Brenda L. Eakin

Effectiveness of a tailored intervention to increase factory workers' use of hearing protection.

BackgroundIn the United States it is estimated that more than 30 million workers are exposed to harmful levels of noise on the job. When engineering or administrative controls cannot be used to reduce noise, workers should always use hearing protection devices (HPDs) when exposed to loud noise to prevent noise-induced hearing loss (NIHL). Previous research has shown that workers do not always use HPDs when required; therefore, it is essential that workers assume personal responsibility for preventing NIHL by increasing their use of HPDs. ObjectivesThis study tested the effectiveness of an individually tailored multimedia intervention to increase use of HPDs by factory workers. MethodsA randomized controlled design was used to compare the effects of a tailored intervention (n = 446) with two other interventions (a nontailored predictor-based intervention (n = 447) and a control intervention (n = 432)) on workers’ self-reported use of HPDs 6 to 18 months following the intervention. ResultsOnly those workers receiving the tailored intervention significantly increased their use of HPDs from pretest to posttest. However, this increase significantly differed from the nontailored group but not from the control group. ConclusionsIndividually-tailored interventions offer promise for changing behavior. In light of the similarity between the results for the tailored intervention and the control intervention groups, further research is needed to understand barriers to HPD use and how to maximize the benefits of individually tailored interventions in this setting.

Effectiveness of an Intervention to Increase Construction Workers' Use of Hearing Protection

In this project we tested the effectiveness of a theory-based intervention (video, pamphlets, and guided practice session) to increase the use of hearing protection devices (HPDs) among Midwestern construction workers and a national group of plumber/pipefitter trainers. Posttest measures were collected 10--12 months following this intervention. Penders Health Promotion Model (1987) provided the conceptual basis for development of the training program. A total of 837 highnoise- exposed workers were included in the analysis: 652 regional Midwestern construction workers and 185 national plumber/pipefitter trainers. Effectiveness of the intervention was determined through the sequence of analyses recommended by Braver and Braver (1988) for the Solomon Four-Group Design. Analysis of variance and covariance of postintervention use and intention to use HPDs and a meta-analytic test were done. These analyses indicated that the intervention significantly increased use of HPDs but had no effect on intention to use HPDs in the future. Pretesting had no effect on use. Actual or potential applications of this research include guidance in the development of successful theorybased interventions to increase use of HPDs.

Applying the Health Promotion Model to Development of a Worksite Intervention

Introduction. Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. Purpose. The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. Subjects/Setting. Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. Design. Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. Measures. All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). Results. Linear regression and Pearsons correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. Conclusion. Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future.

Mexican Adolescents' Alcohol Use, Family Intimacy, and Parent-Adolescent Communication

Despite widespread adolescent alcohol use, research on individual and contextual factors among Mexican adolescents is limited. This study describes the relationship between adolescent risk/protective factors, parent-adolescent communication, and their effects on alcohol use of 14- to 17-year-old adolescents living in Mexico (N = 829; 458 girls, 371 boys). In this study, adolescents reported that 55% ever used alcohol, 24% used alcohol in the past 30 days, and 10% reported binge drinking. Adolescents with high family intimacy were less likely to report ever using alcohol and binge drinking. Regression analysis revealed that parent-adolescent communication mediated the effect of family intimacy on overall and binge drinking. Alcohol use prevention with Mexican adolescents should focus on family intimacy and parent-adolescent communication.

Effects of booster interventions on factory workers' use of hearing protection.

BackgroundThe provision of reinforcements or boosters to interventions is seen as a logical approach to enhancing or maintaining desired behavior. Empirical studies, however, have not confirmed the effectiveness of boosters nor assessed the optimum number of boosters or the timing for their delivery. ObjectivesThis randomized controlled trial contrasted the effect of four booster conditions (a) 30 days; (b) 90 days; (c) 30 and at 90 days; and (d) no boosters of the intervention to increase the use of hearing protection devices (HPDs). MethodsA total of 1,325 factory workers completed a computerized questionnaire and were randomly assigned to one of three computer-based (tailored, nontailored predictor-based, or control) multimedia interventions designed to increase the use of hearing protection devices. After the intervention, colorful boosters specific to the type of training received were mailed to workers’ homes. Posttest measures of use were administered at the time of their next annual audiogram 6 to 18 months after the intervention. ResultsRepeated measures of analysis of variance (ANOVA) showed a significant main effect for the booster (after 30 days) in the group that received tailored training (F [3,442] = 2.722; p = .04). However, in the assessment of the interaction between time (pretest and posttest) and boosters (four groups), the ANOVA did not find significant differences in hearing protection device use for any of the training groups. To assess for significant differences between groups, post hoc comparisons were conducted at the pretest and posttest for the total sample and for the subsample of workers who reported using hearing protection devices less than 100% of the time needed. Sheffé contrasts by intervention group, gender, ethnicity, and hearing ability found no significant changes in the mean use of hearing protection devices for the booster groups. ConclusionsAlthough the provision of boosters represented a considerable commitment of resources, their use was not effective in this study. However, it would be premature to eliminate boosters of interventions. Further study is needed to explore the effects of different booster types for increasing the use of hearing protection devices, and to assess carefully the effects of boosters on other health behaviors in studies with controlled designs.

