Associations Between COVID-19 Vaccine Hesitancy and Socio-Spatial Factors in NYC Transit Workers 50 Years and Older.

This analysis investigates how age, race/ethnicity, and geographic location contributed to vaccine hesitancy in a sample of 645 New York City (NYC) Transport Workers Union (TWU), Local 100 members surveyed in August 2020. Union members ages 50+ were 46% less likely to be vaccine hesitant than their younger counterparts (OR 0.64; 95% CI 0.42, 0.97). Non-Whites (OR 3.95; 95% 2.44, 6.39) and those who did not report their race (OR 3.10; 95% CI 1.87, 5.12) were significantly more likely to be vaccine hesitant than Whites. Those who were not concerned about contracting COVID-19 in the community had 1.83 greater odds (95% CI 1.12, 2.98) of being vaccine hesitant than those who were concerned. Older respondents tended to reside in Queens while vaccine hesitant and non-White respondents were clustered in Brooklyn. General trends observed in COVID-19 vaccine hesitancy persist in a population of high risk, non-healthcare essential workers.

Street-level noise in an urban setting: assessment and contribution to personal exposure.

BACKGROUND: The urban soundscape, which represents the totality of noise in the urban setting, is formed from a wide range of sources. One of the most ubiquitous and least studied of these is street-level (i.e., sidewalk) noise. Mainly associated with vehicular traffic, street level noise is hard to ignore and hard to escape. It is also potentially dangerous, as excessive noise from any source is an important risk factor for adverse health effects. This study was conducted to better characterize the urban soundscape and the role of street level noise on overall personal noise exposure in an urban setting. METHODS: Street-level noise measures were obtained at 99 street sites located throughout New York City (NYC), along with data on time, location, and sources of environmental noise. The relationship between street-level noise measures and potential predictors of noise was analyzed using linear and logistic regression models, and geospatial modeling was used to evaluate spatial trends in noise. Daily durations of street-level activities (time spent standing, sitting, walking and running on streets) were estimated via survey from a sample of NYC community members recruited at NYC street fairs. Street-level noise measurements were then combined with daily exposure durations for each member of the sample to estimate exposure to street noise, as well as exposure to other sources of noise. RESULTS: The mean street noise level was 73.4 dBA, with substantial spatial variation (range 55.8-95.0 dBA). Density of vehicular (road) traffic was significantly associated with excessive street level noise levels. Exposure duration data for street-level noise and other common sources of noise were collected from 1894 NYC community members. Based on individual street-level exposure estimates, and in consideration of all other sources of noise exposure in an urban population, we estimated that street noise exposure contributes approximately 4% to an average individual's annual noise dose. CONCLUSIONS: Street-level noise exposure is a potentially important source of overall noise exposure, and the reduction of environmental sources of excessive street- level noise should be a priority for public health and urban planning.

Musculoskeletal Symptoms in Nurses in the Early Implementation Phase of California's Safe Patient Handling Legislation.

Musculoskeletal injuries and symptoms are prevalent in nurses and are largely associated with strenuous patient handling. In 2011, California enacted legislation that required acute-care hospitals to implement safe patient handling (SPH) policies and programs. To assess the early phase of this legislation, we conducted an epidemiological assessment of organizational SPH practices, musculoskeletal symptoms, and perceptions in a random sample of 396 registered nurses. Among those who worked in hospitals and had patient handling duties (n = 220), the 12 month prevalence of work-related musculoskeletal symptoms was 69% (lower back 54%, neck 41%, shoulders 34%, and hands/wrists 26%). Twenty-two percent of the nurses reported that their hospitals had a "no-lift" policy, 37% reported that their hospitals had lift teams, and 61% reported the availability of mechanical lift equipment such as floor or ceiling lifts. Nurses whose facilities employed lift teams were significantly less likely to report low back pain (OR = 0.54, 95% CI [0.30-0.97]). Nurses whose units had ceiling lifts were significantly less likely to report shoulder pain than nurses with no access to lifts (OR = 0.32, 95% CI [0.10-0.98]). Roughly 60% of respondents were aware of the SPH law, and 33% reported changes in their hospital's patient handling policies or programs since the law went into effect. Hospital SPH practices reported by the nurses in our sample were generally sub-optimal, but our findings suggest positive effects of elements required by SPH legislation. These data will serve as the baseline for future evaluation of the impact of this law in California.

