Hearing loss as a predictor for hearing protection attenuation among miners.

OBJECTIVE: This study investigated risk factors for poor earplug fit, with a focus on the association between hearing loss and personal attenuation ratings (PARs). METHODS: Earplug fit was assessed by obtaining PARs using a real ear at attenuation threshold (REAT) system. Hearing loss was assessed using the unoccluded hearing thresholds measured during the REAT testing and the results of a speech-in-noise test. Potential predictors of PARs were modelled using both simple and multiple linear regression. Hearing loss was the primary predictor of interest. RESULTS: Data were collected from 200 workers at ten above-ground mining sites in the Midwestern USA. Workers reported wearing their hearing protection on average 73.9% of the time in a high noise environment (mean 8-hour time-weighted average noise exposure 85.5 dBA, range 65-103 dBA). One-quarter (26.7%) of workers were found to have a hearing loss (hearing threshold ≥25 dB across 1-4 kHz), and 42% reported symptoms of tinnitus. Workers with a hearing loss had a significantly lower PAR than those without a hearing loss (ß=-5.1, SE=1.7). CONCLUSIONS: The results of the adjusted regression models suggest that workers with hearing loss achieved significantly lower PARs than those without hearing loss. This association between hearing loss and hearing protection devices (HPD) fit brings into focus the potential benefit of fit checks to be included in hearing conservation programmes. Workers found to have hearing loss should be prioritised for fit testing, as their hearing impairment may be associated with poor HPD fit.

Community-based program to increase use of hearing conservation practices among farm and rural youth: a cluster randomized trial of effectiveness.

BACKGROUND: Noise exposure and associated hearing loss affects an estimated 2 million farm youth who are exposed as farm residents, farm family workers, hired workers, children of migrant or seasonal workers, and farm visitors. Risk factors for farm youth include frequent exposure to high farm noise; farm work from an early age, and exposure to high recreational noise (e.g., firearms, ATVs, and personal listening devices). METHODS: This study compared the effectiveness of two interventions and control. The programs included a community-based interactive youth educational program alone (Group A), a community-based interactive youth educational program followed by an Internet-based booster (Group B), and a no-interaction control (Group C). The study used a cluster randomized control design, with equal allocation ratio to each cluster, without blinding. Inclusion criteria included enrollment in grade 4, parental consent, English speaking, and attending a community-based educational event included in the cluster sampling. A total of 1979 youth were enrolled at 36 sites distributed across the 3 study arms in the following distribution: N = 662 in 13 sites (Group A), N = 680 in 12 sites (Group B), and N = 637 in 11 sites (Group C). RESULTS: Comparison with pre-intervention data showed no difference in intent to use hearing conservation strategies in experimental groups. However, knowledge and attitudes toward hearing conservation were improved in the groups receiving the Internet-based booster. Participants reported frequent exposure to sources of hazardous noise (e.g., loud sporting events, firecrackers, personal listening devices). CONCLUSIONS: It is feasible and acceptable to incorporate hearing health education into an already existing system designed to deliver health and safety educational programming to farm and rural youth. The program was adopted by the partner agency for dissemination to up to 100,000 youth annually. Results of this study inform future intervention studies, interventions aimed at farm youth, and interventions to increase use of hearing conservation strategies, as well as offer a base for developing programs for non-English speaking children. TRIAL REGISTRATION: Clinicaltrials.gov registration CT02472821. Date of trial registration: 06/09/2015 (retrospectively registered).

Development and testing of a practicum matching program for baccalaureate nursing education, a local public health unit.

This article describes a novel approach to nursing education, designed to improve the experience of both students in public health nursing, and the local public health unit where they affiliate. Students, faculty, and public health department staff developed a method for matching programs and needs of the local public health unit to the skills and learning needs of nursing students. We describe our experience articulating student competencies, program-specific functions, and an approach to matching student interests and learning opportunities to agency needs. Students, faculty, and staff rated the program moderately to very high in feasibility, satisfaction, and acceptability. Data suggest the novel program served to improve the quality of the practicum affiliation, to the satisfaction of both the school and agency, while contributing to a robust public health learning experience for emerging professional nurses.

Stressors, allostatic load, and health outcomes among women hotel housekeepers: A pilot study.

