Testing the reliability and validity of the modified Amsterdam Inventory for Auditory Disability and Handicap in career firefighters in the United States.

BACKGROUND: Firefighters are routinely exposed to loud noise that put them at risk for hearing loss. A reliable and valid measure to assess firefighters' hearing function is important. This study aims to test the reliability and validity of the modified Amsterdam Inventory for Auditory Disability and Handicap ((m)AIADH) in firefighters. METHOD: A cross-sectional study was conducted using a convenience sample of 239 career firefighters from six partnered fire departments in Central Texas and Northern California. The internal consistency, convergent and criterion validity, and the ability to discriminate groups by measured hearing, perceived hearing, and a combination of measured and perceived hearing, were examined using the total score and score for each of the five subscales of the (m)AIADH. RESULTS: The study participants were primarily men (93%). Satisfactory internal consistency was revealed for the (m)AIADH with Cronbach's alpha above 0.80 for all five subscales. Criterion analysis presented a moderate correlation between the (m)AIADH and the average of hearing threshold at high frequencies (4, 6, and 8 kHz). For convergent validity, the (m)AIADH was moderately to highly related with perceived hearing. There were statistically significant differences in the total (m)AIADH score and the five subscales for measured hearing thresholds except for "intelligibility in quiet." The (m)AIADH also showed a discriminative ability to distinguish between the group with good perceived hearing and the group with bad perceived hearing. CONCLUSION: The (m)AIADH is a reliable and valid measure to assess various dimensions of hearing function among firefighters.

The short form effort-reward imbalance: Measure of occupational stress for firefighters.

PURPOSE: The original effort-reward imbalance (ERI) questionnaire has been widely used as a measure of occupational stress. The need for brief measurement of psychosocial stress at work has risen. This study examined the psychometric properties of a 16-item short form ERI (S-ERI) questionnaire. METHODS: A cross-sectional study was conducted with a convenience sample of 247 career firefighters in the United States. An internet-based survey contained the S-ERI questionnaire, and assessed perceived health, demographics, and work characteristics. Internal consistency was tested by item-total correlation and Cronbach's α coefficients. Factorial validity was assessed by confirmatory factor analysis (CFA), and criterion validity was examined by testing the S-ERI's association with perceived health, controlling for other factors. RESULTS: The study participants were primarily young and mid-aged White males (mean age = 42 years, 75% White non-Hispanic, 93% males). The S-ERI questionnaire showed satisfactory internal consistency, with Cronbach α coefficients above 0.80 for all three scales: effort 0.82, reward 0.83, and overcommitment 0.81. CFA showed all the S-ERI components had a good fit (goodness-of-fit index = 0.99, comparative fit index = 0.92, root mean square error of approximation = 0.06). In terms of criterion validity, significantly increased odds ratios (ORs) for perceived health (those indicating they were less healthy) were found in firefighters in the lowest tertile of reward (OR = 7.06, 95% confidence interval [CI]: 2.86-17.43), and highest tertile of overcommitment (OR = 2.29, 95% CI: 1.00-5.22), after controlling for other factors. CONCLUSION: The S-ERI questionnaire is a reliable and valid measure to assess occupational stress. We recommend the use of S-ERI as a measure of occupational stress when initiating efforts to improve firefighters' wellness.

The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events.

PURPOSE: The purpose of this study was to examine the relationships of nurse staffing level and work environment with patient adverse events. DESIGN: This cross-sectional study used a combination of nurse survey data (N = 4,864 nurses), facility data (N = 58 hospitals), and patient hospital discharge data (N = 113,426 patients) in South Korea. METHODS: The three most commonly nurse-reported adverse events included administration of the wrong medication or dose to a patient, pressure ulcers, and injury from a fall after admission. Multilevel ordinal logistic regression was employed to explore the relationships of nurse staffing level (number of patients assigned to a nurse) and work environment (Practice Environment Scale of the Nursing Work Index) with patient adverse events after controlling for nurse, hospital, and patient characteristics. FINDINGS: A larger number of patients per nurse was significantly associated with a greater incidence of administration of the wrong medication or dose (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.007-1.016), pressure ulcer (OR = 1.01, 95% CI = 1.007-1.016), and patient falls with injury (OR = 1.02, 95% CI = 1.013-1.022). A better work environment had a significant inverse relationship with adverse events; the odds of reporting a higher incidence of adverse events were 45% lower for administration of the wrong medication or dose (OR = 0.55, 95% CI = 0.400-0.758), followed by 39% lower for pressure ulcer (OR = 0.61, 95% CI = 0.449-0.834) and 32% lower for falls with injury after admission (OR = 0.68, 95% CI = 0.490-0.939). CONCLUSIONS: This study found that a larger number of patients per nurse and poor work environment increase the incidence of patient adverse events, such as administration of the wrong medication or dose to a patient, pressure ulcers, and injury from falling after admission. The findings suggest that South Korean hospitals could prevent patient adverse events by improving nurse staffing and work environment. CLINICAL RELEVANCE: Healthcare strategies and efforts to modify adequate nurse staffing levels and better work environments for nurses are needed to improve patient outcomes.

