OiSaeng Hong

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.

Understanding and preventing noise-induced hearing loss

Noise is a major occupational and environmental hazard, causing hearing loss, annoyance, sleep disturbance, fatigue, and hypertension. Although the extra-auditory effects of high-level noise exposure have been reported, noise-induced hearing loss (NIHL) has long been recognized as the primary and most direct health effect of excessive noise exposure. The World Health Organization reported that 16% of the disabling hearing loss in adults is attributable to occupational noise exposure. NIHL has been recognized as an occupational disease and injury since the 18th century among copper workers who suffered hearing loss as a result of hammering on metal. In the 1800s, Fosbroke also mentioned how blacksmiths suffered hearing impairment from continued exposure to noise. The occupational risk of NIHL in industries that expose workers to continuous high levels of noise is well established with more than 30 million U.S. civilian workers estimated to be exposed to potentially damaging noise levels and another 9 million at risk from other ototraumatic agents, including chemicals. In 1996, the NIOSH had established the National Occupational Research Agenda (NORA) that identified NIHL as one of the 21 priority areas to stimulate innovative research and improved workplace practices to reduce NIHL problem. In order to manage this major health problem among workers exposed to occupational noise, it is important to understand the nature of NIHL. Two characteristics of NIHL have been thoroughly established through numerous studies. First, the amount of hearing loss increases with noise intensity and duration of exposure, such that more intense and longer-duration noise exposures cause more severe hearing loss. Second, individual susceptibility to NIHL varies greatly. Not all individuals exposed to a given noise level develop the same degree of hearing loss. Although the reason that some individuals are more susceptible to NIHL than others is not well understood, several factors have been implicated, including age, previous sensorineural hearing loss, cigarette smoking, use of ototoxic medication, type 2 diabetes, and hypertension. The relationship between these factors and NIHL works in reverse as well. For example, a recent animal study by Kujawa and Liberman demonstrated that damage caused by noise exposure early in life made mice more susceptible to age-related hearing loss.

Work-related cardiovascular disease risk factors using a socioecological approach: implications for practice and research

Background: Cardiovascular disease (CVD) is a leading cause of mortality. Numerous investigations have linked occupational factors and CVD. Occupational factors such as overtime work have an enormous effect on the CVD risk of industrial workers. However, risk factors for CVD are not systematically reviewed in the workplace. The purpose of the paper is to review work-related risk factors for CVD. Methods: A systematic review of work-related CVD risk factors was performed, yielding 180 articles. All articles were assessed in relation to inclusion and exclusion criteria, resulting in 44 articles being reviewed. The sole inclusion criteria was work-related environmental factors and intra/inter-personal factors (psychosocial factors), which is based on the socioecological perspective. The articles were also assessed regarding the quality of each study using the scoring methods developed by Cesario et al. and Brown et al. Conclusion: The literature review demonstrated that work environment factors such as shift work, overtime work, and noise and chemical exposures; and psychosocial factors such as job stress, social support, and socioeconomic status cannot be explained or intervened by one single risk factor. Furthermore, certain occupational factors were shown to aggravate or attenuate other risk factors. The implication of these findings is to incorporate work-related environmental and psychosocial factors into assessment of the patient’s CVD risks and intervention plan. Future research should also incorporate a well-defined conceptual framework to address the effects of work-related environmental and psychosocial factors on CVD among CVD patients.

Chemical exposure and hearing loss

Workers are commonly exposed to multiple factors and substances that are hazardous to health. For instance, in 2005, approximately 30% of the European workers reported being exposed to noise during at least a quarter of the time spent in their work environment, 11% reported inhaling vapors such as solvents and thinners; 19% reported exposure to smoke, fumes, powder, or dust; and 14% reported handling chemical substances.1 Although occupational noise exposure has long been recognized in the United States and in Europe as the most deleterious factor to hearing2,3 the impact of chemical-induced hearing loss on workers should not be underestimated.4 A cursory survey of the literature for the last three decades reveals that concern about the effects of chemicals on hearing has grown steadily. The proliferation of work-related substances and medicinal drugs (mostly antitumor drugs and aminoglycosides) has been accompanied by an equivalent increase in the number of scientific publications on the hearing risks encountered by chemical-exposed persons. Cause for concern is even greater when the synergistic risks of co-exposures are considered. For example, physiological factors may increase the severity of a chemical’s effect on hearing. Today, robust evidence also confirms that the effects of ototoxic substances on ear function can be aggravated by noise, which remains a well-recognized cause of hearing impairment. In an expert forecast supervised by the European Agency for Safety and Health at Work5 (EU-OSHA, 2009), a “combined exposure to noise and ototoxic substances” was rated as an emerging risk. Industrial ototoxic chemicals have predominantly been assessed through animal studies, which are supported by data from epidemiologic studies on human workers from various industries. Bergstrom and Nystrom (1986) published the seminal results of a 20-year longitudinal study performed with 319 Swedish employees from different industrial sectors.2 This study began in 1958 and involved testing workers’ hearing regularly. Its findings showed that a large proportion (23%) of the employees working in a chemical division suffered from hearing impairment, despite their exposure to lower noise levels than other divisions. Based on this type of evidence, researchers have long hypothesized that industrial solvents pose an additive risk to hearing. Scientific findings in animals are generally considered qualitatively relevant to human health, provided no substantial difference in biological response (e.g. metabolism) exists between test animals and humans. Despite these findings, current research is limited by the following: a lack of detailed exposure histories; the presence of confounding factors (ototoxic drugs, tobacco, alcohol consumption, aging, and exposures outside the workplace); and the fact that chemical exposure scenarios used in experimental investigations are qualitatively different from real-world occupational settings. In this extensive, but not exhaustive, review of the literature, the authors hope to share the evidence indicating that noise is not the only source of work-related hearing damage and to draw greater attention to the matter of chemically induced hearing loss. The present publication intends to provide occupational physicians and other health professionals with a clear picture of what is known about how chemical substances may affect hearing ability in the general population, and more specifically, in workers. The article describes the following: chemicals that can be noxious to the inner ear; work areas where exposure to ototoxic substances are likely; and the basic features of the physiological mechanisms leading to hearing impairment. This article also addresses the limitations of pure-tone air-conduction audiometry when assessing chemical-induced hearing loss and proposes a more complete approach to evaluate the auditory neurosensory hearing receptor and the neural pathways involved in the stapedial reflex. With the proposed battery of tests, physicians will be able to evaluate both ototoxicity and neurotoxicity. Throughout this manuscript, emphasis is placed on the need for stronger links between primary care and occupational physicians. This could help preserve patients’ hearing status as a part of their overall health.