Hotel housekeepers are exposed to stressors at work and outside of work. A minimal amount is known about these workers' pathophysiological responses to those stressors. Allostatic load is a concept increasingly used to understand pathophysiologic manifestations of individuals' bodily response to stress. The purpose of this study was to examine the associations between work and nonwork stressors, allostatic load, and health outcomes among hotel housekeepers. Work and nonwork stressors (e.g., the number of traumatic events, everyday discrimination, and job strain) and health outcomes (e.g., general health status, physical and mental health, and chronic diseases) were measured. Biometric and anthropometric measures and fasting blood specimens were collected. Blood biomarkers included CRP, HbA1c, HDL, and cortisol. Descriptive analyses, correlations, regressions, and t-tests were conducted. Forty-nine women hotel housekeepers participated, with a mean age of 40 years. One-fifth reported high job strain and more than 40% had at least one traumatic event. Chronic conditions were commonly reported, with about 78%, 55%, and 35% reporting one, two, and three chronic conditions, respectively. Correlation analyses showed that reports of high job strain and everyday discrimination were significantly associated with high ALI quartile score (r = 0.39, p = 0.011; r = 0.41, p = 0.004). Job strain and everyday discrimination had medium to large effect sizes on ALI quartile scores. High ALI quartile score was significantly associated with having at least one chronic disease (r = 0.40, p = 0.005), and it had a large effect size on chronic diseases. To our knowledge, this is the first study to explore allostatic load among hotel housekeepers. Hotel housekeepers have high exposure to stressors within and outside of their work and experience poor chronic conditions. Allostatic load had strong associations with both stressors and health outcomes. Despite this worker group being a hard-to-reach worker group to participate in research studies, this study demonstrates the feasibility of accessing, recruiting and collecting survey data and blood samples among them to determine health risks and guide future targeted interventions.

Efficacy of hearing conservation education programs for youth and young adults: a systematic review.

BACKGROUND: Many youth and young adults experience high noise exposure compounded by lack of access to hearing health education. Although the need for hearing health education programs is evident, the efficacy of these programs for youth is unclear. We evaluated the literature for efficacy of various hearing conservation programs aimed at youth and young adults, and analyzed their strengths and limitations. METHODS: Studies reporting results of hearing conservation or hearing loss prevention programs with youth or young adults, using randomized controlled trials, quasi-experimental designs, experimental design, or qualitative research, and published in peer-reviewed journals in English between 2001 and 2018 were included. Studies were found through searches of selected literature databases (i.e., PubMed, Google Scholar, NIOSH Toxline, and Scopus). Identified publications were assessed for relevance, and data were extracted from the studies deemed relevant. RESULTS: A total of 10 studies were included. Very little evidence of efficacy of hearing conservation educational programs was found in these studies. Several methodological limitations including lack of rigorous study designs, inadequate power, and application of inappropriate statistical analysis were noted. Some use of technology in programs (e.g., smartphone apps, mobile phone text messages, and computers) was observed, but conclusions as to the effectiveness of these tools were limited by the small number of studies and small sample sizes. CONCLUSIONS: The number of studies of educational hearing conservation programs for youth and young adults was low. The efficacy of the program was not reported in most studies, and it is difficult to draw public health conclusions from these studies due to their multiple methodological limitations. While use of technology in hearing conservation educational programs offers promise, its effectiveness has not been studied.

Predictors of Turnover Among Asian Foreign-Educated Nurses in Their 1st Year of US Employment.

OBJECTIVE: The aim of this study was to investigate factors affecting turnover of Asian foreign-educated nurses (FENs), which may lead to improvements in retention strategies. BACKGROUND: Asian FENs working in the United States have considerable rates of turnover. Little is known about which factors are related. METHODS: A cross-sectional design was used. A convenience sample (n = 201) of Asian FENs completed surveys by regular mail and through a website. Backward multivariable logistic regression was performed to identify factors associated with turnover in their 1st year of employment. RESULTS: Most participants were from the Philippines and Korea. Perceived quality of orientation predicted organizational-level turnover and trended toward predicting unit-level turnover. CONCLUSIONS: Healthcare institutions may benefit from developing organizational programs for FENs that are sensitive to their unique needs, in the interest of reducing rapid or early turnover and accompanying negative effects on hospital finances and patient care.

