Validity and reliability of the Musicians' Health Literacy Questionnaire, MHL-Q19.

High prevalence of musicians' physical and mental performance-related health issues (PRHI) has been demonstrated over the last 30 years. To address this, health promotion strategies have been implemented at some post-secondary music institutions around the world, yet the high prevalence of PRHI has persisted. In 2018, an international group of researchers formed the Musicians' Health Literacy Consortium to determine how best to decrease PRHI, and to examine the relationship between PRHI and health literacy. An outcome of the Consortium was the development of a new health literacy tool for musicians, the MHL-Q19, which drew from the theoretical framework of the European health literacy suite of tools, HLS-EU. The aim of the current study was to evaluate the validity and reliability of the MHL-Q19. Participants completed a battery of questionnaires, including the HLS-EU-Q16 for the assessment of general health literacy; the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM); the RAND-12 quality of life questionnaire; and the General Self-Efficacy scale (GSE). We hypothesized that the MHL-Q19 would have a weak correlation with the HLS-EU-Q16; moderate correlation with the physical component scale and weak correlation with the mental component scale of the RAND-12; moderate correlation with the GSE; and finally, moderate correlation with pain interference and weak correlation with pain intensity of the MPIIQM. A total of 549 post-secondary music students from six English-speaking countries completed the battery of questionnaires, and 328 of these participants provided valid responses to the MHL-Q19 alone 2 weeks later. The tool showed acceptable internal consistency and test-retest reliability. Three of our hypotheses were supported, although the strength of the correlations varied from what we had predicted. The fourth hypothesis was not supported; our findings indicate that lower health literacy scores were weakly related to higher MPIIQM pain intensity and interference scores. The results of this study support the notion that musicians' health literacy is a distinct construct that cannot be fully evaluated with existing health literacy tools. Given that this is a new instrument, the evidence presented is positive and promising. Further studies will be needed to refine the tool.

One Year on: The Impact of COVID-19 on the Lives of Freelance Orchestral Musicians in the United Kingdom.

Before the drastic disruption caused by the sudden emergence of the COVID-19 pandemic, 85% of the United Kingdom's 14,000 orchestral musicians were self-employed freelance workers, engaged in busy and varied portfolio careers comprising a combination of orchestral, West End theatre, chamber music, and commercial recording work. Between May and June 2020 we carried out a first study examining the impact of the pandemic on the lives of 24 self-employed orchestral musicians, all established freelancers. Twelve were mid-career and 12 were late-career (described in that study as "seasoned"). They all reported having lost their much-loved performing careers, missing music making and colleagues, and being anxious about the future of the music profession. However, there were some differences between the two groups: the late-career participants demonstrated greater financial and emotional resilience, while the mid-career musicians reported distress, confusion, and anxiety about their identity as musicians. In the present follow-up study, we aimed to examine the impact of the first year of the pandemic on the lives of 21 of the same musicians. We found that while all the mid-career participants remained committed to their performing careers, many late-career participants aged 54-59 had developed interests in non-performing music work, and the older late-career participants, aged 65 and over, feared that they might already, de facto, have retired. We discuss the findings with reference to the precarity of freelance orchestral musicians' lives, lifespan models of musicians' careers, self-determination theory and post-traumatic growth, and their implications for music colleges and musicians' support organizations.

Health education for musicians in the UK: a qualitative evaluation.

Musical training in higher education music institutions (e.g. conservatoires) has been associated with health-related issues among musicians. The Health Promotion in Schools of Music project in the USA and the Healthy Conservatoires project in the UK have therefore recommended health promotion at conservatoires. Few health education courses have been evaluated to date, however. A 5-month health education programme for first-year undergraduate students at a British conservatoire was introduced as part of the core curriculum in September 2016. The programme, which involved both lectures and seminars, was evaluated using quantitative and qualitative approaches. This article reports only the qualitative evaluation. Twenty semi-structured individual interviews were conducted either face-to-face or via Skype in April 2017. The data were transcribed verbatim and analysed thematically. Five themes were identified: (i) the programme as a catalyst for engagement with health; (ii) behavioural changes; (iii) barriers to engaging with the programme material and initiating changes; (iv) suggestions for improvement; and (v) misinformation. Generally, participants viewed the programme as relevant and informative, particularly appreciating the intimate nature of the seminars. They reported that the programme helped them take a broader perspective on musicianship and that they would welcome sessions that are more practical than theoretical. They also reported instances of change in their behaviours relating to both lifestyle and management of music practice. In conclusion, undergraduate music students viewed this health education programme positively. Their feedback illustrates the complex nature of health promotion in the conservatoire setting.

