Attitudes toward use of hearing protection devices and effects of an intervention on fit-testing results.

This study assessed attitudes toward the use of hearing protection devices (HPDs) and the effect of an educational intervention on fit-testing results by comparing personal attenuation ratings (PAR50) before and after the intervention. Employees (n = 327) from a large metal container manufacturer at four geographic locations were tested with a field attenuation estimation system (FAES) to identify workers (n = 91) requiring intervention. PAR50 values significantly increased from baseline to post-intervention (p < .001, 15.1 to 26.9) and at the 6-month follow-up (p < .001, 95% confidence interval = -11.2, -6.3). Perceived self-efficacy scores for using HPDs significantly declined from baseline to post-intervention (p = .006, 95% confidence interval = 0.3, 1.9), but were not significantly related to PAR50. Therefore, a FAES can assist the occupational health nurse to identify workers at high risk (low PAR50), teach proper fit and use of HPDs, and improve hearing protector selection.

Prevalence of hearing loss and accuracy of self-report among factory workers.

Noise represents one of the most common occupational health hazards. A Healthy People 2020 objective aims to reduce hearing loss in the noise-exposed public. The purpose of this study was to describe and compare perceived and measured hearing, and to determine the prevalence of hearing loss among a group of factory workers. Data collected as part of an intervention study promoting hearing protector use among workers at an automotive factory in the Midwest were used. Plant employees (n=2691) provided information regarding their perceived hearing ability, work role, and other demographics. The relationships among audiograms, a single-item measure of perceived hearing ability, and demographic data were explored using chi-square, McNemar's test, Mann-Whitney U-test, sensitivity, and specificity. The prevalence of hearing loss among noise-exposed factory workers was 42% (where hearing loss was defined as >25 dB loss at the OSHA-recommended frequencies of 2, 3, and 4 kHz in either ear). However, 76% of workers reported their hearing ability as excellent or good. The difference in perceived hearing ability was significant at each tested frequency between those with and without measured hearing loss. Self-reported hearing ability was poorly related to results of audiometry. Although this group of workers was employed in a regulated environment and served by a hearing conservation program, hearing loss was highly prevalent. These findings, together with national prevalence estimates, support the need for evaluation of hearing conservation programs and increased attention to the national goal of reducing adult hearing loss.

Meta-analysis of workplace physical activity interventions.

CONTEXT: Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research. EVIDENCE ACQUISITION: Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008. EVIDENCE SYNTHESIS: Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO2max of 3.5 mL/kg/min; for lipids, -0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, -12.6 mg/dL on fasting glucose. CONCLUSIONS: These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.

Effectiveness of computer-based tailoring versus targeting to promote use of hearing protection.

The purpose of this study was to evaluate the effectiveness of 2 computer-based interventions and booster messages on construction workers' use of hearing protection. Construction workers (n = 343) were randomly assigned to receive tailored (addressing individual characteristics) or targeted (addressing shared characteristics) education, with or without booster messages, in an experimental 4-group pretest-post-test design. Post hoc message matching compared the value of tailored and targeted approaches. Participants improved use of hearing protection from 42% to 50% of the time they were exposed to noise 1 year post-intervention. Differences between intervention groups were not significant. The significant improvement in use of hearing protection demonstrates that interventions can have an impact on preventing noise-induced hearing loss. Since targeted and tailored intervention groups did not significantly differ in use of hearing protection, and since targeted interventions are less costly to develop, targeted interventions offer greater value.

Testing decisional balance and self-efficacy applied to workers' use of hearing protection.

