AIRWAVE HEALTH MONITORING STUDY

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Datasets: + COVID-19 UK Non-hospital Antigen Testing Results (Pillar 2); + COVID-19 Vaccination Status; + Emergency Care Data Set (ECDS); + Hospital Episode Statistics Accident and Emergency (HES A and E); + Hospital Episode Statistics Admitted Patient Care (HES APC); + Hospital Episode Statistics Critical Care (HES Critical Care); + Hospital Episode Statistics Outpatients (HES OP); + Mental Health Minimum Data Set (MHMDS); + Mental Health Services Data Set (MHSDS)

Objective for processing

**This Agreement permits the retention and continued processing of data already held. No new data will flow and there is no change to purpose** Imperial College London requires access to NHS England data for the purpose of the following research project: Airwave health monitoring study. Imperial College London are the data controller for the AIRWAVE Health Monitoring Study (AHMS) which was established in 2003 to evaluate possible health risks associated with the use of Terrestrial trunked radio (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. It addresses needs raised in a report by the Advisory Group on Non-Ionising Radiation (AGNIR) on the possible health effects from TETRA. The following is a summary of the aims of the research project provided by Imperial College London: This is the largest study in the world of this occupational group, the police force. Not only are they exposed to the use of the radio system, but being an emergency service and first responder, they are exposed to stress, physical challenges/violence, shift work leading to lack of exercise and poor diet. Many have a sedentary lifestyle which may lead to poor health outcomes. The AIRWAVE study aims to investigate the social and environmental factors which underlie chronic health conditions in this occupational group, including mental health issues, cancer, cardio-metabolic disease and dementia. The Airwave Health Monitoring Study was established to evaluate possible health risks associated with the use of Terrestrial trunked radio (TETRA), a digital communication system used by the police forces 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 has the ability to monitor both cancer and non-cancer health outcomes. The original and continuing aim of the study is to estimate the risk of all cancers, certain mortality outcomes and various non-fatal, non-malignant health disorders in relation to TETRA exposure as well as other risk factors (lifestyle, environmental or genetic). The main focus of the study is on cancer incidence but it will also investigate non-cancer health outcomes (including cardiometabolic, cognitive, neuropsychiatric and neuro-degenerative effects which may be linked to sickness absence and early retirements). There are currently 53,245 participants in the Study (including the Scottish members). This is the largest study in the world of this occupational group. Not only are they exposed to the use of the radio system, but being an emergency service and first responder, they are exposed to stress, physical challenges / violence, shift work leading to lack of exercise and poor diet. Many have a sedentary lifestyle which may lead to poor health outcomes. The Airwave study aims to investigate the social and environmental factors which underlie chronic health conditions in this occupational group, including mental health issues, cancer, cardio- metabolic disease and dementia. The cohort consists of police force employees from Great Britain and c. 53,000 participants are enrolled. Only c. 45,000 participants are flagged by NHS England as the balance live in Scotland. The team continue to estimate the risk of all cancers, certain mortality outcomes and various non-fatal, non- malignant health disorders in relation to TETRA exposure as well as other risk factors (lifestyle, environmental or genetic). This includes cancer incidence but it will also involve the investigation of non-cancer health outcomes including cardiometabolic, cognitive, neuropsychiatric and neuro-degenerative effects (which may be linked to sickness absence and early retirements among other stressors). University of Glasgow, University of Edinburgh and University of Manchester are collaborators on the AIRWAVE Study. A collaboration agreement is in place between Imperial College London and these organisations, permitting relevant staff from these three organisations to access data from the Study. Principally, this relates to questionnaires and surveys completed by members of the cohort, and health screening data collected by the Study team. These collaborating organisations are not responsible for decision making about data collection protocols including the nature of data requested from NHS England as part of this Agreement and are not considered data controllers for the purpose of this Agreement It is recognised that the cohort also provides a valuable opportunity for broader research into risk factors for common diseases affecting a well-defined occupational group. As such, the Airwave Study was approved as a Tissue Bank for broader research into common diseases in 2013, and this was renewed for five years in 2019 and again in 2024. The Police Federation of England and Wales is the statutory staff association for police constables, sergeants, inspectors, and chief inspectors in the forty-three territorial police forces in England and Wales. As the study cohort is based around current and former police officers and staff, representation from the Police Federation was an important part of the study's governance process. A representative from the Police Federation is on the study's access committee, and they play a role in deciding the types of research that the cohort should support. Imperial College London does not have any formal contract agreement with the Police Federation. The Police Federation do not make any decisions regarding the collection or processing of data under this Agreement and will only access aggregated data with small number suppressed. They are therefore not a data controller for the study. The following NHS England Data will be accessed: Imperial College London have used participants' personal identifiers to register the AIRWAVE cohort at University of Swansea’s SAIL databank. SAIL stands for Secure Anonymised Information Linkage and is a databank hosted by University of Swansea. The purpose of sharing the AIRWAVE study data to SAIL is to enable linkage of the AIRWAVE study data with Welsh Health records held in SAIL (such as Digital Health and Care Wales (DHCW), Public Health Wales and ONS). This linked data is currently available only to the AIRWAVE Study team and no-one else can access this data. This linked data enriches the study data, enabling a broader analysis across both England and Wales. A data sharing agreement between Imperial College London and Swansea University is in place covering this flow of data from Swansea University to DHCW. The personal identifiers used to fulfil this registration process included participants' NHS numbers supplied to Imperial College London by NHS England, and other personal identifiers (such as name and Date of Birth) obtained by Imperial College London from participants directly, but which may have been subsequently updated or corrected by NHS England. Imperial College London also provided a pseudonymising ID to University of Swansea/SAIL to enable the linkage of the Welsh healthcare data to the pseudonymised research data. University of Swansea/SAIL do not onward share any AIRWAVE study data with any third party or use it for any purpose other than that described here. • Hospital Episode Statistics - necessary to investigate whether a link exists between lifestyle and occupational exposures including TETRA radio use and adverse health outcomes, such as cardiovascular disease, stroke, diabetes, dementia and mental health diseases. Some data has already been made available to Imperial College London from University of Swansea/SAIL, and will be used in analysis to meet the objectives under this Agreement. o Admitted Patient Care The AIRWAVE Study is currently funded by a NIHR BRC grant which commenced on 1st April 2017 and an MRC programme grant which commenced on 1st July 2018. The funders do not make any decisions regarding the data under this Agreement and will only have access to aggregated outputs with small numbers suppressed. o Accident & Emergency Steering Group: o Critical Care When the AIRWAVE study was established in 2003, it was funded exclusively by the Home Office. They set up a Steering Group as the decision-making body governing the operation of the Study, subject only to the contract between Imperial College London and Home Office defining the aims of the project. It comprised officials responsible for commissioning the research into the Airwave radio system, representatives of working Police officers and staff at all levels, and independent scientific experts. Home Office funding ended in 2019 and the steering group was wound up. The Steering Group would review research reports destined for publication that included highly aggregated analyses of NHS England data were shared with the chair and independent scientific members of the Steering Group. No participant-level cohort data was ever shared with