnaire and invited to participate in the study. A follow-up reminder email was sent 2 wk later. This study and its procedures were approved by the University Institutional Review Board for the protection of human subjects (IRB 18-0668).

Questionnaire

The health history questionnaire obtained information on demographics (age, sex, body mass, and stature), injury history, PA, geographical location of work (i.e., rural or urban), and years of employment as a probation officer. Body mass index (BMI) was calculated from stature and body mass and then classified in accordance with the National Heart, Lung, and Blood Institute’s (NHLBI) guidelines: normal weight (BMI, 18.5–24.9 kg·m−2), overweight (25.0–29.9 kg·m−2), and obesity (BMI ≥ 30.0 kg·m−2) (17). Obesity was further classified into class I obese (BMI, 30.0–34.9 kg·m−2), class II obese (BMI, 35–39.9 kg·m−2), and class III obese (BMI, ≥ 40.0 kg·m−2; severe obesity) (17) for the regression analyses (see below). Because of the relatively low amount of underweight individuals (n = 4; mean ± SD BMI, 18.1 ± 0.4 kg·m−2), participants with a BMI < 18.5 kg·m−2 were included with the normal weight group for all analyses.

Injury history

Participants were asked to indicate if, over the past year, they had sustained a musculoskeletal injury (i.e., strain, sprain, tear, dislocation, bruise, or fracture) while at work for which they had completed an accident report for the department, reported to workers compensation, or received medical care (by a physician or other medical professional). A similar questionnaire was used previously by Jahnke et al. (6).

Physical activity

To assess PA habits, specifically exercise-related PA, participants selected a single value (0–7) which best represented their PA over the past month using the NASA PA scale (18). Previous research (19) has reported the concurrent validity of the scale with the NASA PA scale values related to aerobic fitness. The values in this questionnaire were as follows: 0, do not participate regularly in PA; 1, walk for pleasure, occasionally exercise causing perspiration; 2, 10 to 60 min of moderate PA per week; 3, participate in over 1 h of moderate PA per week; 4, participate in heavy physical exercise less than 30 min·wk−1; 5, participate in heavy physical exercise 30 to 60 min·wk−1; 6, participate in heavy physical exercise 1 to 3 h·wk−1; 7, participate in heavy physical exercise greater than 3 h·wk−1. Participants who had a score of 0 or 1 were placed into a lower PA group, participants with a score between 2 and 4 were placed in a moderate PA group, whereas participants who had a score of 5 or above were placed into a higher PA group.

Statistical analysis

Data were analyzed using SAS software (version 9.4, SAS Institute Inc., Cary, North Carolina). Descriptive analyses were presented as mean ± SD. The prevalence of overweight and obesity (BMI ≥ 25 kg·m−2) combined, and obesity (BMI ≥ 30 kg·m−2) only were calculated according to the NHLBI guidelines (17). To assess the factors associated with previous work-related musculoskeletal injury and PA levels, two multivariable models were conducted. First, a logistic regression model estimated the odds of work-related musculoskeletal injury history within the past year. Second, an ordinal logistic regression model estimated the odds of PA status within the past month. In this model, the ordering of the categories within the outcome variable assessed the odds of having a lower level of PA (i.e., low vs moderate and high combined; and low and moderate combined vs high). Predictor variables in both models included: age (in years; discrete variable); sex (male vs female); employment history (in years; discrete variable); geographical location (urban vs rural); and BMI classification (per NHLBI guidelines). Physical activity status was included as a predictor in the work-related musculoskeletal injury history model, and vice-versa. We reanalyzed the multivariable models stratified by sex to assess potential effect measure modification. Odds ratios (OR) with 95% confidence intervals (CI) were calculated, with those not including 1.00 being deemed statistically significant.

