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Feature
ubMed is an Internet search engine used to
access millions of articles in biomedical and life
science literature. Searching “police officers and
health” on PubMed yields almost 5,000 articles,
and searching “firefighters and health” results in
more than 900 citations. However, only 23 articles
are identified when searching “correctional officers
(COs) and health.” This article is a snapshot of
ongoing work and a growing national consortium of
individuals interested in advancing the well-being
of COs.
In 2006, the National Institute of Safety and
Health (NIOSH) began combining its emphasis
on worker safety with workplace health promo-
tion for a strategy termed Total Worker HealthTM
(TWH).1 Traditionally, safety and health each have
received only individual attention. Corrections is a
profession with clear links among safety, job-
related issues and health. Those connections and
pressing needs for improvements in both health
protection and promotion move COs into the spot-
light for promoting TWH.
Hazards of Correctional Work
Correctional work conditions and practices dif-
fer by facility, region and jurisdiction. As a result,
it is difficult to generalize from the small number
of available studies to make conclusions about
the health of the more than half a million COs in
the U.S. However, the picture that emerges from
the limited available information is concerning.
The authors and others have found that COs have
high rates of stress,2 depression,3 suicide,4 obe-
sity,5 cardiovascular disease risks and injury.6
and Corrections:
Addressing the Safety and Well-
Being of Correctional Officers
P
By Diane Elliot, Kerry Kuehl, Mazen El Ghaziri and Martin Cherniack
All content and images are copyrighted by ACA, 2015, and may not be reprinted,
altered, copied, transmitted or used in any way without written permission.
Kerry Kuehl, M.D., Dr.P.H., was the lead investigator
in the NIOSH-funded “Safety and Health Improve-
ment: Enhancing Law Enforcement Departments”
study,7 which established an evidence-based safety
and health program for municipal and county law
enforcement officers. It was natural to extend that
work to COs. An initial step compared survey find-
ings from COs at prisons of different security levels
in an effort to characterize staff and use that informa-
tion to match facilities in a prospective trial of a pro-
gram to improve COs’ TWH. Despite similar years on
the job across sites, stress levels, body weight, alco-
hol intake and sick days all increased as the security
level intensified. However, even at the minimum-
security sites, COs had higher body weights and
more cardiovascular risk factors than the average
police officer. Findings pointed to a gradient of
increasing stress relating to greater health problems.
Tim Morse, Ph.D., and colleagues from the Cen-
ter for Promoting Health in the New England Work-
place (CPH-NEW) used surveys, focus groups and
physical assessments to understand the health of
COs from two prisons.8 Morse and his colleagues
found COs had more obesity than the U.S. aver-
age. Only 15 percent of COs were in the normal
weight range, about half what is found in the gen-
eral adult population. The COs’ interview data was
remarkable for findings of stress relating to poor
dietary habits and barriers to regular exercise.
Kuehl’s subsequent study among Oregon COs
found only 8 percent of West Coast COs were at
healthy body weights. In addition, the New England
investigators uncovered high levels of depression
among COs.9 In general, about 15 percent of aver-
age adults score in the depressed range, while for
these COs, that number was more than 30 per-
cent. The high stress and depression levels relat-
ed to greater work/family conflicts. Like in other
professions, correctional work issues tend to spill
into life off the job. TWH is about being safe and
healthy 24/7, and examining work’s impact —
both on and off the job — is an important com-
ponent for the work of the TWH Centers of
Excellence.
Stress is Hazardous to Your Heart
There are clear links between stress and both
mental and physical illnesses.10 In particular, high
stress increases risks for “metabolic syndrome.”
Metabolic syndrome is a collection of cardiovascu-
lar risk factors that include central obesity, insulin
resistance and elevated blood sugar, hypertension,
and abnormal lipid levels with higher triglycerides
and lowered HDL (good) cholesterol levels.11 When
experienced individually, each of these factors
increase the risk for heart disease, and when they
cluster together, the risks are multiplied. This greatly
accelerates the risk for atherosclerosis, so much
so that the combination was termed a metabolic
syndrome.
In 2013, the U.S. Department of Justice published
a review of stress among COs.12 The document high-
lighted the many sources of stress for COs, such as
hypervigilance, constant threats of violence, media
scrutiny, a closed work environment, understaffing,
organizational issues and work/family conflicts. An
additional finding from the West Coast prison COs
was that their rates of metabolic syndrome were
almost twice of that observed among police officers.
Precisely how stress leads to metabolic syndrome
is not understood. However, it is clear that the best
management relates to weight loss, regular exercise,
adequate sleep and a healthy diet.
First National Symposium on the Safety
and Well-Being of COs
In July 2014, researchers from the Pacific North-
west and New England were joined by practitioner
and research stakeholders, representatives from
national health and correctional institutes, union
officials and correctional administrators in holding
the 2014 National Symposium on Corrections Worker
Health. More than 60 individuals attended the day-
long meeting, which was webcast to other national
participants. The symposium was a first step in what
is anticipated to be a growing movement to place the
health of COs on the national research agenda.