the Steering Group, and they have never been a data controller or data processor for the purpose this Agreement o Outpatients The datasets previously accessed: • Mental Health – necessary to investigate any association with such factors including psychological distress and effects on common mental health disorders. i. Cancer Registration data details of any cancers participants are registered as having; • Civil Registration Mortality – necessary to evaluate cause-specific mortality in cancers and other chronic diseases in relation to between genetic, lifestyle, environmental and occupational exposures including TETRA radio use. Further, if a participant passes away during the study, it is important that the study is notified of this to ensure that the participant’s family are not contacted regarding study developments. ii. Civil Registration Mortality data details of participants deaths including date and cause; • Cancer Registration – necessary to investigate whether a link exists between lifestyle and occupational exposures including TETRA radio use, and cancer. iii. NHS Registration Data from the Personal Demographic Service details of changes to participants demographics, postal addresses or registered GP practices. • COVID-19 Pillar 2 and vaccination data – as a front-line public facing occupation the police were potentially at increased risk of COVID-19 during the first two years of the pandemic. Thousands of Airwave participants took part in our COVID-19 studies of infection risk and it is important now to investigate the long-term impact on health among this workforce. The Pillar 2 and vaccination data will enable these to be factored into our analyses of health risks among Airwave participants.• Demographics – necessary to continue long-term follow up, indicator of lifetime social class/environmental exposures, and to enable data linkages. AIRWAVE is a national UK study, so the data requested reflects the geographical spread of the cohort across the UK. The level of the Data will be: The AIRWAVE study requires long-term prospective follow-up of the health of the cohort. Previous studies of potential causal factors have been hampered by highly heterogeneous samples, a lack of longitudinal information and appropriate phenotyping, and a reduced ability to make directional or causal inferences. • Identifiable – necessary to link to consented participants. The AIRWAVE study accessed cancer registration and mortality data linked to the cohort participants to allow the researchers to perform statistical analysis to investigate whether a link exists between lifestyle and occupational exposures including TETRA radio use, and cancer. Mortality data was linked to the cohort participants to evaluate cause-specific mortality in cancers in relation to between genetic, lifestyle, environmental and occupational exposures including TETRA radio use. Also if a participant passed away during the study, it is important that the study is notified of this to ensure that the participant’s family are not contacted regarding study developments. NHS Registration data (from the Personal Demographic Service (PDS)) i.e. details of changes to participants’ demographics, postal addresses or registered GP practices, was used to maintain as accurate information as possible about participants contact details (including postal address) and registered GP practice. The Data will be minimised as follows: Data previously uploaded to NHS England for linkage is limited to cohort participants who consented for linkage to health data, and these participants have not withdrawn consent for linkage to health data. • Limited to a study cohort of 53245 participants recruited from police forces, who consented to participate. The processing of this data falls under the General Data Protection Regulation Article 9 (2)(j) – processing necessary for archiving purposes in the public interest, scientific or historical research purposes for statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject: Imperial College London is a public authority with statutory research purpose. Public authorities with research as either an incorporated or statutory purpose (including NHS organisations, Universities and Research Council Institutes) may process personal data where necessary to fulfil their public research function. • Limited to data between 2003 to latest available Additionally the General Data Protection Regulation Article 6 (1)(e) – processing is necessary for the performance of a task carried out in the public interest: Research findings of AHMS will enable evaluation of UK health policy advice to use of terrestrial trunked radio use. • Limited to the following geographic areas: England/Wales Imperial College London is the research sponsor and the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above. The lawful basis for processing personal data under the UK GDPR is: Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; The lawful basis for processing special category data under the UK GDPR is: Article 9(2)(j) - processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject. This processing is in the public interest because it adheres to the UK Policy Framework for Health and Social Care Research, which protects and promotes the interests of patients, service users and the public, and aims to produce generalisable and publicly available information to inform future decisions over patients’ treatments or care. The funding is provided by NIHR. The funding is for the department and is not specifically limited to the study described. The funder will have no ability to suppress or otherwise limit the publication of findings. Data will be accessed by: • Substantive employees of Imperial College London • Contractors – provide details; Some IT support is provided by contractors who are contracted to Imperial College London and have to comply with all the training requirements and the same conditions of access as Imperial College London own staff. • Masters or PhD students enrolled with Imperial College London. Any student working with the Data held under this Data Sharing Agreement (DSA) must have completed relevant data protection and confidentiality training and are subject to Imperial College London’s policies on data protection and confidentiality. Any students accessing the Data will do so under the supervision of a substantive employee of Imperial College London. Imperial College London would be responsible and liable for any work carried out by students. These students would only work on the Data for the purposes described in this DSA. Individuals holding an honorary contract under the supervision of a substantive employee of Imperial College London for the purposes described in this DSA only. Imperial College London must maintain records in a single location that cover the following details of each individual given access under an honorary contract: • Their substantive employer; • Their role in respect of the purpose for the processing specified in the DSA; • The start date and end date of the duration in which the Data will be accessed by the individual under an honorary contract; • The necessity for the Data to be accessed by the person(s) holding an honorary contract, instead of a substantive employee of an organisation named as controller or a processor in this DSA; • Confirmation that an appropriate contract is in place which follows the relevant guidance and is countersigned by the substantive employer of the honorary contract holder. Airwave Scientific Advisory Group (ASAG): A Scientific Advisory Group has been established for the study, replacing the original Steering Group, whose primary purpose is to advise the Airwave Health Monitoring Study’s (Airwave Study) Principal Investigator, research team and senior academic partners on the overall strategy and scientific direction of the study. The membership comprises experts from relevant scientific disciplines at an appropriate senior level and with the expertise necessary to discharge the functions of the ASAG. The Police Federation of England and Wales is the statutory staff association for police constables, sergeants, inspectors, and chief inspectors in the forty-three territorial police forces in England and Wales. As the study cohort is based around current and former police officers and staff, representation from the Police Federation was an important part of the study's governance process. There is representation by two senior members of the police force, and they play a key role in deciding the types of research that the cohort should support. Imperial College London does not have any formal contractual agreement with the Police Federation. The Police Federation do not make any decisions regarding the collection or processing of data under this Agreement and will only access aggregated data with small number suppressed. They are therefore not a data controller for the study. A Participant Advisory Group has been established for the study in order to actively involve participants in shaping the research process, ensuring their voices are considered, and ensure that the research is relevant to participants and the community more broadly. By engaging participants, we aim to enhance the quality, relevance, impact, implementation, and ethical considerations of our research endeavours.