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.

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.

Type 2 diabetes and hearing loss.

Hearing loss is a common public health problem that affects work productivity, functional status, social interactions, personal safety and well-being, and quality of life. In particular, hearing loss is of concern among older adults due to age-related hearing loss and among the working population due to hearing loss associated with noise exposure on the job. In 2009, the Centers for Disease Control and Prevention (CDC) reported that 34.5 million adults in the U.S. experienced ‘‘trouble hearing;’’ a 9% increase since 2000 when 31.5 million U.S. adults reported ‘‘trouble hearing.’’ While aging and exposure to loud noise and other ototoxic substances are well-known risk factors for hearing loss, research conducted over the past several decades has brought attention to sensorineural hearing loss among individuals with other health problems such as diabetes. More than 8% of the population in the U.S. has diabetes mellitus and the incidence is increasing at unprecedented rates; it is expected that by 2050, one in three Americans will suffer from this disease. For those born in 2000, the estimated lifetime risk for developing diabetes is 32.8% for males and 38.5% for females, and the risk is even higher in certain minority groups. Since 1997, diabetes mellitus has been categorized as either type 1 or type 2. Type 1 diabetes is an autoimmune destruction of pancreatic b-cells and subsequent dependence upon insulin therapy. Type 2 diabetes is a disorder characterized by insulin resistance, pancreas b-cell function decline, impaired glucose tolerance, and hyperglycemia; sometimes the b-cell function destruction is enough to require insulin therapy. Risk factors for type 2 diabetes are complex and include genetic predisposition, lifestyle issues such as insufficient exercise, diet and smoking, as well as environmental components. Type 2 diabetes accounts for 90% of all cases of the disease, and traditionally it has been a disease of middle-aged or older people. However, since the 1990s, the age of onset has become apparent among younger adults, and even children. This trend is a serious threat to public health, as diabetes is associated with severe and potentially fatal complications and comorbidities, such as cardiovascular disease, kidney disease, visual impairment, neuropathies, and infectious complications. The person living with diabetes can experience symptoms from such comorbidities which may impact function, emotional well-being, and quality of life as

Noise induced hearing loss among male airport workers in Korea.

The purposes of this study of airport workers were to a) determine the prevalence and symptoms of hearing loss, and b) identify compliance in using hearing protective devices (HPDs) and its relationship with hearing loss. This cross sectional epidemiological study was conducted with 255 noise exposed and 195 non-noise exposed, full time, male workers at a large metropolitan airport in Seoul, Korea. The three measures used were the self administered Occupational Hearing Questionnaire (OHQ), an audiological assessment, and a record review of baseline hearing and noise levels of locations in which the employee worked. The results showed a significant difference in prevalence of hearing loss (more than 25dB) between the noise and the non-noise exposed groups (p < .05). About 60.8% of noise exposed workers reported continuous use of the HPDs. The continuous HPD users had significantly lower rates of hearing loss than the occasional users or non-users. The major symptom for workers with low frequency hearing loss was trouble in communication, whereas tinnitus and fullness in the ear were the most common symptoms for the workers with high frequency hearing loss. The airport workers exposed to excessive noise had a great deal of high frequency hearing loss. The degree of hearing loss present reinforces the need for aggressive hearing conservation programs among airport workers exposed to noise.

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

BackgroundNoise-induced hearing loss (NIHL) is a major occupational health problem that can be prevented through the use of hearing protection devices (HPDs).PurposeThe purpose of this study is to identify significant factors related to firefighters’ use of HPDs.MethodsA 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.ResultsPearson 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% (R2 = .56, adjusted R2 = .54) of the variance in firefighters’ use of HPDs (F13, 372 = 35.65, p < .001).ConclusionsFuture research should focus on incorporating these significant predictors into effective behavioral interventions designed to promote the use of HPDs in this population.