BACKGROUND: The continued prevalence of low rates of hearing protection device (HPD) use by workers exposed to hazardous noise requires ongoing efforts to investigate ways to increase HPD use. OBJECTIVE: The aim of this study was to investigate the utility of the Transtheoretical Model (TTM) for research with factory workers' use of HPDs, specifically focusing on the model suppositions related to the constructs of decisional balance and self-efficacy. METHODS: Using secondary analysis, pretest measures were obtained through a randomized controlled clinical trial of an intervention to increase use of HPDs. The sample included in the analyses were factory workers (N = 1,245) exposed to hazardous noise in a Midwestern automotive manufacturing plant. Using analysis of variance (ANOVA), the TTM constructs pros, cons, and self-efficacy of HPD use were examined across stages. RESULTS: Using ANOVA, significant variance was found across stages of HPD use. Pros, cons, and self-efficacy significantly differed by stage of HPD use in predicted patterns: pros, F(4, 1240) = 46.29, p < .001; cons, F(4, 1240) = 17.14, p < .001; and self-efficacy F(4, 1240) = 7.32, p < .001. The crossover effect of pros and cons occurred in the preparation stage, as expected. CONCLUSIONS: Support was found for the presence of conceptually distinct stages of HPD use and the TTM predictions for decisional balance and self-efficacy across stages. Performance of the TTM constructs within current research on HPD use presents opportunities for increased tailoring of training for factory workers on use of HPDs.

Predictors of hearing protection use for Hispanic and non-Hispanic White factory workers.

The 2000 United States Census reported significant growth in the number of Hispanic workers. The National Institute for Occupational Safety and Health (NIOSH, 1996) has identified noise-induced hearing loss as a significant occupational threat. Current theoretical models need to be evaluated for their utility with Hispanic workers. The Predictors for Use of Hearing Protection Model (PUHPM) is a framework for increasing workers' use of hearing protection devices (HPDs). Using regression analysis, the explained variance in HPD use by the model predictors was examined in a sample of 208 Hispanic factory workers. Explained variance was lower for Hispanics (R2 = .20) than for non-Hispanic Whites (R2 = .37). Further research with Hispanic workers is needed to improve the PUHPM fit.

Staging workers' use of hearing protection devices: application of the transtheoretical model.

The threat of noise-induced hearing loss is a serious concern for many workers. This study explores use of the transtheoretical model as a framework for defining stages of workers' acceptance of hearing protection devices. A secondary analysis was performed using a cross-section of data from a randomized, controlled clinical trial of an intervention to increase use of hearing protection. Use of hearing protection devices was well distributed across the theorized stages of change. Chi-square analysis and analysis of variance revealed significant differences between stages for the variables studied. Discrete stages of hearing protection device use can be identified, laying the foundation for further work investigating use of the transtheoretical model for promoting hearing protection device use. The model can provide a framework for tailoring interventions and evaluating their effects. With further development of the transtheoretical model, nurses may be able to easily identify workers' readiness to use hearing protection devices and tailor training toward that goal.

Comparison of the original and revised structures of the Health Promotion Model in predicting construction workers' use of hearing protection.

Pender's health promotion model (HPM) has been revised, including substantial changes in its structure. The purpose of this study was to compare the fit and predictive usefulness of the original and revised structures of the HPM as applied to the use of hearing protection devices by 703 construction workers. Structural equation modeling was used to evaluate the two alternative forms of the model. Both forms of the model fit well, with the revised structure having a better fit and explaining more of the variance in use of hearing protection (28% vs. 18%). Results support the revised structure of the health promotion model (HPM) over the original form, and indicate it may be useful in understanding and predicting use of hearing protection.

Efficacy of a computer-based hearing test and tailored hearing protection intervention.

Advances in computer technology and accessibility enable researchers to provide individually tailored interventions for behavioral change. Using multimedia technology, this study developed and tested a computer-based hearing test and a tailored intervention. The purpose of this study was to evaluate, using a randomized experimental design, the efficacy of the intervention to increase workers' use of hearing protection. The tailored intervention developed by the research team showed more significant short-term effect measured immediately after the intervention than the control intervention. For the long-term effect measured 1 year after the intervention, both tailored and control groups showed significant increase in their reported use (7% vs. 6%) from preintervention to postintervention, but no significant difference between the two groups. The change accomplished in this study was small progress toward the desired level of 100% use of hearing protection to prevent noise-induced hearing loss. This finding showed that changing workers' hearing protection behavior is difficult.