Processing activities

Imperial College London previously uploaded a cohort with personal identifiers to NHS England as required by the NHS England upload template. These identifiers included NHS Number, date of birth, sex, postcode, and name. A study specific participant identifier was uploaded for each record. NHS England provided linkage between the cohort and the requested datasets. These data were securely transferred to Imperial College London and stored in a managed secure enclave. Imperial College London will transfer data to NHS England. The secure enclave hosting these data is only accessed by users who are substantively employed by the data controller. Users must have an active Imperial College London user login account. Users must complete data protection and security training before they are granted access to the secure enclave. The secure enclave is accessed using remote desktop from machines that are tested for security compliance as part of the connection procedure. Remote desktop connections use secure connection. The remote connection provides a view of the data with all processing contained within the secure enclave. Transfers between the enclave are limited to authorised users, and transfers with the secure enclave are audited. The data will consist of identifying details specifically NHS Number, Date of Birth, Postcode, Gender, Name, and a unique person ID for the cohort to be linked with NHS England data. Record level data from this Agreement will remain in the secure enclave, data environment for data processing and analysis. Only non-personal data such as aggregated data, graphs, and tables with small numbers suppressed are transferred out of the secure enclave by authorised users. All transfers with the secure enclave are audited. NHS England will provide the relevant records from the mortality, HES data, Cancer Registrations, demographics mental health and COVID-19 data to Imperial College London. Except as described below, no third parties will be allowed to access any data provided under this Agreement. The Data will NHS England data is linked to AIRWAVE study data and anonymised data obtained from DHCW and NHS Scotland that are as close as possible in content to the data being supplied under this Agreement, but which relate to cohort members from Wales and Scotland. No other datasets held by Imperial College will be linked to NHS England data. • contain directly identifying data items including Names, NHS Number, Date of Birth, Postcode, Gender which are required to link the Data at record level with data already held by the recipient. AIRWAVE usage data from each participant has been collected from monthly downloads of relevant data from the Home Office, giving information on exposure to Tetra radiation at an individual level. These have been combined with questionnaire data about participants' use of Airwave to derive a TETRA exposure metric. The Data will not be transferred to any other location. Participants’ health outcomes are assessed by linking information on individuals to national records on mortality and cancer incidence, and from absence records supplied by the police force employers. Health outcomes (cancer and all-cause mortality) are received as part of this Agreement and are stored and linked to existing participant data. The Data will be stored on servers at Imperial College London Certified Secure Research Environment (CSRE). Data from this Agreement will remain in a secure enclave environment. Internet access is not available to users while working in this secure enclave. Administrators of the secure enclave are still able to apply the latest security updates from trusted sources such as Microsoft and Oracle. Virtus Secure Data Centre Limited host the Imperial College London data servers. Virtus Secure Data Centre Limited is not permitted to access the Data. Users connect to the secure enclave using remote desktop. The secure enclave only accepts connections from approved users with security compliant workstations. Users only have a screen view of the data by default. File transfers are restricted to specified users, but this is for the upload of scripts and transfer of nonpersonal data (such as graphs and aggregated tables). All data transfers are recorded and kept for audit purposes by a staff member who has the role of “internal auditor”. The internal auditor monitors compliance of the Information Governance Policy including all agreements the groups have with external groups. The Data will be accessed by authorised personnel via remote access. When the Study is completed and closed to further analysis, the data will be archived securely and for such time as is necessary to provide proper audit for published research. The data will be securely destroyed when no further use is required of it. The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract. Virtus SDC are a provider of server hosting services that provide the space, power and environmental controls. They have no access to the underlying data other than as an encrypted filesystem to which they have no access key. For remote access: Except as described below, no third parties will be allowed to access any data provided under this agreement. - Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA; Airwave Study is working with Dementia Platform UK (DPUK), a public-private partnership funded by the Medical Research Council (for more information on DPUK, please refer to https://www.dementiasplatform.uk/). - Access controls granting users the minimum level of access required are in place; DPUK are working with the NHS Wales Informatics Service (NWIS) and the SAIL Databank (https://saildatabank.com/) to make available a variety of health-related data to cohorts such as ours. The Airwave Health Monitoring Study believe that this type of linkage is covered by the participants’ existing consent through reasonable expectations. - Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data; NWIS have an established procedure for linking cohorts to their health data that makes minimal use of personally identifiable data. Essentially, there is a one-time sharing of participants’ names, dates-of-birth, gender and NHS Numbers in order to establish a pseudonymised key through which all subsequent data interchange is based. The data shared by NWIS, along with the Airwave research data (but not health-outcome data provided by NHS England), will be held on servers operated by SAIL. - Multifactor authentication (MFA) is required for remote access; - Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access; - All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy. The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose). Remote processing will be from secure locations within the UK. The data will not leave UK at any time. All personnel accessing the Data have been appropriately trained in data protection and confidentiality. The Data will be linked at person record level with research data collected by the Study, a summary of the types of which are described at https://police-health.org.uk/data-dictionary-version-2. Airwave radio usage data from each participant has been collected from monthly downloads of relevant data from the Home Office, giving information on exposure to TETRA radiation at an individual level. These have been combined with questionnaire data about participants' use of Airwave to derive a TETRA exposure metric. Also, data from absence records supplied by the police force employers. There will be no requirement and no attempt to reidentify individuals when using the Data. The identifying details will be stored in a separate database to the linked dataset used for analysis. Analysts from the Imperial Biomedical Research Centre will analyse the Data for the purposes described above.