Professional classical musicians struggle with a range of occupational health issues. It has therefore been recommended that health education be integrated as part of their higher education training. Although some programmes of this nature have been implemented in recent years, very few were evaluated, so it is often unclear if they work and if so, how. This paper reports the evaluation of one such programme that lasted 5 months and was delivered to first-year undergraduate music students in the UK. Although the evaluation of the programme was complex and involved many measurements, this article reports only the analysis of themes arising from interviews with 20 participants that were audio-recorded and transcribed verbatim. The results of the analysis show that participants viewed the course positively. Specifically, they viewed the programme as relevant and informative, and appreciated the intimate nature of the seminars. The programme seemed to widen their perspective on musicianship and they reported changes in their behaviours related to preventative health and music practice, although they also expressed a preference for an even more practical and thus less theoretical approach.

Identifying barriers and facilitators of hearing protection use in early-career musicians: a basis for designing interventions to promote uptake and sustained use.

OBJECTIVE: The current study aimed to: i) determine the patterns of hearing protection device (HPD) use in early-career musicians, ii) identify barriers to and facilitators of HPD use, and iii) use the Behaviour Change Wheel (BCW) to develop an intervention to increase uptake and sustained use of HPDs. DESIGN: A mixed-methods approach using questionnaires and semi-structured interviews. STUDY SAMPLE: Eighty early-career musicians (age range = 18-26 years; women n = 39), across all categories of musical instrument. RESULTS: 42.5% percent of participants reported using HPDs at least once a week, 35% less than once a week, and 22.5% reported never using HPDs for music-related activities. Six barriers and four facilitators of HPD use were identified. Barriers include the impact of HPDs on listening to music and performing, and a lack of concern about noise exposure. Barriers/facilitators were mapped onto the Theoretical Domains Framework. Following the systematic process of the BCW, our proposed intervention strategies are based on 'Environmental Restructuring', such as providing prompts to increase awareness of noisy settings, and 'Persuasion/Modelling', such as providing credible role models. CONCLUSIONS: For the first time, the present study demonstrates the use of the BCW for designing interventions in the context of hearing conservation.

Developing Familiarity in a New Duo: Rehearsal Talk and Performance Cues.

Context and Aims: Social and cognitive processes underlying individual classical musicians' and duo performers' preparation for performance have been explored using longitudinal case studies. Social processes can be inferred from rehearsal talk and recent studies have focused on its content and nature. Cognitive processes can be inferred from score annotations representing musicians' thoughts while practicing, rehearsing (rehearsal features), and playing or singing from memory (performance cues). We report three studies conducted by two practitioner-researchers: (1) of rehearsal talk; (2) of rehearsal features and thoughts while performing; and (3) a triangulation (as it were) of the two kinds of data to gauge the potential for rehearsal talk to predict the use of performance cues. Methods: A singer and viola player formed a new duo to prepare two songs, new to them both, for two performances on the same day and a third performance 10 months later. Their practice and rehearsal sessions, over the course of seven days, were recorded and transcribed. The musicians annotated copies of the scores after rehearsing and after each performance. Each musician performed one of the two songs from memory. First, verbal data were coded and analyzed using two frameworks for categorizing socio-emotional interactions and musical dimensions, respectively. Second, their annotations were categorized and compared, and finally the frameworks were combined so that correlations between rehearsal talk and performance cues could be calculated. Results: The musicians' verbal interactions were positive and task-related; significant changes over time were observed only in the extent to which they showed solidarity toward each other. Analysis of their annotations illustrates similarities and differences between their attention to specific features of the music while rehearsing and performing, particularly from memory. Rehearsal talk predicted performance cues in the third performance, but not the first or second. Conclusion: Musicians' talk cannot be assumed to reflect musicians' actions. The study of musicians' verbal interactions may be less useful for determining cognitive than social processes underlying preparation for performance. Nevertheless, the study provides a detailed snapshot of classical musicians' "real world" preparation for performance, highlighting the role of spontaneity in performance, and underlining differences between what happens in the studio and what can happen on stage.

The Experiences of Mid-career and Seasoned Orchestral Musicians in the UK During the First COVID-19 Lockdown.