Lessons Learned From a Practice-Based, Multisite Intervention Study With Nurse Participants.

PURPOSE: To identify challenges and solutions to the efficient conduct of a multisite, practice-based randomized controlled trial to improve nurses' adherence to personal protective equipment use in ambulatory oncology settings. DESIGN: The Drug Exposure Feedback and Education for Nurses' Safety (DEFENS) study is a clustered, randomized, controlled trial. Participating sites are randomized to Web-based feedback on hazardous drug exposures in the sites plus tailored messages to address barriers versus a control intervention of a Web-based continuing education video. APPROACH: The study principal investigator, the study coordinator, and two site leaders identified challenges to study implementation and potential solutions, plus potential methods to prevent logistical challenges in future studies. FINDINGS: Noteworthy challenges included variation in human subjects' protection policies, grants and contracts budgeting, infrastructure for nursing-led research, and information technology variation. Successful strategies included scheduled Web conferences, site-based study champions, site visits by the principal investigator, and centrally based document preparation. Strategies to improve efficiency in future studies include early and continued engagement with contract personnel in sites, and proposed changes to the common rule concerning human subjects. The DEFENS study successfully recruited 393 nurses across 12 sites. To date, 369 have completed surveys and 174 nurses have viewed educational materials. CONCLUSIONS: Multisite studies of nursing personnel are rare and challenging to the existing infrastructure. These barriers can be overcome with strong engagement and planning. CLINICAL RELEVANCE: Leadership engagement, onsite staff support, and continuous communication can facilitate successful recruitment to a workplace-based randomized, controlled behavioral trial.

Effects of interventions on use of hearing protectors among farm operators: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to compare the effectiveness of three interventions designed to promote hearing protector device (HPD) use. DESIGN: Randomized controlled trial. STUDY SAMPLE: Farm operators (n = 491) were randomly assigned to one of five intervention groups: (1) interactive web-based information with mailed assortment of HPDs; (2) Interactive web-based information only; (3) static web-based information with mailed assortment of HPDs; (4) Static web-based information only; or (5) mailed assortment of HPDs only. Data were analysed using a mixed model approach. RESULTS: HPD use increased among all participants, and increased more among participants receiving the mailed HPDs (with or without information) compared to participants receiving other interventions. Participants receiving the interactive web-based information had comparable increased use of HPDs to those receiving the static web-based information. Participants receiving the mailed HPDs had more positive situational influences scale scores than other participants. Program satisfaction was highest among mailed and web-based information groups. CONCLUSIONS: A mailed assortment of hearing protectors was more effective than information. Interactive and static information delivered via web were similarly effective. Programs interested in increasing HPD use among farmers should consider making hearing protectors more available to farmers.

Turnover and Associated Factors in Asian Foreign-Educated Nurses.

OBJECTIVES: The purposes of this study are to (1) describe the gap between expected and perceived organizational experiences among Asian foreign-educated nurses (FENs) in the United States and (2) to examine factors associated with turnover in their 1st year of employment. BACKGROUND: Little is known about factors associated with turnover among Asian FENs. METHODS: A cross-sectional design with a convenience sampling was conducted. Subjects (n = 201) responded either via Web-based or mail survey. A series of simple and multivariable logistic regressions were used. RESULTS: Expectations of FENs before organizational entry were significantly higher than their experiences. The FENs who reported less organizational responsibility than expected were more likely to leave their 1st employment to move to another organization or unit. CONCLUSION: This study may contribute to our understanding of the potential factors that assist or interfere with the organization's administrative retention plan for Asian FENs.

Gender differences in use of hearing protection devices among farm operators.