Expected output

The aim of the Airwave Health Monitoring Study (AHMS) is to examine associations between risk factors and the risk of cancer outcomes, other chronic disease and all cause and cause specific mortality among members of Police forces in Great Britain. The expected outputs of the processing will be: The Airwave Health Monitoring Study also provides a rare and timely opportunity to investigate the causes and ameliorating (resilience) factors associated with occupational stress and mental health difficulties in a defined population of serving police officers and staff. Using the extensive baseline data and the planned additional mental health measures, coupled with routinely available data harnessed through record linkage, a series of analyses may be performed to identify the main environmental and stressful factors in the British police forces, how they interact with non-occupational stress and the strength of association with psychological distress and common mental health disorders. The genetic data in AHMS also allows an investigation into how an individual’s genetic and environmental propensity to common mental disorders (e.g. anxiety and depression) interact with stressful occupational factors to modify the risk of mental health disorders. In addition, the study also aims to identify which personal (e.g. coping style, resilience, alcohol use) and workplace factors mitigate the risk (i.e. foster resilience) of mental health disorders and work absenteeism following stressful occupational experiences. • A report of findings to the scientific community, medical professionals, Police, Home Office and the general public. Findings of this research project will be published in peer-reviewed scientific journals (subject to acceptance) and in summary form on the study website (https://www.police-health.org.uk/publications). All such outputs will report aggregated results only with small numbers suppressed, and no individual will ever be identified. • Submissions to peer reviewed journals The recruitment phase was completed on the 31st of March 2015. The report describing short term outcomes (median 5.9 years) has been published (Gao et al 2018, British Journal of Cancer). However, the follow up and data analysis phase continue which is essential for further cases to accrue with concomitant improvement in precision. The target date for submission of updated scientific outcomes papers (in peer reviewed journals) on any possible mid to long-term health implications for Police personnel related to use of Airwave (the main purpose of the Study) will be 2025. • Presentations at high-profile international epidemiology conferences (e.g. NIHR HPRU meetings, Bioelectromagnetics Society, International Society for Environmental Epidemiology which attract researchers, practitioners, regulators, governmental authorities and industry), the UK Occupational and Environmental Epidemiology (OEE) Meeting, British Association of Public Safety Communications Officials “BAPCO” and the public Imperial Festival. The Airwave study team expect that all of the papers will, subject to acceptance, be published in high impact peer review journals of epidemiology, occupational and environmental health. The target audience for these papers are the scientific community, medical professionals, Police, Home Office and the general public. • presentations at Police Federation Conferences, In addition to scientific papers, other outputs expected are: • presentations outlining the project’s findings regarding the relationship between TETRA use and health outcomes at high-profile international epidemiology conferences (e.g. NIHR HPRU meetings, Bioelectromagnetics Society, International Society for Environmental Epidemiology which attract researchers, practitioners, regulators, governmental authorities and industry), the UK Occupational and Environmental Epidemiology (OEE) Meeting, British Association of Public Safety Communications Officials “BAPCO” and the public Imperial Festival. Target dates for these presentations are the same as those for the published reports regarding the respective health outcomes. [1 paragraph unchanged] • ResearchFIsh – annually • Research Fish • dissemination of the project’s findings to wider stakeholders • lay executive summaries of published reports on the Airwave study website(https://www.police-health.org.uk/publications), aimed at study participants, police personnel more generally and the wider public and scientific community. • lay executive summaries of published reports on the Airwave study website, aimed at study participants. Target dates: same as those for the published reports regarding the respective health outcomes. Imperial College London will produce and publish scientific reports quantifying the effects of COVID-19 on police health and interactions with other occupational stressors which will place the effects of the COVID-19 pandemic in a wider context. They will also investigate and publish the molecular basis for understanding who was at particular risk of long-term health issues related to the pandemic period. Outputs relevant to the health of the police force will be shared with the Police Federation representing the participants and with the Home Office concerning the policy response. Specifically, a Police Federation representative sits on the Data Access Committee as a conduit for the results to the wider police community. The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived. Outputs will only include aggregate data with small numbers suppressed, and will not reveal individually identifiable data. Disseminations also include presentations at Police Federation Conferences, press release, media engagement. The outputs will be communicated to relevant recipients through the following dissemination channels: The study team have sent newsletters to participants (also published on the study website) in 2016, 2019 and 2022. • Journals of epidemiology, occupational and environmental health. The study team aim to produce multiple papers per annum over the course of the project. • Public reports • Direct bilateral engagement with NO • Patient Information leaflets available at [give details]NO • Public promotion of the researchvia NIHR HPRU and UKHSAif appropriate• Participant newsletters YES • Reports aimed at [participants through newsletters and website • press release when appropriate • media engagement when appropriate The target date for submission of updated scientific outcomes papers (in peer-reviewed journals) on any possible mid-term health implications for Police personnel related to use of Airwave is 2027; and at least 2032 to investigate longer-term effects.