The introduction of social distancing, as part of efforts to try and curb the spread of the COVID-19 pandemic, has brought about drastic disruption to the world of the performing arts. In the UK the majority of professional orchestral musicians are freelance and therefore self-employed. These players, previously engaged in enjoyable, busy, successful, portfolio careers, are currently unable to earn a living carrying out their everyday work of performing music, and their future working lives are surrounded by great uncertainty. The aim of the present study was to examine how established professional musicians are experiencing this period, and to look for similarities and differences between the experiences of musicians in the middle of their performing careers (aged 35-45), with those of older players (aged 53 and over). Single semi-structured interviews were carried out over Zoom with 24 freelance, self-employed orchestral musicians; 12 mid-career musicians aged 35-45, and 12 seasoned musicians aged 53 and over. Thematic analysis identified themes common to both groups: the loss of a much-loved performing career, missing music making and colleagues, and anxiety about the future of the music profession. It also identified differences between the two groups: challenges to their identity as a musician, the extent of their anxiety about finances, the extent of their emotional distress, attitudes toward practicing and engaging in collaborative music making, and confusion over future career plans. Findings are discussed with reference to lifespan models of musicians' career development, the PERMA model of wellbeing, and the concept of resilience.

Investigating the effects of noise exposure on self-report, behavioral and electrophysiological indices of hearing damage in musicians with normal audiometric thresholds.

Musicians are at risk of hearing loss due to prolonged noise exposure, but they may also be at risk of early sub-clinical hearing damage, such as cochlear synaptopathy. In the current study, we investigated the effects of noise exposure on electrophysiological, behavioral and self-report correlates of hearing damage in young adult (age range = 18-27 years) musicians and non-musicians with normal audiometric thresholds. Early-career musicians (n = 76) and non-musicians (n = 47) completed a test battery including the Noise Exposure Structured Interview, pure-tone audiometry (PTA; 0.25-8 kHz), extended high-frequency (EHF; 12 and 16 kHz) thresholds, otoacoustic emissions (OAEs), auditory brainstem responses (ABRs), speech perception in noise (SPiN), and self-reported tinnitus, hyperacusis and hearing in noise difficulties. Total lifetime noise exposure was similar between musicians and non-musicians, the majority of which could be accounted for by recreational activities. Musicians showed significantly greater ABR wave I/V ratios than non-musicians and were also more likely to report experience of - and/or more severe - tinnitus, hyperacusis and hearing in noise difficulties, irrespective of noise exposure. A secondary analysis revealed that individuals with the highest levels of noise exposure had reduced outer hair cell function compared to individuals with the lowest levels of noise exposure, as measured by OAEs. OAE level was also related to PTA and EHF thresholds. High levels of noise exposure were also associated with a significant increase in ABR wave V latency, but only for males, and a higher prevalence and severity of hyperacusis. These findings suggest that there may be sub-clinical effects of noise exposure on various hearing metrics even at a relatively young age, but do not support a link between lifetime noise exposure and proxy measures of cochlear synaptopathy such as ABR wave amplitudes and SPiN. Closely monitoring OAEs, PTA and EHF thresholds when conventional PTA is within the clinically 'normal' range could provide a useful early metric of noise-induced hearing damage. This may be particularly relevant to early-career musicians as they progress through a period of intensive musical training, and thus interventions to protect hearing longevity may be vital.

Fit to Perform: A Profile of Higher Education Music Students' Physical Fitness.

The physical demands of music making are well acknowledged, but understanding of musicians' physical and fitness profiles is nonetheless limited, especially those of advanced music students who are training to enter music's competitive professional landscape. To gain insight into how physical fitness is associated with music making, this study investigated music students' fitness levels on several standardized indicators. Four hundred and eighty three students took part in a fitness screening protocol that included measurements of lung function, flexibility (hypermobility, shoulder range of motion, sit and reach), strength and endurance (hand grip, plank, press-up), and sub-maximal cardiovascular fitness (3-min step test), as well as self-reported physical activity (IPAQ-SF). Participants scored within age-appropriate ranges on lung function, shoulder range of motion, grip strength, and cardiovascular fitness. Their results for the plank, press-up, and sit and reach were poor by comparison. Reported difficulty (22%) and pain (17%) in internal rotation of the right shoulder were also found. Differences between instrument groups and levels of study were observed on some measures. In particular, brass players showed greater lung function and grip strength compared with other groups, and postgraduate students on the whole were able to maintain the plank for longer but also demonstrated higher hypermobility and lower lung function and cardiovascular fitness than undergraduate students. Seventy-nine percent of participants exceeded the minimum recommended weekly amount of physical activity, but this was mostly based on walking activities. Singers were the most physically active group, and keyboard players, composers, and conductors were the least active. IPAQ-SF scores correlated positively with lung function, sit and reach, press-up and cardiovascular fitness suggesting that, in the absence of time and resources to carry out comprehensive physical assessments, this one measure alone can provide useful insight into musicians' fitness. The findings show moderate levels of general health-related fitness, and we discuss whether moderate fitness is enough for people undertaking physically and mentally demanding music making. We argue that musicians could benefit from strengthening their supportive musculature and enhancing their awareness of strength imbalances.