RESULTS

Demographic and work characteristics

Of the total North Carolina probation officers (N = 1866) employed, there were 1323 (70.9%) who completed the entire survey and the mean ± SD age and employment history was 39.9 ± 10.0 and 10.2 ± 8.4 yr, respectively (Table 1). Additionally, the majority of participants were male (53.5%), from rural areas (62.3%), and overweight/obese (BMI ≥ 25.0 kg·m−2; 80.8%), with 49.9% classified as obese (BMI ≥ 30 kg·m−2). When examining the individual obesity categories, 26.0% of participants were classified as class I obese (30.0–34.9 kg·m−2), 14.3% as class II obese (35–39.9 kg·m−2), and 9.5% as class III obese (BMI ≥ 40.0 kg·m−2). The largest proportion of participants had moderate levels of PA within the past month (40.3%) and 7.3% reported sustaining a work-related musculoskeletal injury within the past year. When examining work-related musculoskeletal injury history and PA level, respondents classified as obese were the most likely to have had an injury within the past year (Fig. 1) and had the largest proportions of low PA within the past month (Fig. 2).

TABLE 1
TABLE 1:
Baseline demographic and work characteristics (mean [SD] or %) of 1323 probation officers.
FIGURE 1
FIGURE 1:
BMI classifications of the probation officers who sustained a work-related musculoskeletal injury within the past year (n = 96). BMI classifications were calculated as follows: normal weight (BMI, 18.5–24.9 kg·m−2), overweight (25.0–29.9 kg·m−2), class I obese (BMI, 30.0–34.9 kg·m−2), class II obese (BMI, 35.0–39.9 kg·m−2), and class III obese (BMI ≥ 40.0 kg·m−2). Due to the relatively low amount of underweight individuals (n = 4; mean ± SD BMI, 18.1 ± 0.4 kg·m−2), participants with a BMI < 18.5 kg·m−2 were included with the normal weight group for all analyses.
FIGURE 2
FIGURE 2:
PA habits were assessed and categorized across body mass index (BMI) classifications. PA habits were calculated by having participants select a value (0–7) which best represented their PA habits within the previous month using the NASA PA scale. Participants who had a score of 0 or 1 were placed into the low PA group, participants with a score between 2 and 4 were placed in the moderate PA group, whereas participants who had a score of 5 or above were placed into the high PA group. BMI classifications were calculated as follows: normal weight (BMI 18.5–24.9 kg·m−2), overweight (BMI, 25.0–29.9 kg·m−2), class I obese (30.0–34.9 kg·m−2), class II obese (BMI, 35.0–39.9 kg·m−2), and class III obese (BMI ≥ 40.0 kg·m−2). Due to the relatively low amount of underweight individuals (n = 4; mean ± SD BMI, 18.1 ± 0.4 kg·m−2), participants with a BMI < 18.5 kg·m−2 were included with the normal weight group for all analyses.

Odds of work-related musculoskeletal injury within the past year

In the multivariable logistic regression model, age and obesity were the only factors associated with sustaining a work-related musculoskeletal injury within the past year. Controlling for all covariates, older probation officers displayed higher odds of having sustained a work-related musculoskeletal injury within the past year (1-yr increase; OR = 1.06; 95% CI = 1.04–1.09; Table 2). Additionally, probation officers categorized as class III obese had a higher odds of sustaining a work-related musculoskeletal injury within the past year than their normal weight colleagues (OR = 2.56; 95% CI = 1.19–5.51). Similar associations between each variable and work-related musculoskeletal injury within the past year were found in the sex-specific models (Table 2).

TABLE 2
TABLE 2:
Logistic regression estimated the odds of work-related musculoskeletal injury history within the past year in probation officers.

Odds of lower PA within the past month

In the multivariable ordinal logistic model, the assumption of proportional odds was met (P = 0.20). Sex, employment history, and BMI classification were found to be associated with the odds of lower PA within the past month (Table 3). Controlling for all covariates, the odds of having a lower level of PA within the past month was lower in males than females (OR, 0.38; 95% CI, 0.31–0.47). Additionally, the odds of lower PA within the past month increased with more years of employment (1-yr increase; OR, 1.03; 95% CI, 1.01–1.04). Furthermore, compared with normal weight officers, the odds of lower PA within the past month were higher among those classified as overweight (OR, 1.57; 95% CI, 1.16–2.13), class I obese (OR, 2.38; 95% CI, 1.74–3.27), class II obese (OR, 3.22; 95% CI, 2.24–4.64), and class III obese (OR, 2.98; 95% CI, 1.98–4.49). Similar patterns were found when analyses were restricted to males (proportional odds assumption P = 0.15) and females only (proportional odds assumption P = 0.39).