Lifelong occupational exposures and hearing loss among elderly Latino Americans aged 65-75 years.

OBJECTIVE: The purpose of this study is to determine the relationship between occupational exposures and hearing among elderly Latino Americans. DESIGN: A descriptive, correlational design used for this secondary analysis with the data from the Sacramento Area Latino Study of Aging (SALSA). STUDY SAMPLE: A total of 547 older adults were included. RESULTS: A majority of participants (58%) reported occupational exposures to loud noise and/or ototoxic chemicals. About 65% and over 90% showed hearing loss at low and high frequencies, respectively. Participants with occupational exposure to loud noise and/or ototoxic chemicals were, significantly, two times more likely to have hearing loss at high frequencies compared to those without exposure (OR = 2.29; 95% CI: 1.17 = 4.51, p = .016), after controlling for other risk factors of hearing loss such as age, gender, household income, current smoking, and diabetes. However, lifelong occupational exposure was not significantly associated with hearing loss at low frequencies (OR = 1.43; 95% CI: 0.94 = 2.18, p = .094). CONCLUSION: Lifelong occupational exposure to loud noise and/or ototoxic chemicals was significantly associated with hearing loss among elderly Latino Americans. Healthy work life through protection from harmful auditory effects of occupational exposures to noise and chemicals will have a positive impact on better hearing in later life.

Predictors of hearing protection behavior among firefighters in the United States.

BACKGROUND: Noise-induced hearing loss (NIHL) is a major occupational health problem that can be prevented through the use of hearing protection devices (HPDs). PURPOSE: The purpose of this study is to identify significant factors related to firefighters' use of HPDs. METHODS: A total of 404 firefighters from 35 fire departments in multiple states in the United States participated in an Internet-based survey from March 2010 to May 2011. RESULTS: Pearson correlations and multiple regression analysis suggested that several modifying and cognitive-perceptual factors were significantly related to HPD use, including noise exposure, interpersonal influences, organizational support, perceived barriers to HPD use, and perceived susceptibility to hearing loss. The multiple regression model explained 56% (R(2) = .56, adjusted R(2) = .54) of the variance in firefighters' use of HPDs (F(13, 372) = 35.65, p < .001). CONCLUSIONS: Future research should focus on incorporating these significant predictors into effective behavioral interventions designed to promote the use of HPDs in this population.

The effect of a booster intervention to promote hearing protection behavior in operating engineers.

BACKGROUND: Booster interventions may be useful in promoting workers' hearing protection device (HPD) use. Previous research on the effectiveness and the optimal timeframe for boosters is limited and inconsistent. METHODS: In this randomized controlled trial, 403 workers were assigned to receive an individually tailored booster, a control booster, or no booster. The booster intervention groups were further divided by timeframe. Frequency of HPD use was measured 12 months post-intervention. RESULTS: The booster intervention groups significantly accounted for the variance in HPD use in Year 2. Workers in middle-term booster (67-94 days) group reported a significantly greater increase in HPD use in Year 2 than those in other timeframes, when potential covariates were controlled for. CONCLUSIONS: Booster intervention letters mailed between 67 and 94 days post-initial intervention may promote HPD use among participants. Future research should explore additional factors associated with optimal booster design, including more innovative mobile and internet-based approaches.

Heavy and light/moderate smoking among building trades construction workers.