Physical Activity, Sedentary Behavior, Anxiety, and Pain Among Musicians in the United Kingdom.

CONTEXT AND AIMS: Although some exercise-based interventions have been associated with lower levels of pain and performance-related musculoskeletal disorders (PRMDs) among musicians, the evidence is still mixed. Furthermore, little is known about musicians' general engagement in physical activity (PA), their knowledge of PA guidelines, or the relevant training they receive on pain prevention and the sources of such training. Similarly, little is known about the relationship between PA and PRMDs and other risk factors for PRMDs. METHODS: Following a cross-sectional correlational study design, both standardized and ad hoc measurements were used to investigate self-reported PA [International Physical Activity Questionnaire - Short Form (IPAQ-SF)], knowledge of PA guidelines, and barriers to engaging in PA [Centers for Disease Control (CDC); Determinants of Physical Activity Questionnaire (DPAQ)]; sedentary behavior [Sedentary Behavior Questionnaire (SBQ)]; pain [36-Item Short Form Survey Instrument (SF-36)] and PRMDs (frequency and severity); reported physical exertion (RPE); anxiety [Hospital Anxiety and Depression Scale (HADS)]; practice behaviors (e.g., practice time; taking breaks frequency; warming up); and relevant training among conservatoire students in the United Kingdom. The entire set of questionnaires was administered both online and via hard copies between June 2017 and April 2018. RESULTS: Demographic information was obtained from 111 respondents, mostly undergraduate students (UGs) from seven conservatoires. They reported high levels of engagement in PA, despite poor knowledge of PA guidelines. Teachers were the most frequently mentioned source of pain prevention information (by 43% of respondents), and 62% agreed that they had received advice on why they should engage in cardio PA. Sedentary behavior was comparable to normative data. Levels of bodily pain and PRMDs were low, but 43% showed "abnormal" clinical anxiety and found playing their instruments "somewhat hard" (RPE) on average. Bodily pain interfering with practice and performance was positively correlated with frequency and severity of PRMDs, anxiety, and RPE. Frequency and severity of PRMDs were also associated with sedentary behavior at the weekend. Anxiety was associated with RPE. No association was found between PA and PRMDs. CONCLUSION: The relationship between PA and PRMDs and pain remains unclear and needs further investigation. While health education needs to be improved, other pathways may need to be taken. Given the high levels of anxiety, the ideology of Western classical music itself may need to be challenged.

Health Education Literacy and Accessibility for Musicians: A Global Approach. Report from the Worldwide Universities Network Project.

OBJECTIVE: To address the need for accessible health education and improved health literacy for musicians throughout their lifespan. METHODS: Formation of a multicultural, international, and interdisciplinary collaborative research team, funded by the Worldwide Universities Network. The goal is to design a multi-strand research program to develop flexible and accessible approaches to health education for musicians, thus improving their health literacy. RESULTS: Two team meetings took place in 2018. The first was held 11 to 15 April 2018 in Perth, Australia, and involved a review of existing literature and interventions on health education in music schools, intensive development of research topics, aims, and methodologies, and identification of potential funding sources to support future large-scale research programs. This resulted in the draft design of three research projects, finalized during a second meeting in Maastricht, the Netherlands, 27 to 31 August 2018. DISCUSSION: These intensive meetings identified the need for both cultural change in music education settings as well as improved health literacy in musicians across global geographical regions. A global project to address health literacy and health education accessibility for musicians has commenced.

Health Education for Musicians.