The Impact of the Nursing Practice Environment on Missed Nursing Care.

OBJECTIVES: Missed nursing care is an emerging problem negatively impacting patient outcomes. There are gaps in our knowledge of factors associated with missed nursing care. The aim of this study was to determine the relationship between the nursing practice environment and missed nursing care in acute care hospitals. METHODS: This is a secondary analysis of cross sectional data from a survey of over 7.000 nurses from 70 hospitals on workplace and process of care. Ordinary least squares and multiple regression models were constructed to examine the relationship between the nursing practice environment and missed nursing care while controlling for characteristics of nurses and hospitals. RESULTS: Nurses missed delivering a significant amount of necessary patient care (10-27%). Inadequate staffing and inadequate resources were the practice environment factors most strongly associated with missed nursing care events. CONCLUSIONS: This multi-site study examined the risk and risk factors associated with missed nursing care. Improvements targeting modifiable risk factors may reduce the risk of missed nursing care.

Mass fatality preparedness among medical examiners/coroners in the United States: a cross-sectional study.

BACKGROUND: In the United States (US), Medical Examiners and Coroners (ME/Cs) have the legal authority for the management of mass fatality incidents (MFI). Yet, preparedness and operational capabilities in this sector remain largely unknown. The purpose of this study was twofold; first, to identify appropriate measures of preparedness, and second, to assess preparedness levels and factors significantly associated with preparedness. METHODS: Three separate checklists were developed to measure different aspects of preparedness: MFI Plan Elements, Operational Capabilities, and Pre-existing Resource Networks. Using a cross-sectional study design, data on these and other variables of interest were collected in 2014 from a national convenience sample of ME/C using an internet-based, anonymous survey. Preparedness levels were determined and compared across Federal Regions and in relation to the number of Presidential Disaster Declarations, also by Federal Region. Bivariate logistic and multivariable models estimated the associations between organizational characteristics and relative preparedness. RESULTS: A large proportion (42%) of respondents reported that less than 25 additional fatalities over a 48-hour period would exceed their response capacities. The preparedness constructs measured three related, yet distinct, aspects of preparedness, with scores highly variable and generally suboptimal. Median scores for the three preparedness measures also varied across Federal Regions and as compared to the number of Presidential Declared Disasters, also by Federal Region. Capacity was especially limited for activating missing persons call centers, launching public communications, especially via social media, and identifying temporary interment sites. The provision of staff training was the only factor studied that was significantly (positively) associated (p < .05) with all three preparedness measures. Although ME/Cs ranked local partners, such as Offices of Emergency Management, first responders, and funeral homes, as the most important sources of assistance, a sizeable proportion (72%) expected federal assistance. CONCLUSIONS: The three measures of MFI preparedness allowed for a broad and comprehensive assessment of preparedness. In the future, these measures can serve as useful benchmarks or criteria for assessing ME/Cs preparedness. The study findings suggest multiple opportunities for improvement, including the development and implementation of national strategies to ensure uniform standards for MFI management across all jurisdictions.

Using participatory action research to identify strategies to improve pandemic vaccination.

OBJECTIVE: Developing and implementing effective strategies to increase influenza vaccination rates among health care personnel is an ongoing challenge, especially during a pandemic. We used participatory action research (PAR) methodology to identify targeted vaccination interventions that could potentially improve vaccine uptake in a medical center. METHODS: Front-line medical center personnel were recruited to participate in 2 PAR teams (clinical and nonclinical staff). Data from a recent medical center survey on barriers and facilitators to influenza (seasonal, pandemic, and combination) vaccine uptake were reviewed, and strategies to increase vaccination rates among medical center personnel were identified. RESULTS: Feasible, creative, and low-cost interventions were identified, including organizational strategies that differed from investigator-identified interventions. The recommended strategies also differed by team. The nonclinical team suggested programs focused on dispelling vaccination-related myths, and the clinical team suggested campaigns emphasizing the importance of vaccination to protect patients. CONCLUSIONS: PAR methodology was useful to identify innovative and targeted recommendations for increasing vaccine uptake. By involving representative front-line workers, PAR may help medical centers improve influenza vaccination rates across all work groups.