The symposium was opened by Oregon Depart-
ment of Corrections (DOC) Deputy Director Mitch
Morrow. Morrow was a CO for 26 years and rose
through the ranks to his current position. He spoke
about the recent epidemic of CO suicides and their
worker compensation claims being the highest
among all state workers. He passionately called for
effective strategies to reduce these risks and the
need to increase research funding to understand and
address COs’ health risks. Keynote speakers included
• Maintain a healthy body weight;
• Exercise for at least 30 minutes every
day;
• Eat at least five servings of fruits and
vegetables each day;
• Obtain at least seven hours of sleep each
day;
• Promote a culture of wellness and peer
support; and
• Visit your physician for an annual check up.
Figure 1: Ways to Improve Well-Being
Margaret Kitt, M.P.H., M.D., deputy director at NIOSH,
and Marie Garcia, Ph.D., a social science analyst in
the Justice Systems Research Division at the National
Institute of Justice.
John Violanti, Ph.D., presented information about
the increased risk of suicide among COs.13 Violanti
served 23 years as a New York state trooper and
spent the next 25 years studying the health of police
officers. He is best known for the Buffalo Cardio-
metabolic Occupational Police Stress (BCOPS)
study, a longitudinal study of police officers’ health.14
BCOPS identified the connections among police
work, shift schedules, sleep disorders, obesity, car-
diovascular risk factors and cancer. More recently,
Violanti has turned his attention to the problems
of COs. He has documented elevated suicide risks
among COs and identified that suicide is part of a
much larger problem of stress and emotional strain.15
Oliver Wirth, Ph.D., a research psychologist at
NIOSH, and Jean Meade, M.D., D.V.M., Ph.D., M.P.H.,
a program council government member at NIOSH,
shared their early wellness work with COs. Meade
facilitated development of a post-traumatic stress
disorder service dog training program in a unique
veterans-only prison housing unit. An unanticipated
positive outcome of the training was that the COs
also felt better when the service dogs were present.
That observation resulted in plans to study the ben-
efits of human-animal interactions on COs, as well as
their inmate trainers. All of the morning symposium
presentations are available as free online videos.16
The afternoon sessions provided a series of inter-
active discussions, where participants rotated among
content experts to share information. The topics
included fatigue management, work/family balance,
juvenile corrections, ergonomics, organizational
culture, stress and CO safety. Meeting organizers
were gratified by the meetings’ outcomes. Martin
Cherniack, M.D., M.P.H., executive director of CPH-
NEW at the University of Connecticut, remarked,
“I was really struck by the enthusiasm and collabo-
ration among researchers, union leaders, [COs] and
federal officials. Now it’s time for solutions.”
Kuehl, who coordinated the meeting held in
Portland, Ore., noted, “With our findings indicating
the high health risks of COs, this is a critical time
to work with labor and management, and state and
federal agencies to make this public safety work-
force a high priority for funded research.” Mazen El
Ghaziri, Ph.D., M.P.H., R.N., coordinates the consor-
tium’s ongoing work and is preparing a conference
summary paper, including the roundtable reports.
It will join the presentation materials that are cur-
rently available online.17 El Ghaziri indicated that the
summary paper will lay the groundwork to apply for
future grants and advance policies that protect and
promote health in this high-risk workforce.
Conclusion
The review of CO stressors concluded that, while
there are local efforts and recommended best prac-
tices, there are no proven effective safety and health
programs for COs, and more studies are needed.18
Investigators from both TWH centers are actively
working to fill that gap and enhance the safety and
well-being of COs. At the Oregon Healthy Workforce
Center, Kuehl is analyzing findings from the Oregon
DOC study, a randomized trial of a team-centered,
peer-led scripted safety and health program among
four Oregon facilities. The University of Connecticut’s
DOC study builds on its work that early employment
years may be a particularly vulnerable time for COs.
In addition, its prior studies indicate participatory
approaches that involve all stakeholders in identi-
fying issues and solutions appear to be more effec-
tive.19 The University of Connecticut’s current work
includes educational and mentoring activities for
new hires, as well as programs for established COs
addressing nutrition, fitness, ergonomics and on-the-
job injuries. These New England studies are planned
to run through 2016.
Impacting the safety and well-being of COs pres-
ents challenges. Working behind prison walls, with-
out ongoing interactions with the public, makes COs
less visible than other public safety professions, such
as emergency medical services, firefighting and law
enforcement. In addition, as Violanti emphasized
when talking about suicide among police detectives,
the “blue line” of law enforcement culture can be
difficult to traverse when getting individuals to admit
vulnerability, seek out assistance and alter current
practices and culture. For COs, the blue line is a
Impacting the safety and well-being of COs presents challenges.
Working behind prison walls, without ongoing interactions with the
public, makes COs less visible than other public safety professions,
such as emergency medical services, firefighting and law enforcement.
barbed wire fence of security and challenging work
structures that require time to build trust, ensure
confidentiality and involve all stakeholders to effec-
tively impact both systemwide and individual CO
issues.
The objectives of the collaboration among CO
investigators, led by El Ghaziri, are placing correc-
tions on the agendas of national institutes that con-
trol research funds for that work; facilitating the
sharing of information among those involved in pro-
moting the health and safety of COs; and assisting in
the design and conduct of multicenter prospective
trials of comprehensive TWH programs for COs.