OBJECTIVE: The purpose of the study was to identify the correlates of heavy smoking (defined as more than one pack of cigarettes per day) in building trades construction workers. DESIGN AND SAMPLE: This study used cross-sectional data from the MassBUILT smoking cessation intervention study at Massachusetts building trades unions with the sample of 763 smokers. MEASURES: Data collected included information about smoking behavior, individual, psychological, interpersonal, and occupational factors obtained through self-reported questionnaires. RESULTS: Approximately 21% of smokers were heavy smokers. Significant factors related to heavy smoking were: older age (OR = 1.10; 95% CI: 1.06-1.14), male gender (OR = 4.55; 95% CI: 1.62-12.79), smoking the first cigarette of the day within 30 min of waking (OR = 4.62; 95% CI: 2.81-7.59), smoking initiation at earlier age (OR = 0.93; 95% CI: 0.87-1.00), higher temptation to smoke (OR = 1.55; 95% CI: 1.17-2.05), household smoking (OR = 1.90; 95% CI: 1.18-3.06) or living alone (OR = 4.11; 95% CI: 1.70-9.92), and exposure to chemicals at work (OR = 1.61; 95% CI: 1.06-2.53). CONCLUSION: Addressing the influence of these factors on heavy smoking could lead to the development of targeted, multiple components in comprehensive cessation strategies for blue-collar smokers.

An Internet-based tailored hearing protection intervention for firefighters: development process and users' feedback.

BACKGROUND: Noise-induced hearing loss is a significant occupational injury for firefighters exposed to intermittent noise on the job. It is important to educate firefighters about using hearing protection devices whenever they are exposed to loud noise. Computer technology is a relatively new health education approach and can be useful for tailoring specific aspects of behavioral change training. The purpose of this study is to present the development process of an Internet-based tailored intervention program and to assess its efficacy. METHOD: The intervention programs were implemented for 372 firefighters (mean age = 44 years, Caucasian = 82%, male = 95%) in three states (California, Illinois, and Indiana). The efficacy was assessed from firefighters' feedback through an Internet-based survey. RESULTS: A multimedia Internet-based training program was developed through (a) determining program content and writing scripts, (b) developing decision-making algorithms for tailoring, (c) graphic design and audio and video productions, (d) creating computer software and a database, and (e) postproduction quality control and pilot testing. Participant feedback regarding the training has been very positive. Participants reported that they liked completing the training via computer (83%) and also that the Internet-based training program was well organized (97%), easy to use (97%), and effective (98%) and held their interest (79%). Almost all (95%) would recommend this Internet training program to other firefighters. CONCLUSION: Interactive multimedia computer technology using the Internet was a feasible mode of delivery for a hearing protection intervention among firefighters. Participants' favorable feedback strongly supports the continued utilization of this approach for designing and developing interventions to promote healthy behaviors.

Association of Occupational Stress With Tinnitus Among Career Firefighters in the United States.

OBJECTIVE: This study explores the relationship between occupational stress and tinnitus among firefighters, a group often exposed to two tinnitus risk factors: high stress and noise. METHODS: This cross-sectional study includes 240 firefighters in the United States. Data describing demographic characteristics, occupational stress, noise exposure, and tinnitus were collected by survey. Occupational stress was measured using the short version of the Effort-Reward Imbalance Questionnaire. RESULTS: Forty-three percent of participants reported experiencing tinnitus within the past month. For occupational stress, higher effort (odds ratio, 1.25; 95% confidence interval, 1.05 to 1.49) and higher effort-reward ratio (odds ratio, 12.28; 95% confidence interval, 3.08 to 48.86) were associated with increased odds of tinnitus, after adjustment for demographic characteristics and noise exposure. CONCLUSIONS: Occupational stress may increase the likelihood of tinnitus for firefighters, an already at-risk group of workers. Health providers should incorporate stress assessment into tinnitus management programs.

Job Stress and Sleep Disturbances Among Career Firefighters in Northern California.