Emergency preparedness in a sample of persons with disabilities.

OBJECTIVE: The objective of this study was to characterize emergency preparedness in this vulnerable population, and to ascertain the role of the personal assistant (PA) and the potential impact of prior emergency experience on preparedness efforts. DESIGN: Cross-sectional Internet-based survey conducted in 2011. SETTING: Convenience sample. PARTICIPANTS: Two-hundred fifty-three community residents with cognitive and /or physical disabilities, all receiving personal assistance services. MAIN OUTCOME VARIABLES: Emergency preparedness, operationalized as responses to a seven-item scale. RESULTS: The mean score for the emergency preparedness scale was 2.32 (SD = 2.74), range 0-7. Even though 62.8 percent (n = 159) of the participants had previously experienced one or more large-scale emergencies, only 47.4 percent (n = 120) of the entire sample and 55.3 percent (n = 88) of those with actual emergency experience reported preparing an emergency plan. Sixty-three percent (n = 76) of those reporting a plan had involved their PA in its development. Participants who reported such involvement were significantly more likely to have higher scores on the emergency preparedness scale (p < 0.001). Participants who had experienced a prior emergency were also more likely to score higher on the emergency preparedness scale (p < 0.001). In general, participants reported limited attention to other basic preparedness recommendations: only 28 percent (n = 70) had prepared a "go-bag" with necessary supplies, 29 percent (n = 74) had developed a strategy for communicating with their PA during emergencies, and 32 percent (n = 81) had stockpiled emergency supplies. Of particular importance, only 26 percent (n = 66) had made alternative back-up plans for personal assistance. CONCLUSIONS: Involving the PA in the planning process and experiencing an emergency were both significantly associated with higher emergency preparedness scores in this sample of people living with disabilities. However, critical deficiencies in preparedness were noted, such as lack of back-up plans for replacing their PA. Despite a concerted national effort to improve preparedness in the population of people living with disabilities, important preparedness gaps remain. These findings highlight the need for additional study on emergency preparedness barriers in people living with disabilities so that effective strategies to reduce vulnerabilities can be identified.

Estimation of permanent noise-induced hearing loss in an urban setting.

The potential burden of noise-induced permanent threshold shift (NIPTS) in U.S. urban settings is not well-characterized. We used ANSI S3.44-1996 to estimate NIPTS for a sample of 4585 individuals from New York City (NYC) and performed a forward stepwise logistic regression analysis to identify predictors of NIPTS >10 dB. The average individual is projected to develop a small NIPTS when averaged across 1000-4000 Hz for 1- to 20-year durations. For some individuals, NIPTS is expected to be substantial (>25 dB). At 4000 Hz, a greater number of individuals are at risk of NIPTS from MP3 players and stereos, but risk for the greatest NIPTS is for those with high occupational and episodic nonoccupational (e.g., power tool use) exposures. Employment sector and time spent listening to MP3 players and stereos and participating in episodic nonoccupational activities associated with excessive noise levels increased the odds of NIPTS >10 dB at 4000 Hz for 20-year durations. Our results indicate that the risk of NIPTS may be substantial for NYC and perhaps other urban settings. Noise exposures from "noisy" occupational and episodic nonoccupational activities and MP3 players and stereos are important risk factors and should be a priority for public health interventions.

Prevalence and factors associated with 2009 to 2011 influenza vaccinations at a university medical center.