Context and aims: Many musicians suffer for their art, and health is often compromised during training. The Health Promotion in Schools of Music (HPSM) project has recommended that health education should be included in core curricula, although few such courses have been evaluated to date. The aim of the study was to design, implement and evaluate a compulsory health education course at a UK conservatoire of music. Methods: The course design was informed by a critical appraisal of the literature on musicians' health problems and their management, existing health education courses for musicians, and the HPSM recommendations. It was delivered by a team of appropriately-qualified tutors over 5 months to 104 first-year undergraduate students, and evaluated by means of questionnaires at the beginning and end of the course. Thirty-three students who had been in their first year the year before the course was introduced served as a control group, completing the questionnaire on one occasion only. Items concerned: hearing and use of hearing protection; primary outcomes including perceived knowledge and importance of the topics taught on the course; and secondary outcomes including physical and psychological health and health-promoting behaviors. The content of the essays written by the first-year students as part of their course assessment served as a guide to the topics they found most interesting and relevant. Results: Comparatively few respondents reported using hearing protection when practicing alone, although there was some evidence of hearing loss, tinnitus, and hyperacusis. Perceived knowledge of the topics on the course, and awareness of the risks to health associated with performing music, increased, as did self-efficacy; otherwise, there were negative effects on secondary outcomes, and few differences between the intervention and control groups. The topics most frequently covered in students' essays were managing music performance anxiety, and life skills and behavior change techniques. Conclusion: There is considerable scope for improving music students' physical and psychological health and health-related behaviors through health education, and persuading senior managers, educators and students themselves that health education can contribute to performance enhancement.

Music performance anxiety in classical musicians - what we know about what works.

When pursued professionally, the demands of musical training and performance can interfere with musicians' well-being and health. Music performance anxiety, while energising at optimal levels, impairs performance quality when excessive. A range of interventions has been explored to address it. However, the poor methodological quality of such studies and the complexity of this issue should mobilise further research resources in this direction.

Fit to Perform: An Investigation of Higher Education Music Students' Perceptions, Attitudes, and Behaviors toward Health.

Making music at the highest international standards can be rewarding, but it is also challenging, with research highlighting pernicious ways in which practicing and performing can affect performers' health and wellbeing. Several studies indicate that music students' perceptions, attitudes, and behaviors toward health and healthy living are less than optimal, especially considering the multiple physical and psychological demands of their day-to-day work. This article presents the results of a comprehensive screening protocol that investigated lifestyle and health-related attitudes and behaviors among 483 undergraduate and postgraduate students (mean age = 21.29 years ± 3.64; 59% women) from ten conservatoires. The protocol included questionnaires measuring wellbeing, general health, health-promoting behaviors, perfectionism, coping, sleep quality, and fatigue. On each measure, the data were compared with existing published data from similar age groups. The results indicate that music students have higher levels of wellbeing and lower fatigue than comparable samples outside of music. However, they also reveal potentially harmful perceptions, attitudes, and behaviors toward health. Specifically, engagement in health responsibility and stress management was low, which along with high perfectionistic strivings, limited use of coping strategies, poor sleep quality, and low self-rated health, paints a troubling picture both for the music students and for those who support their training. The findings point to the need for more (and more effective) health education and promotion initiatives within music education; in particular, musicians should be better equipped with mental skills to cope with constant pressure to excel and high stress levels. In part, this calls for musicians themselves to engage in healthier lifestyles, take greater responsibility for their own health, and be aware of and act upon health information in order to achieve and sustain successful practice and performance. For that to happen, however, music educators, administrators, and policy makers must play an active role in providing supportive environments where health and wellbeing is considered integral to expert music training.

Vibrotactile Presentation of Musical Notes to the Glabrous Skin for Adults with Normal Hearing or a Hearing Impairment: Thresholds, Dynamic Range and High-Frequency Perception.