OBJECT: This study examined the association between job stress and sleep disturbance among career firefighters. METHODS: A cross-sectional survey study was conducted with 154 career firefighters working in Northern California, US job stress was measured using the short form of the Effort-Reward Imbalance questionnaire and sleep was measured with the Patient-Reported Outcomes Measurement Information System Sleep Disturbance. RESULTS: Approximately 75% experienced sleep disturbance. For firefighters' job stress, high effort (odds ratio [OR] = 3.68; 95% confidence interval [CI]: 1.25-10.80), high effort-reward ratio (OR = 3.55; 95% CI: 1.23-10.23), and high overcommitment (OR = 9.09; 95% CI: 2.30-35.85) were significantly associated with increased likelihood of sleep disturbance, after adjustment for other factors. CONCLUSIONS: Job stress significantly affected firefighters' sleep health, suggesting the need to design effective health promotion interventions to reduce job stress and improve sleep quality for these public service workers.

Cigarette smoking in building trades workers: the impact of work environment.

BACKGROUND: Blue-collar workers smoke at higher rates than white-collar workers and the general population. Occupational factors may contribute to smoking behavior in this group. However, little is known about the role of occupational factors in explaining cigarette-smoking patterns. METHODS: This study used cross-sectional data from the MassBUILT smoking cessation intervention study. Multivariable logistic regression analysis was conducted to investigate the association of occupational factors with current cigarette smoking among 1,817 building trades workers. RESULTS: Current cigarette smoking was significantly associated with the following occupational factors: union commitment (OR = 1.06; 95% CI: 1.00-1.12); exposure to dust (OR = 1.50; 95% CI: 1.15-1.95), exposure to chemicals (OR = 1.41; 95% CI: 1.11-1.79); and concern about exposure to occupational hazards (OR = 0.93; 95% CI: 0.91-0.95). CONCLUSION: The findings highlight the need to explicate the pathways by which occupational factors may contribute to current smoking behavior among building trades workers. Smoking cessation programs for this population should consider work-related occupational factors along with individual approaches.

Firefighter hearing health: an informatics approach to screening, measurement, and research.

OBJECTIVE: The purpose of this study was to evaluate the use of a standardized interface terminology, the Omaha System, with respect to noise-induced hearing loss (NIHL). DESIGN: A descriptive, correlational design was employed for this secondary analysis with the data from an ongoing hearing protection intervention study. STUDY SAMPLE: A total of 346 firefighters were included. RESULTS: First, an evidence-based standardized care plan (EB-SCP) for hearing screening was developed and validated by clinical experts. Second, occupational health records were used to compute Omaha System Knowledge, Behavior, and Status outcomes. Third, research data were mapped to Omaha System rating scales. For Knowledge, the mean score was close to 'adequate' (3.7). For Behavior, the mean score was close to 'rarely appropriate' (2.2). For Status, the mean score was close to 'minimal sign/symptom' (4.4). Significant positive relationships were found between Knowledge and Behavior (Spearman's rho =.13, p =.01), and between Behavior and hearing Status (Spearman's rho =.12, p =.02). CONCLUSIONS: Findings support the validity of the new Knowledge, Behavior, and hearing Status. Informatics methods such as the standardized NIHL EB-SCP and outcome data sets will create opportunities for clinical decision support and data exchange across various health care settings, thus supporting population-based hearing health assessments and outcomes.

Factors associated with metabolic syndrome among Korean office workers.

To assess the prevalence of metabolic syndrome (MetS) and identify risk factors associated with MetS among Korean office workers, this cross-sectional study was conducted with 776 office workers. The prevalence of MetS was 13.5%; elevated waist circumference (27.5%), elevated fasting glucose (23.1%), elevated triglycerides (22.2%), low high-density lipoprotein cholesterol (HDL-C) (13.4%), and elevated BP (9.4%). Having any medical health problems (OR = 3.98, 95% CI: 2.01-7.85), more knowledge of MetS (OR = 1.26, 95% CI: 1.02-1.56), higher BMI (OR = 1.42, 95% CI: 1.30-1.57), current smoking (OR = 3.78, 95% CI: 1.04-13.73), and physical inactivity (OR = 3.22, 95% CI: 1.21-8.58) were significantly associated with increased likelihood of MetS. Addressing the influence of these factors on MetS could lead to the development of workplace-based intervention strategies to encourage lifestyle changes and prevent the risk of MetS among Korean office workers.

Program Development and Effectiveness of Workplace Health Promotion Program for Preventing Metabolic Syndrome among Office Workers.