BACKGROUND: Information on the rates and factors associated with influenza vaccinations, although limited, is important because it can inform the development of effective vaccination campaigns in a university medical center setting. METHODS: A study was conducted in 2011 to identify individual and organizational level barriers and facilitators to influenza vaccination among clinical and nonclinical personnel (N = 428) from a major university medical center. RESULTS: Seventy-one percent of clinical personnel (n = 170) reported pandemic H1N1 vaccination compared with 27% of nonclinical personnel (n = 258), even though vaccine was made widely available to all personnel at no cost. Similarly, disparate rates between clinical and nonclinical personnel were noted for the 2009/2010 seasonal influenza vaccine (82% vs 42%, respectively) and 2010/2011 combination (pandemic plus seasonal) influenza vaccine (73% vs 28%, respectively). Factors associated with pandemic vaccination in nonclinical personnel included the following: high level of influenza-related knowledge, concern regarding influenza contagion, history of previous influenza vaccinations or influenza illness, participation in vaccine-related training, and awareness of the institution's written pandemic plan. For clinicians, past history of seasonal influenza vaccination was associated with pandemic vaccination. For all participants, taking any 1 or more of the 3 influenza vaccines available in 2009 to 2011 was associated with intent to take a hypothetical future novel pandemic vaccine (odds ratio, 6.7; 95% confidence interval: 4.32-10.44; P < .001). CONCLUSION: Most of the risk factors associated with lack of vaccination uptake are amenable to organizational strategies.

Mass transit ridership and self-reported hearing health in an urban population.

Information on prevalence and risk factors associated with self-reported hearing health among mass transit riders is extremely limited, even though evidence suggests mass transit may be a source of excessive exposure to noise. Data on mass transit ridership were collected from 756 study participants using a self-administered questionnaire. Hearing health was measured using two symptom items (tinnitus and temporary audiometric threshold shift), two subjective measures (self-rated hearing and hearing ability), and two medical-related questions (hearing testing and physician-diagnosed hearing loss). In logistic regression analyses that controlled for possible confounders, including demographic variables, occupational noise exposure, nonoccupational noise exposure (including MP3 player use) and use of hearing protection, frequent and lengthy mass transit (all forms) ridership (1,100 min or more per week vs. 350 min or less per week) was the strongest predictor of temporary threshold shift symptoms. Noise abatement strategies, such as engineering controls, and the promotion of hearing protection use should be encouraged to reduce the risk of adverse impacts on the hearing health of mass transit users.

Safety in the home healthcare sector: development of a new household safety checklist.

OBJECTIVES: Unsafe household conditions could adversely affect safety and quality in home health care. However, risk identification tools and procedures that can be readily implemented in this setting are lacking. To address this need, we developed and tested a new household safety checklist and accompanying training program. METHODS: A 50-item, photo-illustrated, multi-hazard checklist was designed as a tool to enable home healthcare paraprofessionals (HHCPs) to conduct visual safety inspections in patients' homes. The checklist focused on hazards presenting the greatest threat to the safety of seniors. A convenience sample of 57 HHCPs was recruited to participate in a 1-hour training program, followed by pilot testing of the checklist in their patients' households. Checklist data from 116 patient homes were summarized using descriptive statistics. Qualitative feedback on the inspection process was provided by HHCPs participating in a focus group. RESULTS: Pretesting and posttesting determined that the training program was effective; participating HHCPs' ability to identify household hazards significantly improved after training (P<0.001). Using the checklist, HHCPs were able to identify unsafe conditions, including fire safety deficiencies, fall hazards, unsanitary conditions, and problems with medication management. Home healthcare paraprofessionals reported that the checklist was easy to use and that inspections were well accepted by patients. Inspections took roughly 20 minutes to conduct. CONCLUSIONS: Home healthcare paraprofessionals can be effectively trained to identify commonplace household hazards. Using this checklist as a guide, visual household inspections were easily performed by trained HHCPS. Additional studies are needed to evaluate the reliability of the checklist and to determine if hazard identification leads to interventions that improve performance outcomes.

Exposures to transit and other sources of noise among New York City residents.