Expected measurable benefits

(1) Safety of Airwave. The primary objective of the Study is to ascertain whether or not there is any link between use of Airwave and the long-term health of its users. Were such a link identified, it would be relevant and important to both Airwave users and management to understand in what circumstances risks might be increased. Alternatively, a finding of no demonstrable effect would be reassuring to the Airwave user community and would place any current and future concerns about possible health effects into proper context based on objective evidence. The study team have published on cancer risk to data showing a small excess cancer risk among users of Airwave which was unlikely to be the result of use of Airwave. The study team have detected changes in the EEG and ECG which are physiological effects which are likely to be the results positioning of the radio on the chest and the stimulation of the vagal nerve. Although having physiological effects not detrimental health outcomes are anticipated long term monitoring of the health of the cohort will continue. The study team also detected a small but non-significant cancer risk associated with greater use of the radio amongst users which requires continued follow up of the cohort. In other work the study team have shown effects of genetic risk of elevated blood pressure and on alcohol use. Research findings will enable evaluation of UK health policy advice to use of terrestrial trunked radio use. (2) Helping future generations. The study is generating new knowledge of benefit not only to police officers and staff as individuals, but to the wider community and to society as a whole. Analyses of data and samples will help to better understand the risks and causes of future diseases and ill health, and thus inform improved preventive and treatment strategies. There are many special aspects of the Airwave cohort including the occupational setting, given the particular nature of police duties and working patterns, the relatively young age of the cohort, and the inclusion of large numbers of women as well as men, which make this study uniquely valuable. The results generated from the use of this resource will inform future policy and practice both for the betterment of police force health and for the health of the public more generally. The benefits on health will be assessed on epidemiological analysis, translating those benefits to the health of the Police Force will be done by advocacy through the Home Office, Senior Police Staff and the Police Federation. The results will also feed into wider benefits for the population at large and into policies for improved health eg through dietary recommendations and lifestyle changes. The use of the data could : (3) Clarity in respect of health effects of long-term use of radio frequency technology. Continuing to gather the data necessary to undertake and report on the Study’s analyses of Airwave use and health will allow the potential long-term health effects to be better understood, and to place any future claims of possible harm into proper context based on the evidence. The findings would be relevant to, and inform, strategic decisions about future investment in radio communications systems within the Police Service. • help the system to better understand the health and care needs of police force. (4) Responsibility to the health and welfare of the workforce. Policing is a highly complex occupation with specific patterns of working and occupational risks with potential health effects that are not well understood. The Study has established a ‘broad and deep’ biomedical resource with which to continue to monitor the health and well-being of the workforce, and to help understand the causes and risks of ill-health and disease. Results will inform possible preventive approaches and best practice for maintenance of a healthy and engaged workforce. • lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience. • advance understanding of regional and national trends in health and social care needs. • advance understanding of the need for, or effectiveness of, preventative health and care measures for particular populations or conditions such as obesity and diabetes. • support knowledge creation or exploratory research (and the innovations and developments that might result from that exploratory work). The genetic data in AHMS also allows an investigation into how an individual’s genetic and environmental propensity to disease and common mental disorders (e.g. anxiety and depression) interact with occupational factors to modify the risk of adverse health outcomes including mental health disorders. In addition, the study aims to identify which personal (e.g. smoking, coping style, resilience, alcohol use) and workplace factors mitigate the risk (i.e. foster resilience) of disease and mental health disorders and work absenteeism. Based on the above analyses, the study will deliver a comprehensive account of occupational stressors, risk factors and potential confounding effects experienced by this front-line workforce and their links to health outcomes and wellbeing. This will inform and feed into improved working conditions and practices within the British Police Forces to maintain and protect health of the workforce. The recruitment phase was completed on the 31st of March 2015. A report describing cancer incidence in relation to TETRA radio use over a median period of 5.9 years has been published (Gao et al 2018, British Journal of Cancer). We are now in the process of updating this analysis with more recent data and it is essential that the follow-up and data analysis phase continue to allow further cases to accrue with concomitant improvement in precision and longer-term follow-up. Outputs relevant to the health of the police force will be shared with the Police Federation representing the participants and with the Home Office concerning the policy response. Specifically, as noted, a Police Federation representative sits on the Data Access Committee as a conduit for the results to the wider police community. Long-term health issues related to the pandemic period- Understanding these complex issues and their long-term outcomes will enable lessons to be learnt and interventions to be implemented for pandemic planning to protect the health of these and other front-line personnel. Understanding the molecular basis of resulting long-term ill health may lead to improved treatment and preventative strategies.

Benefits reported

The use of the NHS England data to maintain the cohort of participants in the AIRWAVE Airwave study has supported more than 120 research projects, resulting in more than 60 publications. over 80 publications to date and has contributed to the evidence base for decision makers. Details can be accessed here: https://police-health.org.uk/publications. Examples of key publications are: • A paper in 2017 on the genetic basis of high-blood pressure was [6 words unchanged] genomes of a million people of European ancestry, the Airwave Study being but one of many cohorts contributing to the result. result, and crucially providing high-quality replication data. It found 535 novel blood pressure loci that not only offer new [6 words unchanged] but also highlight shared genetic architecture between blood pressure and lifestyle exposures. The findings identify new biological pathways for blood pressure regulation with potential for improved cardiovascular disease prevention in the future. In August 2019, an original research article on the use of TETRA personal radios and risk of sickness absence in the journal Environmental Research was published. No previous study has investigated the possibility of longer-term exposures to TETRA and subsequent occurrence of symptoms or ill-health which might lead to increased rates of sickness absence from work. The paper is here: https://www.sciencedirect.com/science/article/pii/S0013935119302646?via%3Dihub The findings identify new biological pathways for blood pressure regulation with potential for improved cardiovascular disease prevention in the future. Published in December 2018 in the British Journal of Cancer, this is the first analysis of whether there is a correlation between the use of the Airwave radio system and the long-term risk of cancer to its users. The paper can be accessed at https://rdcu.be/be9jR. Because the paper is published in a scientific journal and is aimed at an audience of scientific professionals, some of the language is necessarily technical. However, the conclusions drawn and the short discussion should still be accessible to a lay audience. • A publication in 2019 on the interaction between HbA1c (a component of blood used to identify diabetes), diet and genome A publication in 2019 on the interaction between HbA1c (a component of blood used to identify diabetes), diet and genome, highlights The findings highlight the importance of a healthy diet high in wholegrains along with maintaining a healthy weight in controlling HbA1c and risk of diabetes among high-genetic-risk groups. The mental health of emergency services personnel has become a key area of concern in recent years. This paper, however, indicates lower rates of mental disorders than reported in other studies focusing on police employees. Although mental ill health was associated with increased diastolic blood pressure, the authors conclude that it was unlikely to be clinically significant. • A paper on diet published in 2018: ‘A cross-sectional investigation into the occupational and socio- demographic characteristics of British police force employees reporting a dietary pattern associated with cardiometabolic risk: findings from the Airwave Health Monitoring Study’ A paper on diet published in 2018: ‘A cross-sectional investigation into the occupational and socio-demographic characteristics of British police force employees reporting a dietary pattern associated with cardiometabolic risk: The findings from the Airwave Health Monitoring Study’; concludes concluded that the disparities in diet quality found in the general populations of [17 words unchanged] job strain with diet quality supports the targeting of workplace nutritional interventions. • Elliott P et al. Environ Res 2019;175:148-55. Personal radio use linked to sickness absence (SA) records (32,102 participants) showed no difference in SA for radio users vs non-users. • Stevelink SAM et al. PLoS One 2020;15:e0240902. Police employees exposed to traumatic incidents in the past 6 months had a 6-fold increase in PTSD vs. those with no recent trauma. • Davies B et al. Open Forum Infect Dis 2021;8:ofab496. Similar performance comparing self- and nurse-administered LFTs for SARS-CoV-2 antibodies among police and other key workers. • Dehghan A et al. PNAS 2022;119:e2206083119. Metabolome-wide association study on ABCA7 gene indicates a role for ceramide metabolism in Alzheimer's disease.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