However, findings from a national study are years
away, and the well-being of COs cannot wait. In the
meantime, the items in Figure 1 are ways COs can
apply the same diligence used to protect individuals
in the community to protecting the health of COs and
correctional facility staff.
ENDNOTES
1 Schill, A. and L.C. Chosewood. 2013. The NIOSH Total Worker
HealthTM program: An overview. Journal of Occupational and Envi-
ronmental Medicine, 55(12):S8-S11.
2 Bower, J. 2013. Correctional officer wellness and safety litera-
ture review. Washington, D.C.: U.S. Department of Justice Office
of Justice Programs Diagnostic Center. Retrieved from www.
ojpdiagnosticcenter.org/sites/default/files/spotlight/download/
NDC_CorrectionalOfficerWellnessSafety_LitReview.pdf.
3 Obidoa, C., D. Reeves, N. Warren, S. Reisine and M. Cherniack.
2011. Depression and work family conflict among corrections
officers. Journal of Occupational and Environmental Medicine,
53(11):1294-1301.
4 Violanti, J.M., C.F. Robinson and R. Shen. 2013. Law enforcement
suicide: A national analysis. International Journal of Emergency
Mental Health and Human Resilience, 15(4):289-297.
5 Morse, T., J. Dussetschleger, N. Warren and M. Cherniack. 2011.
Talking about health: Correction employees’ assessments of obsta-
cles to healthy heaving. Journal of Occupational and Environmental
Medicine, 53(9):1037-1045.
6 Konda, S., A. Reichard and H. Tiesman. 2012. Occupational inju-
ries among U.S. correctional officers, 1999-2008. Journal of Safety
Research, 43(3):181-186.
7 Kuehl, K.S., D.L. Elliot, L. Goldberg, D.P. MacKinnon, B.J. Vila, J.
Smith, M. Mioevic, H.P. O’Rourke, M.J. Valente, C. DeFrancesco, A.
Sleigh and W. McGinnis. 2014. The safety and health improvement:
Enhancing law enforcement departments study: Feasibility and
findings. Frontiers in Public Health, 2:38.
8 Morse, T. et al. 2011.
9 Obidoa, C. et al. 2011.
10 Murphy, L.R. 1996. Stress management in work settings: A
critical review of the health effects. American Journal of Health Pro-
motion, 11(2):112-135.
11 O’Neill, S. and L. O’Driscoll. 2014. Metabolic syndrome: A clos-
er look at the growing epidemic and its associated pathologies.
Obesity Review, 16(1):1-12.
12 Bower, J. 2013.
13 Violanti, J.M. et al. 2013.
14 Violanti, J.M., C.M. Burchfiel, D.B. Miller, M.E. Andrew, J. Dorn,
J. Wactawski-Wende, C.M. Beighley, K. Pierino, P.N. Joseph, J.E.
Vena, D.S. Sharp and M. Trevisan. 2006. The Buffalo Cardio-met-
abolic Occupational Police Stress (BCOPS) pilot study: Methods
and participant characteristics. Annals of Epidemiology, 16(2):148-
156.
15 Violanti, J.M. et al. 2013.
16 Portland State University. 2014. 2014 national symposium on
corrections worker health – full version. Retrieved from www.
youtube.com/watch?v=Tn8sIbh_CgY&.
17 Portland State University. 2014. 2014 national symposium on
corrections worker health: Conference materials. Portland, Ore.:
Portland State University. Retrieved from www.ohsu.edu/xd/
research/centers-institutes/oregon-institute-occupational-health-
sciences/oregon-healthy-workforce-center/education-outreach/
upload/Conference-materials-FINALsm.pdf.
18 Bower, J. 2013.
19 Robertson, M., R. Henning, N. Warren, S. Nobrega, M.
Dove-Steinkamp, L. Tibirica, A. Bizarro and CPH-NEW Research
Team. 2013. The intervention design and analysis scorecard: A
planning tool for participatory design of integrated health and
safety interventions in the workplace. Journal of Occupational and
Environmental Medicine, 55(12):86-88.
Diane Elliot, M.D., and
Kerry Kuehl, M.D., Dr.P.H.,
are professors of medicine
in the Division of Health
Promotion and Sports Med-
icine at Oregon Health
and Science University.
Both are faculty inves-
tigators at the Oregon
Health Workforce Center,
a Total Worker HealthTM
Center of Excellence fund-
ed by the National Insti-
tute of Safety and Health.
Mazen El Ghaziri, Ph.D.,
M.P.H., R.N., is a postdoctoral fellow at the Center for
the Promotion of Health in the New England Workplace,
another Total Worker HealthTM Center of Excellence, and
the Division of Occupational and Environmental Medi-
cine at the University of Connecticut Health Center. Martin
Cherniack, M.D., M.P.H., is a professor of medicine in the
Division of Occupational and Environmental Medicine
at the University of Connecticut Health Center and co-
director of the Center for the Promotion of Health in the New
England Workplace.