TABLE 3
TABLE 3:
Ordinal logistic regression estimated odds of PA status within the past month in probation officers.

DISCUSSION

The findings of the present study indicated that greater than 80% of respondents were overweight or obese (BMI ≥ 25 kg·m−2), whereas nearly 50% were obese (BMI ≥ 30 kg·m−2). Surprisingly, these estimates from our sample of probation officers were higher than the current estimates in US adults (69.5% of adults with BMI ≥ 25 kg·m−2; 36.4% of adults with BMI ≥ 30 kg·m−2) (20). Furthermore, it is important to note that 9.5% of sampled probation officers were classed as severe or morbidly obese (BMI ≥ 40 kg·m−2), which poses significant health concerns (9). When compared with other public safety occupations (i.e., firefighters, law enforcement officers), the prevalence of overweight and obesity is similar, whereas the prevalence of obesity alone was higher in our sample of probation officers. For example, previous studies with similar age groups as the current study (range of mean values; 37.6–42.3 yr) have reported the prevalence of overweight and obesity to range from 79.5% to 80.4%, whereas the prevalence of obesity ranged from 23.6% to 37.5% (4,5,21–23). It is possible that the prevalence of obesity in the current study may be due to the timing of the data collection period. For instance, all the data collected in the current study occurred in 2015, whereas the data from these previous studies occurred between 2004 and 2013 (i.e., more recent data may show the prevalence of obesity is higher than in previous years) (4,5,21–23). This was noted by Hales, et al. (24) who reported that the prevalence of obesity among US adults increased from 33.7% in 2007 to 2008 to 39.6% in 2015 to 2016.

Obesity has been linked to a significant number of risk factors associated with various adverse health conditions (e.g., cardiovascular disease, diabetes mellitus) (8–10) and increased health care costs (8). The large (~10%) prevalence of severe obesity (class III) in probation officers is particularly concerning as previous studies have suggested that severe obesity is associated with a larger number of comorbidities which occur at an earlier age of onset, and includes a higher risk of premature death (25). Furthermore, the negative impacts of overweight or obesity (e.g., high BMI or percent fat) may also influence occupational performance, which is critical in probation officers who encounter potentially dangerous and physically demanding confrontations. For example, previous studies have reported that increases in BMI or percent body fat are associated with poorer performance during various tasks specific to public safety occupations (e.g., simulated defensive tactics, firefighter ability tests, functional balance assessment) (2,26,27). While the cause of the high prevalence of obesity seen in public safety occupations is multifactorial, it is commonly linked to low levels of PA (13,14), poor dietary habits (28), and various work-related factors (e.g., long working hours, overnight shift work) (11). These are supported in part by our findings which demonstrated that overweight and obese probation officers were more likely to participate in lower amounts of PA in the past month than their normal weight colleagues (Fig. 2). In addition, our findings suggest that female probation officers were more likely to perform lower amounts of PA than their male colleagues (Table 3), which is similar to previous reports in US adults (29). These findings may highlight the need for intensified efforts from management to improve PA levels to help combat the high prevalence of obesity.

Factors associated with work-related musculoskeletal injury within the past year

Work-related musculoskeletal injuries account for one third of all occupational injuries each year and are the primary cause of nonfatal injuries in public safety occupations in the United States (15,30). Approximately 7% of probation officers in the current study (n = 96) reported a previous work-related musculoskeletal injury within the past year, and of those, the majority were severely obese (Fig. 1). Furthermore, participants who were severely obese were 2.5 times as likely (OR, 2.56; 95% CI, 1.19–5.51) to sustain an injury within the past year than their normal weight colleagues (Table 2). Although previous studies did not categorize participants into similar groups as used in the current study (i.e., class I, II, and III obesity), authors have reported that obese workers are more likely to sustain an occupational musculoskeletal injury than their normal weight counterparts (31–33). In a similar public safety occupation, Jahnke et al. (1) reported that obese firefighters (BMI ≥ 30 kg·m−2) were over five times as likely to experience a musculoskeletal injury than their normal weight colleagues. Additionally, Poston et al. (5) reported that class II and III obese (BMI ≥ 35 kg·m−2) firefighters missed five times the amount of work due to injury than their normal weight colleagues. These studies, in conjunction with the results of the current study, may demonstrate that severe obesity is a significant risk factor associated with work-related injuries and subsequent absenteeism in public safety occupations. Although the cause(s) of work-related musculoskeletal injuries in our sample of probation officers is unknown, it is possible that excessive body weight (i.e., obesity) played a significant role. In addition to being associated with musculoskeletal pain (34), obesity has been suggested to negatively impact work-related postures and motions, which may influence biomechanical demands (12) and alter skeletal muscle function (i.e., impaired fatigue resistance) (35). Furthermore, recent authors have reported obesity is associated with a higher incidence of occupational injuries caused by slips, trips, and falls compared to their normal weight colleagues (31), which may be due to a reduced ability to maintain balance in obese workers (36).