Hemodynamic responses to upright exercise of adolescent cardiac transplant recipients

To characterize the hemodynamic response to exercise after cardiac transplantation, we asked seven adolescent transplant patients (aged 15.1 +/- 0.7 years; mean +/- SE) to perform upright discontinuous exercise to volitional exhaustion on a mechanically braked cycle ergometer. Data were compared with those of seven control subjects matched for age, gender, body mass, percentage of fat, and body surface area. The transplant group had lower peak power output values (92 +/- 13 vs 146 +/- 30 watts; p less than or equal to 0.001) and maximum oxygen consumption values (22 +/- 8 vs 32 +/- 8 ml/kg per minute; p less than or equal to 0.03), despite achieving the same peak venous lactic acid concentration (6.2 +/- 3 vs 5.9 +/- 3 mEq/L; p = not significant). The transplant group had a diminished heart rate in response to exercise--44% lower than the control group had (delta = 49 +/- 6.4 vs 87 +/- 9.1 beats/min; p = 0.005). The cardiac output response to exercise was maintained in the transplant group (delta = 6.5 +/- 1.5 vs 4.6 +/- 0.8 L/min; p = not significant) by an augmented stroke volume response (delta = 31 +/- 10 vs -4 +/- 3.4 ml; p = 0.01), which may relate to a greater decrease in systemic vascular resistance during exercise (delta = -13.7 +/- 2.2 vs -6.3 +/- 1.2 Wood units; p = 0.02). Thus adolescents who have undergone cardiac transplantation have a normal cardiac output response to upright exercise. This is accomplished, despite a blunted heart rate response, by an augmented stroke volume that may relate to the greater decrease in systemic resistance during exercise.

Perceived exertion and exercise intensity in children with or without structural heart defects

To assess the ability of children with cardiac disease to quantify their effort during exercise with the Borg perceived exertion scale, and to determine the validity of the scale for use with children by comparing the ratings with direct measurements of exercise intensity, we exercised 36 children with various cardiac defects and 15 normal children to exhaustion with the Bruce treadmill protocol. The subjects were able to quantify exercise intensity, so perceived exertion ratings can be used to predetermine the level of exercise intensity in an unmonitored setting and may be useful in defining appropriate exercise programs.

Selecting Control Interventions for Clinical Outcome Studies

In the current research environment the design and management of control groups is becoming more complex. The selection of a control group design is dependent on study goals, presence and quality of existing interventions, urgency of the problem or issue being addressed by the intervention, and factors related to the study site. The purpose of the presentation is to identify various approaches to the design of control groups in experimental studies and to identify their strengths, limitations, and applications. A case study exemplifies the issues associated with control group selection and design.

From research to practice: the importance of community collaboration in the translation process.

In order for effective interventions to make an impact on their target population, they must be successfully translated and disseminated to the organizations that will ultimately deliver them to those in need. ¡Cuídate!, a culturally based intervention to reduce HIV sexual risk among Latino youth, was identified by the Centers for Disease Control and Prevention’s (CDC) Prevention Research Synthesis (PRS) project as “best evidence” of intervention efficacy and selected as part of the CDC’s Replicating Effective Programs (REP). The REP process consisted of the design, development, and field-testing of the ¡Cuídate! program package in community-based, nonacademic settings. Project staff worked with CDC and community-based partners throughout the REP process. Community partners included a community advisory board (CAB) and four case agencies. Case agency staff participated in a facilitator training and subsequently implemented the ¡Cuídate! program at their respective agencies. Process evaluation findings showed that facilitators were able to effectively use program materials and implement the program with fidelity. Adolescent participants reported they liked the program and would recommend the project to others. Only slight modifications to program and training materials were necessary following evaluation. Lessons learned included the importance of interdisciplinary collaboration and utilizing the resources available from each collaborative partner.

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.