PURPOSE: Although farm operators have frequent exposure to hazardous noise and high rates of noise-induced hearing loss, they have low use of hearing protection devices (HPDs). Women represent about one-third of farm operators, and their numbers are climbing. However, among published studies examining use of HPDs in this worker group, none have examined gender-related differences. The purpose of this study was to examine gender-related differences in use of hearing protection and related predictors among farm operators. MATERIALS AND METHODS: Data previously collected at farm shows and by telephone were analyzed using t-tests and generalized linear model with zero inflated negative binomial (ZINB) distribution. FINDINGS: The difference in rate of hearing protector use between men and women farm operators was not significant. There was no difference between men and women in most hearing protector-related attitudes and beliefs. CONCLUSION: Although men and women farm operators had similar rates of use of hearing protectors when working in high-noise environments, attitudes about HPD use differed. Specifically, interpersonal role modeling was a predictor of HPD use among women, but not for men. This difference suggests that while farm operators of both genders may benefit from interventions designed to reduce barriers to HPD use (e.g., difficulty communicating with co-workers and hearing warning sounds), farm women have unique needs in relation to cognitive-perceptual factors that predict HPD use. Women farm operators may lack role models for use of HPDs (e.g., in peers and advertising), contributing to their less frequent use of protection.

Social Desirability Bias in Self-Reporting of Hearing Protector Use among Farm Operators.

OBJECTIVE: The purposes of this study were (i) to examine the relationship between reported hearing protector use and social desirability bias, and (ii) to compare results of the Marlowe-Crowne social desirability instrument when administered using two different methods (i.e. online and by telephone). METHODS: A shortened version of the Marlowe-Crowne social desirability instrument, as well as a self-administered instrument measuring use of hearing protectors, was administered to 497 participants in a study of hearing protector use. The relationship between hearing protector use and social desirability bias was examined using regression analysis. The results of two methods of administration of the Marlowe-Crowne social desirability instrument were compared using t-tests and regression analysis. RESULTS: Reliability (using Cronbach's alpha) for the shortened seven-item scale for this sample was 0.58. There was no evidence of a relationship between reported hearing protector use and social desirability reporting bias, as measured by the shortened Marlowe-Crowne. The difference in results by method of administration (i.e. online, telephone) was very small. CONCLUSIONS: This is the first published study to measure social desirability bias in reporting of hearing protector use among farmers. Findings of this study do not support the presence of social desirability bias in farmers' reporting of hearing protector use, lending support for the validity of self-report in hearing protector use in this population.

Protocol of a randomized controlled trial of hearing protection interventions for farm operators.

BACKGROUND: Hearing loss and tinnitus are prevalent in America, and noise-induced hearing loss is a leading cause of hearing loss. Noise-induced hearing loss has negative impact on quality of life, physical and emotional functioning, social life, and employment. In addition, noise-induced hearing loss results in heavy social and economic burdens on families and communities from all ethnic and socioeconomic groups. Farmers are a group that is particularly high risk for noise-induced hearing loss, and is underserved by programs designed to limit that risk. They are among the most noise-exposed group of workers, and experience the second highest prevalence of noise-induced hearing loss among all occupational categories. In agriculture, 1.5 million workers (43.3%) report exposure to hazardous noise. Although use of hearing protection devices (HPDs) would protect them from noise-induced hearing loss, use among farmers is low. METHODS/DESIGN: The purpose of this project is to compare the effectiveness of several approaches to influencing hearing protector use. Approaches include: a) an interactive, predictors-based intervention delivered via the Internet; b) a static informational web site; and c) a mailed sampler of hearing protectors. The goals are to further develop an intervention to promote farmers' use of HPDs, and compare the effectiveness of the interventions delivered in various combinations. Participants will include 701 farmers. Sites will be affiliates of a major farmer organization. Data will be collected at baseline, 6, and 12 months. A random intercept mixed model will be used to explore the fixed effects of the three NIHL prevention interventions over time while adjusting for age and gender. This project will involve a partnership between the University of Michigan and a major farmer organization to accomplish project aims. DISCUSSION: Results of this study will be used to inform future research-to-practice studies to increase hearing protector use. Increased use of hearing protectors is expected to reduce rates of noise-induced hearing loss and other negative effects of high noise exposure, and improve quality of life in this high-risk and underserved group. TRIAL REGISTRATION: Clinicaltrials.gov NCT01454895 Registered 14 October, 2011.

Protocol of a test of hearing health education programs for farm and rural youth.