When controlling for all other variables, a 1-yr increase in age was associated with a 6% increase in the odds of sustaining an injury in the previous year (OR, 1.06; 95% CI, 1.04–1.09). Some previous studies have reported similar results (37); however, contrasting findings (younger adults more likely to sustain a work-related injury) have also been presented in the literature (38,39). The discrepancy between these findings may be due to differences in the physical demands of specific occupations (40), as blue collar workers (e.g., manual laborers) may be more likely to have sustained occupational injuries than white collar workers (e.g., office administrators) (38,39). Additionally, although it is likely that age-related occupational injuries are a function of job-related experience (37), the combined impacts of the age-related decline in physical abilities (e.g., muscular strength, aerobic capacity) (41) and an increase in the frequency of physical impairments (e.g., sensory or cognitive disabilities) (42) may place older workers at an increased risk of injury. Interestingly, our findings suggest that a 1-yr increase in employment was associated with increased odds of participating in lower amounts of PA in the past month (OR, 1.03; 95% CI, 1.01–1.04). Thus, it is possible that the reduced levels of PA with increasing years of employment may exacerbate the age-related changes in physical abilities (3,26) and increase the likelihood of work-related musculoskeletal injury in probation officers. Collectively, these findings may highlight the need for workers to maintain or increase PA levels during their tenure as a probation officer to counteract the age-related increases in work-related musculoskeletal injures.

Limitations of the current study include examining data from probation officers in North Carolina. Thus, our sample may be biased and our findings may not be generalizable to all probation officers in the United States. It is important to note that additional demographic (e.g. race, education history, smoking), work-related characteristics (e.g., long working hours, overnight shift work), and health-related (e.g., dietary habits) variables were not collected in the current study which may be related to PA habits and/or musculoskeletal injury. Further, our current injury questionnaire did not specify details on the injury (e.g., type, location, activity performed). Future research is needed to identify more specific injury characteristics as reported in other public safety personnel (6). Our findings may also be limited by typical biases related to survey research, such as recall and social desirability bias. Lastly, it is important to note that although a small percentage (0.3%) of our sample was classified as underweight, these participants were grouped in with our normal weight group for all analyses and may have unique health concerns when compared with their normal weight colleagues (43).

CONCLUSIONS

In summary, this study reports findings from a questionnaire of 70.9% of all North Carolina probation officers. Results from our study suggest that nearly 50% were obese, with approximately 10% classified as severely obese. Additionally, older and severely obese participants demonstrated a greater odds of sustaining a work-related musculoskeletal injury in the past year, when compared with their younger and normal weight colleagues, respectively. Furthermore, years of employment, BMI classification, and sex influenced the odds of participating in lower amounts of PA in the past month. These findings may highlight key areas of concern for an understudied subset of law enforcement officers and may help to inform future worksite health-related decisions for public safety administrators. Future studies are needed to determine the impact of feasible, worksite-specific exercise and nutritional strategies, and the influence of implementing physical employment standards for probation officers.

The authors would like to thank the North Carolina Department of Public Safety for supporting this project and all the probation officers who participated in this study.

E. D. R. was the principle investigator of a service contract with the North Carolina Department of Public Safety during the time of data collection. All results in this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Results of the present study do not constitute endorsement by the American College of Sports Medicine.

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Keywords:

PHYSICAL EMPLOYMENT STANDARDS; OCCUPATIONAL HEALTH; LAW ENFORCEMENT; PHYSICAL ACTIVITY; AGING; PUBLIC SAFETY

Copyright © 2019 by the American College of Sports Medicine