Presentation of music as vibration to the skin has the potential to facilitate interaction between musicians with hearing impairments and other musicians during group performance. Vibrotactile thresholds have been determined to assess the potential for vibrotactile presentation of music to the glabrous skin of the fingertip, forefoot and heel. No significant differences were found between the thresholds for sinusoids representing notes between C1 and C6 when presented to the fingertip of participants with normal hearing and with a severe or profound hearing loss. For participants with normal hearing, thresholds for notes between C1 and C6 showed the characteristic U-shape curve for the fingertip, but not for the forefoot and heel. Compared to the fingertip, the forefoot had lower thresholds between C1 and C3, and the heel had lower thresholds between C1 and G2; this is attributed to spatial summation from the Pacinian receptors over the larger contactor area used for the forefoot and heel. Participants with normal hearing assessed the perception of high-frequency vibration using 1s sinusoids presented to the fingertip and were found to be more aware of transient vibration at the beginning and/or end of notes between G4 and C6 when stimuli were presented 10dB above threshold, rather than at threshold. An average of 94% of these participants reported feeling continuous vibration between G4 and G5 with stimuli presented 10dB above threshold. Based on the experimental findings and consideration of health effects relating to vibration exposure, a suitable range of notes for vibrotactile presentation of music is identified as being from C1 to G5. This is more limited than for human hearing but the fundamental frequencies of the human voice, and the notes played by many instruments, lie within it. However, the dynamic range might require compression to avoid the negative effects of amplitude on pitch perception.

Making myself understood: perceived factors affecting the intelligibility of sung text.

Singing is universal, and understanding sung words is thought to be important for many listeners' enjoyment of vocal and choral music. However, this is not a trivial task, and sung text intelligibility is probably affected by many factors. A survey of musicians was undertaken to identify the factors believed to have most impact on intelligibility, and to assess the importance of understanding sung words in familiar and unfamiliar languages. A total of 143 professional and amateur musicians, including singers, singing teachers, and regular listeners to vocal music, provided 394 statements yielding 851 references to one or more of 43 discrete factors in four categories: performer-related, listener-related, environment-related and words/music-related. The factors mentioned most frequently in each of the four categories were, respectively: diction; hearing ability; acoustic; and genre. In more than a third of references, the extent to which sung text is intelligible was attributed to the performer. Over 60% of respondents rated the ability to understand words in familiar languages as "very important," but only 17% when the text was in an unfamiliar language. Professional musicians (47% of the sample) rated the importance of understanding in both familiar and unfamiliar languages significantly higher than amateurs but listed fewer factors overall and fewer listener-related factors. The more important the respondents rated understanding, the more performer-related and environment-related factors they tended to list. There were no significant differences between the responses of those who teach singing and those who do not. Enhancing sung text intelligibility is thus perceived to be within the singer's control, at least to some extent, but there are also many factors outside their control. Empirical research is needed to explore some of these factors in greater depth, and has the potential to inform pedagogy for singers, composers, and choral directors.

The mental representation of music notation: notational audiation.

This study investigated the mental representation of music notation. Notational audiation is the ability to internally "hear" the music one is reading before physically hearing it performed on an instrument. In earlier studies, the authors claimed that this process engages music imagery contingent on subvocal silent singing. This study refines the previously developed embedded melody task and further explores the phonatory nature of notational audiation with throat-audio and larynx-electromyography measurement. Experiment 1 corroborates previous findings and confirms that notational audiation is a process engaging kinesthetic-like covert excitation of the vocal folds linked to phonatory resources. Experiment 2 explores whether covert rehearsal with the mind's voice also involves actual motor processing systems and suggests that the mental representation of music notation cues manual motor imagery. Experiment 3 verifies findings of both Experiments 1 and 2 with a sample of professional drummers. The study points to the profound reliance on phonatory and manual motor processing--a dual-route stratagem--used during music reading. Further implications concern the integration of auditory and motor imagery in the brain and cross-modal encoding of a unisensory input.

Development and disadvantage: implications for the early years and beyond.

Links have long been made between literacy and economic development, and recent governments in the UK have put great emphasis on the teaching of literacy to raise educational standards. There is substantial evidence to show that spoken and written language share some processes in common and that the development of literacy is supported by the development of spoken language. Anecdotal evidence from early years practitioners suggests that many children coming into early years education, particularly those from disadvantaged socioeconomic backgrounds, may not have the spoken language skills needed to develop reading and writing. This preliminary study aimed to investigate the extent to which the spoken language skills of children reared in poverty are depressed in comparison with the general population, and in comparison with their general cognitive abilities. Two tests were administered to children in their first term at nursery school to measure their spoken language skills and cognitive abilities: CELF-PUK and BAS II. More than half of the children were found to be language-delayed, although girls' receptive language abilities were significantly better than those of boys. Participants' language skills were also significantly depressed in comparison with their cognitive abilities. Government initiatives to raise awareness of spoken language in the early years are discussed, and implications for the future role of speech and language therapists working in the pre-school sector are considered.