The Airwave Health Monitoring Study was established in 2003 to evaluate possible health risks associated with the use of Terrestrial trunked radio (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. It addresses needs raised in a report by the Advisory Group on Non-Ionising Radiation (AGNIR) on the possible health effects from TETRA. There are currently c. 53,000 participants in the Study (including the Scottish members). **This Agreement permits the retention and continued processing of data already held. No new data will flow and there is no change to purpose** It is recognised that the cohort also provides a valuable opportunity for broader research into common diseases affecting a well-defined occupational group. As such, the Study was approved as a Tissue Bank for broader research into common diseases in 2013, and this was renewed for five years in February 2019. Imperial College London are the data controller for the AIRWAVE Health Monitoring Study (AHMS) which was established in 2003 to evaluate possible health risks associated with the use of Terrestrial trunked radio (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. It addresses needs raised in a report by the Advisory Group on Non-Ionising Radiation (AGNIR) on the possible health effects from TETRA. The original and continuing aim of the study is to estimate the risk of all cancers, certain mortality outcomes and various non-fatal, non-malignant health disorders. As well as the focus on cancer incidence, the study will investigate non-cancer health outcomes (including cognitive, neuropsychiatric and neuro-degenerative effects which may be linked to sickness absence and early retirements). This is the largest study in the world of this occupational group, the police force. Not only are they exposed to the use of the radio system, but being an emergency service and first responder, they are exposed to stress, physical challenges/violence, shift work leading to lack of exercise and poor diet. Many have a sedentary lifestyle which may lead to poor health outcomes. The AIRWAVE study aims to investigate the social and environmental factors which underlie chronic health conditions in this occupational group, including mental health issues, cancer, cardio-metabolic disease and dementia. The cohort consists of police force employees from Great Britain and c. 53,000 participants are enrolled. Only c. 45,000 participants are flagged by NHS Digital as the balance live in Scotland. Participants are flagged for mortality and cancer incidence. The original and continuing aim of the study is to estimate the risk of all cancers, certain mortality outcomes and various non-fatal, non-malignant health disorders in relation to TETRA exposure as well as other risk factors (lifestyle, environmental or genetic). The main focus of the study is on cancer incidence but it will also investigate non-cancer health outcomes (including cardiometabolic, cognitive, neuropsychiatric and neuro-degenerative effects which may be linked to sickness absence and early retirements). The Study uses the personal identifiers of members of their cohort, including NHS Number and those data that have been corrected by NHS Digital, to enable the Airwave study to work with Dementia Platform UK (DPUK). The cohort consists of police force employees from Great Britain and c. 53,000 participants are enrolled. Only c. 45,000 participants are flagged by NHS England as the balance live in Scotland. Imperial College London are the sole data controller and the only organisation that will process data under this data sharing agreement. Under GDPR Article 6, Imperial College London's lawful basis for processing data is 6(1)(e) 'a task in the public interest' as Imperial College London is a public authority and the data will be used for research in the public interest. Under GDPR Article 9, the lawful basis for processing is 9(2)(j) 'scientific or historical research'. University of Glasgow, University of Edinburgh and University of Manchester are collaborators on the AIRWAVE Study. A collaboration agreement is in place between Imperial College London and these organisations, permitting relevant staff from these three organisations to access data from the Study. Principally, this relates to questionnaires and surveys completed by members of the cohort, and health screening data collected by the Study team. These collaborating organisations are not responsible for decision making about data collection protocols including the nature of data requested from NHS England as part of this Agreement and are not considered data controllers for the purpose of this Agreement The Police Federation of England and Wales is the statutory staff association for police constables, sergeants, inspectors, and chief inspectors in the forty-three territorial police forces in England and Wales. As the study cohort is based around current and former police officers and staff, representation from the Police Federation was an important part of the study's governance process. A representative from the Police Federation is on the study's access committee, and they play a role in deciding the types of research that the cohort should support. Imperial College London does not have any formal contract agreement with the Police Federation. The Police Federation do not make any decisions regarding the collection or processing of data under this Agreement and will only access aggregated data with small number suppressed. They are therefore not a data controller for the study. Imperial College London have used participants' personal identifiers to register the AIRWAVE cohort at University of Swansea’s SAIL databank. SAIL stands for Secure Anonymised Information Linkage and is a databank hosted by University of Swansea. The purpose of sharing the AIRWAVE study data to SAIL is to enable linkage of the AIRWAVE study data with Welsh Health records held in SAIL (such as Digital Health and Care Wales (DHCW), Public Health Wales and ONS). This linked data is currently available only to the AIRWAVE Study team and no-one else can access this data. This linked data enriches the study data, enabling a broader analysis across both England and Wales. A data sharing agreement between Imperial College London and Swansea University is in place covering this flow of data from Swansea University to DHCW. The personal identifiers used to fulfil this registration process included participants' NHS numbers supplied to Imperial College London by NHS England, and other personal identifiers (such as name and Date of Birth) obtained by Imperial College London from participants directly, but which may have been subsequently updated or corrected by NHS England. Imperial College London also provided a pseudonymising ID to University of Swansea/SAIL to enable the linkage of the Welsh healthcare data to the pseudonymised research data. University of Swansea/SAIL do not onward share any AIRWAVE study data with any third party or use it for any purpose other than that described here. Some data has already been made available to Imperial College London from University of Swansea/SAIL, and will be used in analysis to meet the objectives under this Agreement. The AIRWAVE Study is currently funded by a NIHR BRC grant which commenced on 1st April 2017 and an MRC programme grant which commenced on 1st July 2018. The funders do not make any decisions regarding the data under this Agreement and will only have access to aggregated outputs with small numbers suppressed. Steering Group: When the AIRWAVE study was established in 2003, it was funded exclusively by the Home Office. They set up a Steering Group as the decision-making body governing the operation of the Study, subject only to the contract between Imperial College London and Home Office defining the aims of the project. It comprised officials responsible for commissioning the research into the Airwave radio system, representatives of working Police officers and staff at all levels, and independent scientific experts. Home Office funding ended in 2019 and the steering group was wound up. The Steering Group would review research reports destined for publication that included highly aggregated analyses of NHS England data were shared with the chair and independent scientific members of the Steering Group. No participant-level cohort data was ever shared with the Steering Group, and they have never been a data controller or data processor for the purpose this Agreement The datasets previously accessed: i. Cancer Registration data details of any cancers participants are registered as having; ii. Civil Registration Mortality data details of participants deaths including date and cause; iii. NHS Registration Data from the Personal Demographic Service details of changes to participants demographics, postal addresses or registered GP practices. AIRWAVE is a national UK study, so the data requested reflects the geographical spread of the cohort across the UK. The AIRWAVE study requires long-term prospective follow-up of the health of the cohort. Previous studies of potential causal factors have been hampered by highly heterogeneous samples, a lack of longitudinal information and appropriate phenotyping, and a reduced ability to make directional or causal inferences. The AIRWAVE study accessed cancer registration and mortality data linked to the cohort participants to allow the researchers to perform statistical analysis to investigate whether a link exists between lifestyle and occupational exposures including TETRA radio use, and cancer. Mortality data was linked to the cohort participants to evaluate cause-specific mortality in cancers in relation to between genetic, lifestyle, environmental and occupational exposures including TETRA radio use. Also if a participant passed away during the study, it is important that the study is notified of this to ensure that the participant’s family are not contacted regarding study developments. NHS Registration data (from the Personal Demographic Service (PDS)) i.e. details of changes to participants’ demographics, postal addresses or registered GP practices, was used to maintain as accurate information as possible about participants contact details (including postal address) and registered GP practice. Data previously uploaded to NHS England for linkage is limited to cohort participants who consented for linkage to health data, and these participants have not withdrawn consent for linkage to health data. The processing of this data falls under the General Data Protection Regulation Article 9 (2)(j) – processing necessary for archiving purposes in the public interest, scientific or historical research purposes for statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject: Imperial College London is a public authority with statutory research purpose. Public authorities with research as either an incorporated or statutory purpose (including NHS organisations, Universities and Research Council Institutes) may process personal data where necessary to fulfil their public research function. Additionally the General Data Protection Regulation Article 6 (1)(e) – processing is necessary for the performance of a task carried out in the public interest: Research findings of AHMS will enable evaluation of UK health policy advice to use of terrestrial trunked radio use.

