Chronic occupational noise, stressors & susceptibility in cardiovascular illness

描述(申请人提供)：慢性职业噪声对心血管疾病的检查因以下原因而变得复杂：(1)听力保护的强大调节作用，在持续的高噪声环境中更警惕地佩戴；(2)工作场所噪声、工作压力、制造业工作中的污染物暴露、高温和体力消耗之间的强烈相关性；以及(3)多种可能的原因途径(听觉功能和身体压力；烦恼和心理社会压力)。我建议利用我们与美国铝业公司独特的合作伙伴关系提供的丰富的多站点数据集，其中包括就业记录、医疗索赔、现场体检、工作需求调查、W-2记录和工业卫生措施。我们将使用在400名员工子集上收集的独特耳朵剂量测量来验证噪声暴露，开发多水平纵向模型来考虑工厂中随时间变化的噪声的影响，并检查其他工作场所压力来源(例如，工作压力和污染物)的混杂情况。最后，我们将考虑噪声作为慢性应激源对相关污染物暴露的易感性的影响。这笔助学金将把我从目前在哈佛的职位过渡到耶鲁的全职职位。我与耶鲁大学的同事在美国铝业的研究上合作了两年，并继续受益于他们在职业流行病学和噪音暴露评估方面的丰富专业知识。我计划发展丰富的流行病学研究生涯，围绕我在研究社会应激源和污染物暴露之间的乘数效应方面的专业知识而建立。 公共卫生相关性：心血管疾病是美国成年人死亡的主要原因。尽管慢性噪声和噪声性听力损失是最普遍的职业危害之一，但目前尚不清楚与噪声相关的压力是否会改变对其他工作场所污染物的反应，或者是否可以通过改变噪声与听力损失的关系来进行听力保护干预，从而降低高血压风险。

DESCRIPTION (provided by applicant): The examination of chronic occupational noise on cardiovascular illness has been complicated by: (1) the powerful modifying effect of hearing protection, more vigilantly worn in consistently high-noise environments, (2) strong correlations among workplace noise, job strain, contaminant exposures, heat, and physical exertion in manufacturing jobs, and (3) multiple possible causal pathways (auditory function and physical stress; annoyance and psychosocial stress). I propose to leverage our rich multi-site dataset of employment records, medical claims, on-site medical exams, job demand surveys, W-2 records, and industrial hygiene measures, provided through our unique partnership with the Alcoa Inc. We will validate noise exposures using unique in-ear dose measures being collected on a subset of 400 employees, develop multi-level longitudinal models to consider effects of time-varying noise across plants, and examine confounding by other workplace stressors (e.g., job strain, contaminants). Finally, we will consider the effect of noise, as a chronic stressor, to influence susceptibility to correlated contaminant exposures. This grant will transition me from my current position at Harvard to a full-time position at Yale. I have worked with Yale colleagues for two years on the Alcoa study, and continue to benefit from their rich expertise in occupational epidemiology and noise exposure assessment. I plan to develop a rich epidemiology research career built around my expertise in examining multiplicative effects between social stressors and contaminant exposures. Public Health Relevance: Cardiovascular illness is a leading cause of death among American adults. Though chronic noise and noise-induced hearing loss are among the most prevalent occupational hazards, it remains unknown whether noise-related stress alters response to other workplace contaminants, or whether hearing protection interventions, which modify the noise-hearing loss relationship, may reduce hypertension risk as well.