BACKGROUND: Farm and rural youth have frequent exposure to hazardous noise on the farm and recreationally, and have an increased prevalence of noise-induced hearing loss. There is a lack of programs to prepare this high-risk population to use hearing conservation strategies. METHODS: The purpose of this project is to test innovative hearing health education programs delivered to a large target group and to determine the effectiveness and sustainability of these programs in promoting hearing health among farm and rural youth. Specifically, this project includes: a) an interactive face-to-face informational program alone, b) an interactive face-to-face informational program followed by an Internet-based booster, and c) a no-intervention control. Sites will include selected affiliates of a major farm youth safety education organization. Data will be collected at baseline, 3, and 12 months. A linear mixed model will be used to compare the effectiveness of the three interventions over time. Descriptive statistics will be used to compare program costs and sustainability ratings. DISCUSSION: Outcomes of this project will provide knowledge necessary to implement quality and cost-effective services to farm and rural youth, a high-risk and underserved population, that can be implemented and sustained after the study is completed. TRIAL REGISTRATION: Clinicaltrials.gov NCT02472821 Registered 09 Jun, 2015.

Farm and rural adolescents' perspective on hearing conservation: reports from a focus group study.

This study explored the attitudes, beliefs, and behaviors of rural and farm adolescents regarding hearing conservation strategies. This qualitative study took place at two high schools in rural Michigan. Twenty-five adolescents living and working on farms or living in rural areas participated in one of two focus groups. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded and analyzed by two researchers and checked by an additional researcher to ensure reliability. Noise exposure was ubiquitous among participants, both in farm-related (e.g., equipment, livestock) and non-farm-related (e.g., music, firearms) activities. Perceived barriers to use of hearing protection devices outweighed perceived benefits, resulting in uncommon use of protection. When hearing protection was used, it was usually earmuffs or earplugs. Participants indicated a lack of training in noise hazards and protective strategies. Despite their acknowledged risk of hearing loss, participants did not associate their use of hearing protection today with their hearing ability later in life. Categories emerging that relate to hearing protector use included: Barriers, benefits, self-efficacy, situational influences, impersonal influences, cues to action, susceptibility, and severity. Farm and rural adolescents are at risk for noise exposure and hearing loss. The findings stress the significance of work environment and adult modeling in facilitating hearing conservation behaviors. As indicated by the youths' recommendations, school-based interventions may be an effective approach to address this health concern. Intervention studies are needed to test various approaches that can effectively promote use of hearing conservation strategies among rural and farm adolescents.

Cultural Health Practices of Migrant Seasonal Farmworkers.

This study explored culturally related health practices among Hispanic migrant seasonal farmworkers. In this cross-sectional qualitative study, six Hispanic migrant seasonal farmworkers from southeastern Michigan farms were interviewed. Four major themes emerged from the study. Financial and employment limitations, rather than folk health care practices, were more likely to influence use of professional care systems. There was limited use of folk healers and culturally-related practices, primarily due to lack of access. Results may be used to identify needs and develop culturally appropriate programs and services to improve the health of Hispanic migrant seasonal farmworkers.

Strategies to enhance participant recruitment and retention in research involving a community-based population.

Challenges associated with recruiting and retaining community-based populations in research studies have been recognized yet remain of major concern for researchers. There is a need for exchange of recruitment and retention techniques that inform recruitment and retention strategies. Here, the authors discuss a variety of methods that were successful in exceeding target recruitment and retention goals in a randomized clinical trial of hearing protector use among farm operators. Recruitment and retention strategies were 1) based on a philosophy of mutually beneficial engagement in the research process, 2) culturally appropriate, 3) tailored to the unique needs of partnering agencies, and 4) developed and refined in a cyclical and iterative process. Sponsoring organizations are interested in cost-effective recruitment and retention strategies, particularly relating to culturally and ethnically diverse groups. These approaches may result in enhanced subject recruitment and retention, concomitant containment of study costs, and timely accomplishment of study aims.

How Depression and Anxiety Impact Adherence to COVID-19 Prevention Practices in Urban Liberia.