This paper aims to develop and analyze the effects of a socio-ecological model-based intervention program for preventing metabolic syndrome (MetS) among office workers. The intervention program was developed using regular health examinations, a "health behavior and need" assessment survey among workers, and a focus group study. According to the type of intervention, subjects took part in three groups: health education via an intranet-based web magazine (Group 1), self-monitoring with the U-health system (Group 2), and the target population who received intensive intervention (Group 3). The intervention programs of Group 1 and Group 2, which relied on voluntary participation, did not show significant effects. In Group 3, which relied on targeted and proactive programs, showed a decrease in waist circumference and in fasting glucose (p < 0.001). The MetS score in both males (-0.61 ± 3.35 versus -2.32 ± 2.55, p = 0.001) and females (-3.99 ± 2.05 versus -5.50 ± 2.19, p = 0.028) also showed a statistically significant decrease. In light of the effectiveness of the intensive intervention strategy for metabolic syndrome prevention among workers used in this study, companies should establish targeted and proactive health care programs rather than providing a healthcare system that is dependent on an individual's voluntary participation.

Double Jeopardy: Hearing Loss and Tinnitus Among Noise-Exposed Workers.

The purpose of this study was to determine the prevalence and characteristics of tinnitus and assess the relationship between tinnitus and hearing loss among firefighters and operating engineers, who are exposed to noise on-the-job. The study analyzed existing data from two different populations (154 firefighters and 769 operating engineers) who completed a survey and audiometric tests as part of a hearing loss prevention intervention study. Approximately 40% of both groups reported tinnitus; 34% of firefighters and 59% of operating engineers showed hearing loss at noise-sensitive frequencies (4 kHz and 6 kHz). Firefighters with high frequency hearing loss (odds ratio [OR] = 2.31; 95% confidence interval [CI] = [1.05, 5.11]) and those with perceived impaired hearing status (OR = 3.53; 95% CI = [1.27, 9.80]) were significantly more likely to report tinnitus. Similarly, operating engineers who had hearing loss at both low (OR = 2.10; 95% CI = [1.40, 3.15]) and high frequencies (OR = 2.00; 95% CI = [1.37, 2.90]), and perceived impaired hearing status (OR = 2.17; 95% CI = [1.55, 3.05]) were twice as likely to report tinnitus. This study demonstrated that tinnitus is a considerable problem for noise-exposed workers. Workers with hearing loss demonstrated significantly higher rates of tinnitus. Comprehensive workplace hearing conservation programs should include tinnitus management for noise-exposed workers, along with other key elements such as noise control and hearing protection.

Occupational factors associated with obesity and leisure-time physical activity among nurses: A cross sectional study.

BACKGROUND AND OBJECTIVE: Adverse working conditions contribute to obesity and physical inactivity. The purpose of this study was to examine the associations of occupational factors with obesity and leisure-time physical activity among nurses. METHODS: This study used cross-sectional data of 394 nurses (mean age 48 years, 91% females, 61% white) randomly selected from the California Board of Registered Nursing list. Data on demographic and employment characteristics, musculoskeletal symptom comorbidity, physical and psychosocial occupational factors, body mass index (BMI), and physical activity were collected using postal and on-line surveys from January to July in 2013. RESULTS: Of the participants, 31% were overweight and 18% were obese; 41% engaged in regular aerobic physical activity (≥ 150 min/week) and 57% performed regular muscle-strengthening activity (≥ 2 days/week). In multivariable logistic regression models, overweight/obesity (BMI ≥ 25 kg/m(2)) was significantly more common among nurse managers/supervisors (OR=2.54, 95% CI: 1.16-5.59) and nurses who worked full-time (OR=2.18, 95% CI: 1.29-3.70) or worked ≥ 40 h per week (OR=2.53, 95% CI: 1.58-4.05). Regular aerobic physical activity was significantly associated with high job demand (OR=1.63, 95% CI: 1.06-2.51). Nurses with passive jobs (low job demand combined with low job control) were significantly less likely to perform aerobic physical activity (OR=0.49, 95% CI: 0.26-0.93). Regular muscle-strengthening physical activity was significantly less common among nurses working on non-day shifts (OR=0.55, 95% CI: 0.34-0.89). Physical workload was not associated with obesity and physical activity. CONCLUSIONS: Our study findings suggest that occupational factors significantly contribute to obesity and physical inactivity among nurses. Occupational characteristics in the work environment should be considered in designing effective workplace health promotion programs targeting physical activity and obesity among nurses.

