Voice Disorders, Stress, and Indoor Environmental Quality: A Cross-Sectional Study of Finnish Teachers

ABSTRACT Voice disorders are common in teachers. In addition to the extensive use of their voice, voice problems are associated with stress, a poor indoor environmental quality (IEQ), and frequently also with a decreased work ability. However, epidemiological data on these problems are scarce, and there is little information on the interaction between voice disorders, stress, and the IEQ concerning the work ability of teachers. The overall purpose of this thesis was to study the variables associated with voice disorders, especially the stress at work, a poor IEQ, and the work ability of teachers. A cross-sectional study was conducted with 1 198 primary and secondary school teachers in three cities across Finland (81% females, 19% males). Voice disorders were assessed with a voice screening questionnaire. The stress at work and work ability were measured with validated, single-item questions. The indoor environment was assessed by using the MM 040 questionnaire, and a technical assessment of school buildings was utilized in relation to a subsample of 538 teachers. The prevalence of voice disorders over the 12-month period was 54%, and stress was most significantly associated with voice disorders (OR 3.6). Teachers with voice disorders reported more indoor environmental complaints, such as noise and stuffy air, than those without voice disorders. The results also indicated a possible association between a poor condition of school buildings and voice disorders, and there was an agreement between perceived and technical assessments. Work ability was the best in the teachers without voice disorders or stress, and the prevalence of sick leaves was also the lowest in this group. Stress and voice disorders together had a stronger association with a decreased work ability than when they were evaluated separately. Voice disorders, stress, and the perceptions of a poor indoor environment, such as stuffy air and dust, were all clearly associated with work ability. This study advances our understanding of teachers’ work ability that particularly highlights the relation between voice disorders, stress at work, and a poor IEQ for their work ability. Follow-up studies are needed to investigate the causality of these three variables for work ability. In order to better maintain teachers’ work ability, special attention should be paid to their occupational health, when there are problems rising from the IEQ, and the teachers suffer from voice disorders and stress at work. KEYWORDS: Voice, voice symptoms, voice problems, stress at work, indoor air quality, perceived, technical assessment, work ability, absence due to sicknessTIIVISTELMÄ Äänihäiriöt ovat yleisiä opettajilla. Runsaan puhumisen lisäksi ääniongelmat liittyvät stressiin ja koulujen sisäympäristön puutteisiin. Niillä on yhteyttä myös alentuneeseen työkykyyn. Opettajien äänihäiriöiden, työhön liittyvän stressin ja sisäympäristön yhteisvaikutuksesta työkykyyn on kuitenkin vain vähän väestöpohjaista tietoa. Tämän väitöstyön tavoitteena oli tutkia äänihäiriöiden yleisyyttä työhön liittyvään stressiin ja koulujen sisäympäristön puutteisiin sekä niiden yhteyttä opettajien työkykyyn. Kyselytutkimukseen vastasi yhteensä 1198 peruskoulun opettajaa kolmesta kaupungista eri puolilta Suomea. Äänihäiriöitä tutkittiin lyhyellä äänioirekyselyllä, ja muita muuttujia arvioitiin viisiportaisen stressikysymyksen, Työkykypistemäärän sekä MM 040 -sisäilmastokyselyn avulla. Osatutkimuksessa verrattiin koulujen sisäilman laatua opettajien äänihäiriöihin (n = 538) sekä teknisen arvion että itsearvioinnin avulla. Noin puolella (54 %) tutkituista opettajista esiintyi äänihäiriöitä, ja stressi oli niiden merkittävin selittäjä. Äänihäiriöistä kärsivät raportoivat sisäympäristöön liittyviä puutteita, kuten melu ja tunkkainen ilma, selvästi muita enemmän. Koulujen teknisen arvion ja itsearvioinnin välillä oli merkitsevä yhteys, ja tulokset viittasivat siihen, että äänihäiriöillä olisi yhteyttä myös teknisesti arvioituun koulurakennusten huonoon kuntoon. Paras työkyky oli opettajilla, joilla ei ollut äänihäiriöitä tai stressiä, ja heillä oli myös vähiten sairauslomia. Stressi ja äänihäiriöt olivat vahvemmin yhteydessä heikentyneeseen työkykyyn yhdessä kuin erikseen arvioituina. Äänihäiriöt, työhän liittyvä stressi ja sisäympäristön puutteet, mm. tunkkainen ilma ja pöly, olivat kaikki selkeästi yhteydessä alentuneeseen työkykyyn. Tämä tutkimus tuo lisää tietoa opettajien työkyvystä ja korostaa erityisesti äänihäiriöiden, työhön liittyvän stressin ja koulujen sisäympäristön puutteiden yhteyttä alentuneeseen työkykyyn. Seurantatutkimukset ovat tarpeen syy-yhteyden selvittämiseksi. Opettajien työkyvyn tukemiseen on hyvä kiinnittää erityistä huomiota työterveyshuollossa myös silloin, kun he kärsivät äänihäiriöistä ja stressistä ja heidän työpaikkansa sisäympäristössä on puutteita. AVAINSANAT: Ääni, äänioireet, äänihäiriöt, opettaja, stressi, työhön liittyvä stressi, sisäympäristö, sisäilma, koettu, tekninen arviointi, työkyky, sairauspoissaol