To evaluate the contributions of common noise sources to total annual noise exposures among urban residents and workers, we estimated exposures associated with five common sources (use of mass transit, occupational and nonoccupational activities, MP3 player and stereo use, and time at home and doing other miscellaneous activities) among a sample of over 4500 individuals in New York City (NYC). We then evaluated the contributions of each source to total noise exposure and also compared our estimated exposures to the recommended 70 dBA annual exposure limit. We found that one in ten transit users had noise exposures in excess of the recommended exposure limit from their transit use alone. When we estimated total annual exposures, 90% of NYC transit users and 87% of nonusers exceeded the recommended limit. MP3 player and stereo use, which represented a small fraction of the total annual hours for each subject on average, was the primary source of exposure among the majority of urban dwellers we evaluated. Our results suggest that the vast majority of urban mass transit riders may be at risk of permanent, irreversible noise-induced hearing loss and that, for many individuals, this risk is driven primarily by exposures other than occupational noise.

Mass fatality preparedness in the death care sector.

OBJECTIVE: To characterize mass fatality preparedness of the death care sector (ie, funeral industry organizations) and to determine the workforce's ability and willingness to report to duty during a hypothetical high fatality pandemic event. METHODS: Anonymous, Web-based, cross-sectional survey of a national funeral industry sample. Preparedness was characterized using descriptive statistics. Factors significantly associated with ability and willingness were identified using chi-squared bivariate analysis. RESULTS: Respondents (N = 492) generally rated their organizational preparedness planning as suboptimal; only six of thirteen preparedness checklist items were typically in place. In contrast, response intentions were uniformly high; more than 80% of the respondents were willing to report to work, although high prevalence of secondary obligations might hinder this. CONCLUSIONS: Preparedness strategies that address interorganizational, surge capacity, and personal emergency planning are likely to be most efficacious. STATEMENT OF CLINICAL SIGNIFICANCE: Occupational medicine plays an important role in emergency preparedness and response. Funeral industry organizations could benefit from skills and resources of occupational medicine, including training, fit testing, development of plans, and coordination and hosting of planning exercises.

Factors associated with the ability and willingness of essential workers to report to duty during a pandemic.

OBJECTIVE: To determine essential workers' ability and willingness to report to duty during a serious pandemic outbreak and to identify modifiable risk factors. METHODS: Workers (N = 1103) from six essential workgroups completed an anonymous, cross-sectional survey. RESULTS: Although a substantial proportion of participants reported that they would be able (80%), fewer would be willing (65%) to report to duty. Only 49% of participants would be both able and willing. Factors significantly associated with ability/willingness included individual-level (eg, intentions to adhere to respiratory protection and pandemic vaccination recommendations) and organizational-level factors (eg, preparedness planning for respiratory protection and worker vaccination programs). CONCLUSIONS: During a serious pandemic event, non-illness-related shortfalls among essential workers could be substantial. Organizational preparedness efforts should focus on worker protection programs and the development of policies that would facilitate the attendance of healthy workers.

Pandemic-related ability and willingness in home healthcare workers.

OBJECTIVE: To assess pandemic-related attitudes and behavioral intentions of home healthcare workers (HHCWs). DESIGN: Cross-sectional survey. SETTING: New York City. PARTICIPANTS: A convenience sample of 384 HHCWs. MAIN OUTCOME VARIABLES: Ability and willingness to report to work during a pandemic influenza outbreak. RESULTS: A large proportion of HHCWs reported that they would be either unable or unwilling (or both) to provide care to their current (83 percent) or new (91 percent) patients during a pandemic. Ability was significantly associated with not having children living at home, having alternatives to mass transportation, not having a spouse/partner employed as a first responder or healthcare worker, and having longer tenure (ie, six or more years) in homecare. During an outbreak, 43 percent of HHCWs said they would be willing to take care of current patients and only 27 percent were willing to take care of new patients. Willingness to care for both current and new patients was inversely associated with fear for personal safety (p < 0.01). Provision of key elements of a respiratory protection program was associated with decreased fear (p < 0.05). Most participants (86 percent) had not received any work-based, pandemic-related training, and only 5 percent reported that their employer had an influenza pandemic plan. CONCLUSIONS: Given that a large majority of the participating HHCWs would either be unable or unwilling to report to duty during a pandemic, potential shortfalls in this workforce may occur. To counter this, organizations should focus on strategies targeting intervenable barriers to ability and to willingness (ie, the provision of a vaccine and respiratory protection programs).