Knowledge of Occupational Chemical Exposure and Smoking Behavior in Korean Immigrant Drycleaners.

To examine the association between knowledge of chemical exposure at work and cigarette smoking among Korean immigrant drycleaners. A cross-sectional survey was conducted with a total of 151 Korean immigrant drycleaners (mean age = 49 years, 64 % male) from 96 drycleaning shops in a Midwestern state. The data were collected on demographic and work-related characteristics, knowledge of occupational chemical exposure, health concerns associated with chemical exposure, and smoking status. Approximately 25 % of participants were current smokers. The multivariate regression showed that greater knowledge of occupational chemical exposures was significantly associated with a lower likelihood of current smoking [odds ratio (OR) .63; 95 % confidence interval (CI) .41-.95]. Furthermore, male gender (OR 6.32; 95 % CI 1.66-24.00), shorter-term residence in the US (OR .93; 95 % CI .88-.98), and having multiple duties (OR 2.76; 95 % CI 1.01-7.51) were important covariates associated with current smoking among Korean immigrant drycleaners. Knowledge on occupational chemical exposure was significantly associated with smoking among Korean immigrant drycleaners. Smoking cessation programs for this population should consider integrated approaches that incorporate work environment factors into individual and sociocultural components.

Wearable Technology Surveillance Data for the Personal Health Record Using the Omaha System: Noise Exposure, Cardiovascular and Stress Biomarkers.

This poster describes a method to prepare noise and health data from wearable technology for standardized representation in the electronic personal health record thus enabling individuals to identify noise-related health risks. Using a case study approach, the authors demonstrate transformation of data to the Omaha System standardized terminology in order to depict the data graphically in a personal health record.

The association between occupational exposures and cigarette smoking among operating engineers.

The purpose of this study was to determine the relationship between occupational exposures and cigarette smoking among operating engineers. A cross-sectional survey was conducted with operating engineers (N = 412) from a midwestern state in the United States. The survey included validated questions on cigarette smoking, occupational exposures, demographics, comorbidities, and health behaviors. About 35% were current smokers. Those exposed to asphalt fumes, heat stress, concrete dust, and welding fumes were less likely to smoke (odds ratio [OR] = .79, 95% confidence interval [CI]: .64-.98). Other factors associated with smoking included younger age (OR = .97, 95% CI: .94-.99), problem drinking (OR = 1.07, 95% CI: 1.03-1.12), lower Body Mass Index (OR = .95, 95% CI: .90-.99), and being separated/widowed/divorced (OR = 2.24, 95% CI: 1.19-4.20). Further investigation is needed for better understanding about job-specific exposure patterns and their impact on cigarette smoking among operating engineers.

Global occupational health and safety responsibilities of occupational health nurses based in the United States.

The health and safety of workers is the primary concern of occupational health nurses. The purpose of this study was to identify the global occupational health and safety responsibilities of occupational health nurses based in the United States and factors contributing to these global responsibilities. A total of 2,123 American Association of Occupational Health Nurses, Inc. members completed a web-based survey and were included in the study. Approximately 12% (n = 256) of the respondents worked globally. Occupational health nurses with three or four national certifications, OR (odds ratio) = 2.07, 95% confidence interval (CI) [1.08, 3.98], more than 15 years of occupational health nursing experience, OR = 1.23, 95% CI [1.08, 1.39], and a doctoral degree, OR = 2.89, 95% CI [1.40, 5.99], were most likely to work globally. Advanced practice nurses, OR = 1.55, 95% CI [1.12, 2.15], occupational health nurses who worked for large employers, OR = 1.74, 95% CI [1.29, 2.33], and those who supervised other nurses, OR = 1.74, 95% CI [1.29, 2.34], were also more likely to work globally. In contrast, occupational health nurses who personally provided direct care to workers were less likely to work globally, OR = 0.60, 95% CI [0.44, 0.81]. The findings of this study provide direction for future education, practice, and research to increase global responsibilities among occupational health nurses in the United States.