Voice symptoms in teachers during distance teaching: a survey during the COVID-19 pandemic in Finland

Purpose Due to the coronavirus disease of 2019 (COVID-19), teachers during the pandemic have had to adapt to online teaching at short notice. This study aims to investigate the voice symptoms and their environmental risk factors as well as the work ability associated with distance teaching and to compare these with symptoms in previous contact teaching. Methods We conducted a survey of 121 primary and secondary school teachers across Finland. The survey was advertised online through social media and the replies collected from voluntarily participating teachers. Results During distance teaching vocal symptoms appeared less often than in school with 71% teachers experiencing them in regular teaching and 44% in distance teaching, VHI result decreased from 7.88 in school teaching to 4.58 in distance teaching. Acoustic conditions were reported to be more suitable in distance teaching with 73% of teachers finding them adequate during distance teaching in comparison to 46% for those in regular teaching. Background noise was the most disturbing factor for a teacher's voice in the classroom and in distance teaching and this was even more conspicuous in the classroom. Also, subjectively experienced poor indoor air quality at school influenced the voice negatively. Further, voice problems were associated with increased subjective stress levels and reduced ability to work. Conclusion Distance teaching has affected teachers' voices in a positive way compared with regular teaching. This difference is likely to be due to better acoustics and indoor air quality in distance teaching conditions

Self-reported voice disorders of teachers and indoor air quality in schools: a cross-sectional study in Finland

Objective We aimed to study the association between self-reported voice disorders among teachers and indoor air quality in school buildings. Methods We performed a questionnaire study of 538 Finnish teachers working in 67 school buildings utilizing both perceived and technical evaluations; the agreement between these two assessments was also studied. The technical assessment was provided by technical experts. Results Teachers with voice disorders reported significantly more complaints from indoor air than those without voice disorders. The results also indicated a possible connection between the technical assessment and voice disorders. After adjustment for sex, stress and asthma, the prevalence of voice disorders was 47% higher in teachers working in renovated buildings compared to those working in the non-problem buildings (aRR1.47; CI 95% 1.11-1.95). The prevalence of voice disorders was 28% higher among teachers working in buildings with problems compared to those working in non-problem buildings (aRR 1.28; 95% CI 0.99-1.64). Discussion In our study, poor perceived indoor air was significantly associated with self-reported voice disorders in teachers and there was an agreement between the perceived and technical assessments. Our results also indicated a possible connection between the technical assessment and voice disorders. Our results imply the need for longitudinal research with technical assessment to study the effect of renovation on voice disorders

Work ability of teachers associated with voice disorders, stress, and the indoor environment: A questionnaire study in Finland

ObjectivesThe purpose of this study was to determine whether self-reported work ability is associated with voice disorders, stress at work, and the quality of the perceived indoor environment.Study designA cross-sectional study.MethodsWe conducted a questionnaire study of 1 198 Finnish teachers utilizing the Work Ability Score.ResultsThe Work Ability Score median was 8 (Q1: 7, Q3: 9), and 71% (CI 95% 69%–74%) of the subjects reported that they had good work ability. Female teachers had a significantly lower Work Ability Score than male teachers. The median number of days absent due to sickness during the previous year was 4 (Q1: 2, Q3: 10). Voice disorders (adjusted odds ratio (aOR) 2.44; CI95% 1.73–3.44), stress at work (rather or very much vs. not at all or little; aOR 6.53; CI95% 4.31–9.90), and poor perceived indoor environment quality (aOR 2.63; CI95% 1.86–3.71) were all clear risk factors for the Work Ability Score.ConclusionWe determined that decreased work ability in teachers is connected to voice disorders, stress at work, and poor perceived indoor environment quality. Thus, in order to better maintain teachers’ work ability, we recommend that special attention should be paid to occupational health care when there are problems in the indoor environment of teachers, and they suffer from voice disorders and stress.</p