Ethnic differences in predictors of hearing protection behavior between Black and White workers.

The purpose of the study is to determine whether there are ethnic differences in predictors of hearing protection behavior between Black and White workers. The Predictors of Use of Hearing Protection Model (PUHPM) derived from Pender's Health Promotion Model (Pender, 1987) was used as a conceptual model. A total of 2,119 (297 Blacks, 1,822 Whites) were included in the analysis. Internal consistency of instrument items was assessed using theta reliability estimates. Significant predictors of the use of hearing protective devices (HPDs) for Black and White workers and differences in predictors between the two groups were examined using multiple regression with interaction terms. Ethnic differences in scale or individual item scores were assessed using chi-square and t-test analyses. Different factors influenced hearing protection behavior among Black and White workers. The model was much less predictive of Blacks' hearing protection behavior than Whites' (R2 = .12 vs. .36). Since the PUHPM was not as effective in predicting hearing protection behavior for Blacks as for Whites, future studies are needed to expand the PUHPM through qualitative study and to develop culturally appropriate models to identify factors that better predict hearing protection behavior as a basis for developing effective interventions.

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.

Relationship of work schedules to gastrointestinal diagnoses, symptoms, and medication use in auto factory workers.

BACKGROUND: Gastrointestinal (GI) complaints are common in shift workers. This study examines the relationship between work schedules and GI symptoms, medications, and diagnoses. METHODS: In a cross-sectional survey of 343 US auto factory workers, four work schedule variables were examined: assigned shift, number of hours worked, number of night hours, and schedule variability. Multiple regression tested the relationship between GI outcomes and work schedule variables while controlling for covariates. RESULTS: The evening shift was associated with more GI symptoms and GI diagnoses. Unexpectedly, more consistent work times were associated with having a GI diagnosis. As schedule variability increased the probability of GI medication use increased in low noise exposure. CONCLUSION: Findings suggest that evening shift and widely varying work start and end times may increase risks for GI disturbances.

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

BACKGROUND: The 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. OBJECTIVES: This 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). METHODS: A total of 1325 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. RESULTS Repeated 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[3442] = 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. CONCLUSIONS: Although 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.

Acute effects of noise on blood pressure and heart rate.

The authors assessed the acute effects of exposure to noise on systolic and diastolic blood pressure, and heart rate, among 46 workers in a midwestern auto assembly plant. Workers wore ambulatory blood pressure monitors and personal noise dosimeters during one work shift. After adjustment for covariates of cardiovascular function, systolic and diastolic blood pressure, along with heart rate, were shown to be significantly positively associated with noise exposure. Although the long-term effect of these associations is not known, results from other studies suggest that they may be harmful. Replication of this study with a larger number of subjects, monitored for several days and in a variety of work settings, is recommended to verify these findings. The results of this and other studies imply that reducing acute noise exposure reduces cardiovascular stress.

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

BACKGROUND: In 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. OBJECTIVES: This study tested the effectiveness of an individually tailored multimedia intervention to increase use of HPDs by factory workers. METHODS: A 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. RESULTS: Only 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. CONCLUSIONS: Individually-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.

Incorporating health services research into nursing doctoral programs.

Despite the successes of the US health care system, problems associated with access, affordability, and quality of care remain to be solved. Health services research (HSR) has the potential to aid nurses in addressing these issues; yet the importance of its inclusion in the academic preparation of nurse researchers has not been consistently recognized. This article discusses the relevance of HSR to nursing, provides a brief review of the history of HSR and its imperatives, and presents rationale for nursing's involvement in HSR. Problems identified by the Re-envisioning PhD project conducted by the University of Washington are assessed for relevance to HSR and nursing doctoral preparation. Recommendations are included for integrating HSR into nursing doctoral programs and meeting HSR capacity building needs for the future.