BACKGROUND: Understanding the relationship between mental health and COVID-19 prevention practices is crucial but challenging considering COVID-19's impact on mental well-being. Liberia, a West African country, had well-documented rates of depression and anxiety prior to COVID-19. Liberia responded aggressively to COVID-19 while case counts remained low; thus, it is an ideal setting to study the relationship of mental health and COVID-19 prevention practices. METHODS: A validated cross-sectional survey was administered to 250 randomly selected residents of Montserrado county, Liberia in June 2021, asking about their mental health and adherence to COVID-19 prevention practices. The survey included the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 to assess for anxiety and depression, respectively. Responses were analyzed using Spearman correlation and regression. RESULTS: Scores indicative of depression were present in 43% (95% confidence interval [CI]: 37-49) of participants; scores indicative of anxiety were present in 41% (95% CI: 34-47). Self-reported adherence to COVID-19 prevention practices was middling and varied greatly by behavior. Higher scores for depression and anxiety were significantly associated with lower adherence to COVID-19 prevention practices. CONCLUSIONS: Results indicate that while the spread of COVID-19 has certainly affected mental health, it is likely that pre-existing mental health conditions affected the spread of COVID-19 through lower adherence to prevention practices. Policymakers should consider investing in mental health services as an important step in managing future epidemics, and the needs of people with poor mental health when designing epidemic responses, particularly in low-income countries where the burdens of adherence are likely to be greater.

Addressing adult hearing loss in primary care.

AIMS: To (a) determine the extent to which primary care providers screen adults for environmental or occupational hearing loss during the primary care visit and (b) determine what techniques are used to screen for hearing loss in the adult primary care patient. BACKGROUND: Although the prevalence of hearing loss is high, the frequency and techniques of screening for hearing loss among primary care providers are unknown. According to the United States Preventative Task Force, hearing screening promotes early detection, adequate treatment, and improved quality of life. DESIGN: It is a retrospective audit. METHODS: Thirty client records were randomly selected from two clinics in 2009 for this retrospective patient record audit. RESULTS/FINDINGS: Physical assessment of the structure of the auditory system was completed in all cases selected. Hearing acuity in all cases was determined by patient self-assessment, as indicated on patient-completed history forms; there was no documentation of objective assessment of auditory function. CONCLUSION: Given the low correlation between perceived and measured hearing ability, assessment of hearing ability by patient report alone may result in failure to detect hearing loss. Research into the nature and extent of barriers to hearing assessment in primary care needs to be explored, and criteria for screening of adults in the primary care setting should be established.

Effectiveness of Motivational Interviewing in Increasing Use of Hearing Protection Devices Among Agricultural Producers.

BACKGROUND: Agricultural producers are frequently exposed to noise that is hazardous to their hearing and cardiovascular health, and have among the highest rates of noise-induced hearing loss of all occupations. However, despite information-sharing approaches, few producers wear sufficient hearing protection. There is a need to develop effective methods of protecting producers from their noise exposure. METHODS: We provided a series of 2 to 3 short (30-minute) telephone-based motivational interviewing (MI) sessions to noise-exposed agricultural producers. We assessed intervention effectiveness through changes in measuring hearing protector use pre- and post-intervention using a one-group pre/posttest design. RESULTS: The sample (N = 29) predominantly consisted of crop producers from Michigan. The mean percentage of time hearing protection was used increased from 44.9% to 51.8% after the intervention, approximately a 7% increase (p =.105). Regression analysis suggested the relationship between intervention dose and use of hearing protection was not correlative. DISCUSSION/CONCLUSION: There was a marginal increase in the use of hearing protection after the intervention, although setting-specific increases in use were uneven. Intervention dose did not correlate with a change in hearing protection use. Further research is warranted to determine the effectiveness of MI, how it compares to information sharing, and to identify intervention dose parameters that promote efficiency.

Predictors of obesity in Michigan Operating Engineers.

Blue collar workers are at risk for obesity. Little is known about obesity in Operating Engineers, a group of blue collar workers, who operate heavy earth-moving equipment in road building and construction. Therefore, 498 Operating Engineers in Michigan were recruited to participate in a cross-sectional survey to determine variables related to obesity in this group. Bivariate and multivariate analyses were conducted to determine personal, psychological, and behavioral factors predicting obesity. Approximately 45% of the Operating Engineers screened positive for obesity, and another 40% were overweight. Multivariate analysis revealed that younger age, male sex, higher numbers of self-reported co-morbidities, not smoking, and low physical activity levels were significantly associated with obesity among Operating Engineers. Operating Engineers are significantly at risk for obesity, and workplace interventions are needed to address this problem.