Processing activities

NHS Digital data is only accessed by substantive employees of Imperial College London and only for the purposes described in this document. NHS Digital data is only linked to AIRWAVE study data and no other datasets held by Imperial College. Imperial College London previously uploaded a cohort with personal identifiers to NHS England as required by the NHS England upload template. These identifiers included NHS Number, date of birth, sex, postcode, and name. A study specific participant identifier was uploaded for each record. NHS England provided linkage between the cohort and the requested datasets. These data were securely transferred to Imperial College London and stored in a managed secure enclave. The secure enclave hosting these data is only accessed by users who are substantively employed by the data controller. Users must have an active Imperial College London user login account. Users must complete data protection and security training before they are granted access to the secure enclave. The secure enclave is accessed using remote desktop from machines that are tested for security compliance as part of the connection procedure. Remote desktop connections use secure connection. The remote connection provides a view of the data with all processing contained within the secure enclave. Transfers between the enclave are limited to authorised users, and transfers with the secure enclave are audited. Record level data from this Agreement will remain in the secure enclave, data environment for data processing and analysis. Only non-personal data such as aggregated data, graphs, and tables with small numbers suppressed are transferred out of the secure enclave by authorised users. All transfers with the secure enclave are audited. Except as described below, no third parties will be allowed to access any data provided under this Agreement. NHS England data is linked to AIRWAVE study data and anonymised data obtained from DHCW and NHS Scotland that are as close as possible in content to the data being supplied under this Agreement, but which relate to cohort members from Wales and Scotland. No other datasets held by Imperial College will be linked to NHS England data. [1 paragraph unchanged] Participants’ health outcomes are assessed by linking information on individual individuals to national records on mortality and cancer incidence, and from absence records supplied by the police force employers. Health outcomes - cancer (cancer and all-cause mortality - mortality) are received as part of this Agreement and are stored and linked to existing participant data. All network traffic is contained within the Imperial College network. A dedicated "dark fibre" link connects the data-centre to the users. Data from this Agreement will remain in a secure enclave environment. Internet access is not available to users while working in this secure enclave. Administrators of the secure enclave are still able to apply the latest security updates from trusted sources such as Microsoft and Oracle. Although Internet access is generally not available to users, security updates to software may still be downloaded from trusted sources such as Microsoft and ORACLE. Users connect to the secure enclave using remote desktop. The secure enclave only accepts connections from approved users with security compliant workstations. Users only have a screen view of the data by default. File transfers are restricted to specified users, but this is for the upload of scripts and transfer of nonpersonal data (such as graphs and aggregated tables). All data transfers are recorded and kept for audit purposes by a staff member who has the role of “internal auditor”. The internal auditor monitors compliance of the Information Governance Policy including all agreements the groups have with external groups. Users connect to the servers via remote desktop. All servers accept connections only from specified users and workstations. Identifiable data will only be accessed from dedicated workstations that sit alongside the users’ college PC. These workstations can only be used to connect to servers holding identifiable data. Data uploading/downloading will be further restricted to specified users and PCs. All data transfers will be recorded and kept for audit purposes by a staff member who has the role of “internal auditor”. The internal auditor will monitor compliance of the Information Governance Policy including all agreements the groups have with external groups. When the Study is completed and closed to further analysis, the data will be archived securely and for such time as is necessary to provide proper audit for published research. The data will be securely destroyed when no further use is required of it. When the Study is completed and closed to further analysis, the data will be archived securely during the life time of the data sharing agreement and for such time as is necessary to provide proper audit for published research. The data will be securely destroyed when no further use is required of it. Virtus SDC are a provider of server hosting services that provide the space, power and environmental controls. They have no access to the underlying data other than as an encrypted filesystem to which they have no access key. [3 paragraphs unchanged] NWIS have an established procedure for linking cohorts to their health data [43 words unchanged] with the Airwave research data (but not health-outcome data provided by NHS Digital), England), will be held on servers operated by SAIL, who have ISO/27001 certification. SAIL.