Web-based training on weapons of mass destruction response for emergency medical services personnel.

OBJECTIVE: To develop, implement, and assess a web-based simulation training program for emergency medical services (EMS) personnel on recognition and treatment of ocular injuries resulting from weapons of mass destruction (WMD) attacks. DESIGN: The training program consisted of six modules: WMD knowledge and event detection, ocular anatomy, ocular first aid (ie, flushing, cupping, and patching), and three WMD simulations (ie, sarin gas release, anthrax release, and radioactive dispersal device). Pretest, post-test, and 1-month follow-up test and a program evaluation were used to measure knowledge gain and retention and to assess the effectiveness of the program. SETTING: New York State EMS. PARTICIPANTS: Four hundred and sixty-four individuals participated in the training program and all waves of the testing (86 percent retention rate). MAIN OUTCOME VARIABLES: The effectiveness of the training intervention was measured using pretest and post-test questionnaires and analyzed using dependent t-tests. RESULTS: Assessment scores for overall knowledge increased from the pretest (mean = 15.7, standard deviation [SD] = 2.1) to the post-test (mean = 17.8, SD = 1.3), p < 0.001, and from pretest (mean = 15.7, SD = 2.1) to 1-month follow-up test (mean = 16.6, SD = 2.0), p < 0.001. Ninety-two percent of respondents indicated that the program reinforced understanding of WMDs. CONCLUSIONS: This training method provides an effective and low-cost approach to educate and evaluate EMS personnel on emergency treatment of eye trauma associated with the use of WMD. Online training should also be supplemented with hands-on practice and refresher trainings.

Nurse work environments and occupational safety in intensive care units.

Using data collected from 39 intensive care units (ICUs) in 23 hospitals across the United States, the purpose of this study was to examine hospital structural characteristics, nurse characteristics, and nurses' working conditions' impact on occupational safety outcomes. ICU with more positive organizational climates had lower rates of occupational injuries and blood and body fluid exposures (p < .05). Similarly, ICUs in hospitals that had attained magnet accreditation had lower rates of negative occupational health incidents (p < .05). Hospital profitability was inversely related to rates of blood and body fluid exposure (p < .05). Monitoring nurses' working conditions and improving the organizational climate of hospitals is likely to improve the safety of the employee and the profitability of the hospital through improved system outcomes (such as lower turnover of the employees) as well as improve the quality of patient care delivered.

Noise levels associated with New York City's mass transit systems.

OBJECTIVES: We measured noise levels associated with various forms of mass transit and compared them to exposure guidelines designed to protect against noise-induced hearing loss. METHODS: We used noise dosimetry to measure time-integrated noise levels in a representative sample of New York City mass transit systems (subways, buses, ferries, tramway, and commuter railways) aboard transit vehicles and at vehicle boarding platforms or terminals during June and July 2007. RESULTS: Of the transit types evaluated, subway cars and platforms had the highest associated equivalent continuous average (L(eq)) and maximum noise levels. All transit types had L(eq) levels appreciably above 70 A-weighted decibels, the threshold at which noise-induced hearing loss is considered possible. CONCLUSIONS: Mass transit noise exposure has the potential to exceed limits recommended by the World Health Organization and the US Environmental Protection Agency and thus cause noise-induced hearing loss among riders of all forms of mass transit given sufficient exposure durations. Environmental noise-control efforts in mass transit and, in cases in which controls are infeasible, the use of personal hearing protection would benefit the ridership's hearing health.

Violence, job satisfaction, and employment intentions among home healthcare registered nurses.

Workplace violence, defined as violent acts directed toward workers, includes physical assault, threat of assault, and verbal abuse and is widely recognized as a threat to workers' health and safety. Healthcare workers, especially nurses, are known to be at high risk. As employees who work alone, have access to drugs, provide care to people in distress, and/or have frequent close contact with clients, they face a greater likelihood of exposure to violence. Nurses' risk has been correlated with degree of patient contact; the odds of physical violence are 7.2 and 9.0 times greater for healthcare workers with moderate and high patient contact, respectively, compared with those with little or no contact.