Self-reported voice disorders of teachers and indoor air quality in schools : a cross-sectional study in Finland

Objective: We aimed to study the association between self-reported voice disorders among teachers and indoor air quality in school buildings. Methods: We performed a questionnaire study of 538 Finnish teachers working in 67 school buildings utilizing both perceived and technical evaluations; the agreement between these two assessments was also studied. The technical assessment was provided by technical experts. Results: Teachers with voice disorders reported significantly more complaints from indoor air than those without voice disorders. The results also indicated a possible connection between the technical assessment and voice disorders. After adjustment for sex, stress and asthma, the prevalence of voice disorders was 47% higher in teachers working in renovated buildings compared to those working in the non-problem buildings (aRR1.47; CI 95% 1.11–1.95). The prevalence of voice disorders was 28% higher among teachers working in buildings with problems compared to those working in non-problem buildings (aRR 1.28; 95% CI 0.99–1.64). Discussion: In our study, poor perceived indoor air was significantly associated with self-reported voice disorders in teachers and there was an agreement between the perceived and technical assessments. Our results also indicated a possible connection between the technical assessment and voice disorders. Our results imply the need for longitudinal research with technical assessment to study the effect of renovation on voice disorders.publishedVersionPeer reviewe

The interaction between voice disorders and stress for work ability of teachers

Objective: Less attention has been paid to the interaction between voice disorders, stress, and indoor environmental quality for work ability in teachers. Therefore, our aim was to study whether lower work ability associated more strongly when the variables of voice disorders and stress at work were combined as opposed to evaluating these two factors separately. Methods: We conducted a questionnaire study including validated self-assessment of work ability and a technical assessment of school buildings utilizing a sample of 1198 and a subsample (n = 538) of Finnish teachers. Results: When combined, voice disorders and stress at work had a stronger association to decreased work ability than when they were evaluated separately. The occurrence of stress was more prevalent in poor and moderate work ability than the occurrence of voice disorders. Nine out of 10 of the teachers who had neither voice disorders nor stress reported good work ability, while four out of 10 of the teachers who suffered from both voice disorders and stress had poor work ability. As regards the background variables, nearly half of the subjects working in the non-problem buildings have neither stress nor voice disorders. Discussion: We recommend offering support for reducing stress at work to improve teachers’ work performance. The findings also support the maintenance of school buildings and keeping them in good condition. Follow-up studies are needed to investigate the possible effects of voice disorders and the associated variables on work ability.publishedVersionPeer reviewe

The interaction between voice disorders and stress for work ability of teachers

ObjectiveLess attention has been paid to the interaction between voice disorders, stress, and indoor environmental quality for work ability in teachers. Therefore, our aim was to study whether lower work ability associated more strongly when the variables of voice disorders and stress at work were combined as opposed to evaluating these two factors separately.MethodsWe conducted a questionnaire study including validated self-assessment of work ability and a technical assessment of school buildings utilizing a sample of 1198 and a subsample (n = 538) of Finnish teachers.ResultsWhen combined, voice disorders and stress at work had a stronger association to decreased work ability than when they were evaluated separately. The occurrence of stress was more prevalent in poor and moderate work ability than the occurrence of voice disorders. Nine out of 10 of the teachers who had neither voice disorders nor stress reported good work ability, while four out of 10 of the teachers who suffered from both voice disorders and stress had poor work ability. As regards the background variables, nearly half of the subjects working in the non-problem buildings have neither stress nor voice disorders.DiscussionWe recommend offering support for reducing stress at work to improve teachers’ work performance. The findings also support the maintenance of school buildings and keeping them in good condition. Follow-up studies are needed to investigate the possible effects of voice disorders and the associated variables on work ability</p