Expected output

The aim of the Airwave Health Monitoring Study (AHMS) is to estimate examine associations between risk factors and the risk of cancer outcomes, other chronic disease and certain all cause and cause specific mortality outcomes among members of Police forces in Great Britain. As a tissue bank the study also has immense value to look at the long-term general health and well-being of a key front-line service, with impact on both occupational and public health. The Airwave Health Monitoring Study also provides a rare and timely opportunity to investigate the causes and ameliorating (resilience) factors associated with occupational stress and mental health difficulties in a defined population of serving police officers and staff. Using the extensive baseline data and the planned additional mental health measures, coupled with routinely available data harnessed through record linkage, a series of analyses may be performed to identify the main environmental and stressful factors in the British police forces, how they interact with non-occupational stress and the strength of association with psychological distress and common mental health disorders. The genetic data in AHMS also allows an investigation into how an individual’s genetic and environmental propensity to common mental disorders (e.g. anxiety and depression) interact with stressful occupational factors to modify the risk of mental health disorders. In addition, the study also aims to identify which personal (e.g. coping style, resilience, alcohol use) and workplace factors mitigate the risk (i.e. foster resilience) of mental health disorders and work absenteeism following stressful occupational experiences. [1 paragraph unchanged] The recruitment phase was completed on the 31st of March 2015. Recently, the The report describing short term outcomes (median 5.9 years) had has been published (Gao et al 2018, British Journal of Cancer). However, the [46 words unchanged] to use of Airwave (the main purpose of the Study) will be 2022. 2025. We The Airwave study team expect that all of the papers will, subject to acceptance, be published [19 words unchanged] the scientific community, medical professionals, Police, Home Office and the general public. [3 paragraphs unchanged] • ResearchFIsh – annually [2 paragraphs unchanged] Outputs relevant to the health of the police force will be shared with the Police Federation representing the participants and with the Home Office concerning the policy response. Specifically, a Police Federation representative sits on the Data Access Committee as a conduit for the results to the wider police community. Outputs will only include aggregate data with small numbers suppressed, and will not reveal individually identifiable data. Disseminations also include presentations at Police Federation Conferences, press release, media engagement. The study team have sent newsletters to participants (also published on the study website) in 2016, 2019 and 2022. The study team aim to produce multiple papers per annum over the course of the project.

Expected measurable benefits

(1) Safety of Airwave. The primary objective of the Study is to [67 words unchanged] concerns about possible health effects into proper context based on objective evidence. The study team have published on cancer risk to data showing a small excess cancer risk among users of Airwave which was unlikely to be the result of use of Airwave. The study team have detected changes in the EEG and ECG which are physiological effects which are likely to be the results positioning of the radio on the chest and the stimulation of the vagal nerve. Although having physiological effects not detrimental health outcomes are anticipated long term monitoring of the health of the cohort will continue. The study team also detected a small but non-significant cancer risk associated with greater use of the radio amongst users which requires continued follow up of the cohort. In other work the study team have shown effects of genetic risk of elevated blood pressure and on alcohol use. (2) Helping future generations. The study is generating new knowledge of benefit [116 words unchanged] police force health and for the health of the public more generally. The benefits on health will be assessed on epidemiological analysis, translating those benefits to the health of the Police Force will be done by advocacy through the Home Office, Senior Police Staff and the Police Federation. The results will also feed into wider benefits for the population at large and into policies for improved health eg through dietary recommendations and lifestyle changes. [2 paragraphs unchanged]

Benefits reported

Publications resulting from data collected by the Airwave study are available at https://www.police-health.org.uk/publications. The use of the NHS England data to maintain the cohort of participants in the AIRWAVE study has supported more than 120 research projects, resulting in more than 60 publications. Details can be accessed here: https://police-health.org.uk/publications. Examples of key publications are: An initial results paper that is based on the cancers data provided by NHS Digital was recently published. (Gao, H. et al. Personal radio use and cancer risks among 48,518 British police officers and staff from the Airwave Health Monitoring Study. Br J Cancer 120, 375-378, doi:10.1038/s41416-018-0365-6 (2019). https://www.ncbi.nlm.nih.gov/pubmed/30585256). A paper in 2017 on the genetic basis of high-blood pressure was based on an analysis of the genomes of a million people of European ancestry, the Airwave Study being but one of many cohorts contributing to the result. It found 535 novel blood pressure loci that not only offer new biological insights into blood pressure regulation but also highlight shared genetic architecture between blood pressure and lifestyle exposures. The findings identify new biological pathways for blood pressure regulation with potential for improved cardiovascular disease prevention in the future. There is also a list at https://www.police-health.org.uk/research/approved-research of the currently approved set of sub-studies of the main study, and this should give more than a flavour of the use being made of the Airwave resource (data and samples). In August 2019, an original research article on the use of TETRA personal radios and risk of sickness absence in the journal Environmental Research was published. No previous study has investigated the possibility of longer-term exposures to TETRA and subsequent occurrence of symptoms or ill-health which might lead to increased rates of sickness absence from work. The paper is here: https://www.sciencedirect.com/science/article/pii/S0013935119302646?via%3Dihub Published in December 2018 in the British Journal of Cancer, this is the first analysis of whether there is a correlation between the use of the Airwave radio system and the long-term risk of cancer to its users. The paper can be accessed at https://rdcu.be/be9jR. Because the paper is published in a scientific journal and is aimed at an audience of scientific professionals, some of the language is necessarily technical. However, the conclusions drawn and the short discussion should still be accessible to a lay audience. A publication in 2019 on the interaction between HbA1c (a component of blood used to identify diabetes), diet and genome, highlights the importance of a healthy diet high in wholegrains along with maintaining a healthy weight in controlling HbA1c among high-genetic-risk groups. The mental health of emergency services personnel has become a key area of concern in recent years. This paper, however, indicates lower rates of mental disorders than reported in other studies focusing on police employees. Although mental ill health was associated with increased diastolic blood pressure, the authors conclude that it was unlikely to be clinically significant. A paper on diet published in 2018: ‘A cross-sectional investigation into the occupational and socio-demographic characteristics of British police force employees reporting a dietary pattern associated with cardiometabolic risk: findings from the Airwave Health Monitoring Study’; concludes that the disparities in diet quality found in the general populations of England and Scotland is also reflected in British police employees. The association of longer working hours and job strain with diet quality supports the targeting of workplace nutritional interventions.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Datasets: + Cancer Registration Data; + Civil Registrations of Death; + Demographics

Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits, Benefits reported.