title: Vocal Problems in Sports and Fitness Instructors: A Study of Prevalence, Risk Factors, and Need for Prevention in France.
abstract: OBJECTIVE
  Sports and fitness instructors (SFIs) are known for being a high-risk population for voice difficulties (VD). However, past studies have encountered various methodological difficulties in determining prevalence and risk factors for VD in SFIs, such as limited population, gender and selection biases, or poor statistical power, because VD were studied as a binary variable. The present research work addresses these issues and aims at studying the prevalence of vocal problems and risk factors in French SFIs, a population in which no such study was conducted yet. Another objective is to survey the French SFIs' habits and expectations regarding vocal prevention and care.
  
  
  METHODS
  This is a cross-sectional study.
  
  
  METHODS
  Three hundred and twenty SFIs answered a questionnaire, whether in an online (n = 267) or a paper (n = 53) version. The questionnaire consisted of 31 items addressing self-reported vocal difficulties, supposed risk factors, and personal health-care history, followed by the Voice Handicap Index assessment.
  
  
  RESULTS
  Prevalence of self-reported vocal difficulties is 55%. The Voice Handicap Index is significantly associated with gender, age, and variables related to work environment (noise and music) and habits (shouting, frequency of classes), as well as with daily sleeping time. Results also indicate that a minority of the SFIs (37%) received information on vocal difficulties, whereas a majority (80%) declares being interested in participating in prevention programs.
  
  
  CONCLUSIONS
  This work confirms that SFIs are a high-risk population for VD, underlines the need for specific information programs in France, and provides relevant data for driving such preventive actions.
authors.affiliation: Institut de Recherche en Informatique de Toulouse, France. Electronic address: fontan.lionel@gmail.com.
authors.forename: Lionel
authors.initials: L
authors.lastname: Fontan
authors.affiliation: Ecole d'orthophonie de la faculté de Médecine Toulouse-Rangueil, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Fraval
authors.affiliation: Ecole d'orthophonie de la faculté de Médecine Toulouse-Rangueil, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Michon
authors.affiliation: Institut de Mathématiques de Toulouse (UMR 5219), Toulouse, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Déjean
authors.affiliation: Unité de la voix et de la déglutition, Service ORL, Hôpital Larrey, CHU Toulouse, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Welby-Gieusse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D020446:Fitness Centers; D005602:France / Q000453:epidemiology; D006184:Habits; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009146:Music; D009622:Noise / Q000009:adverse effects; D016272:Occupational Health; D010470:Perceptual Masking; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012890:Sleep; D013061:Speech Acoustics; D013065:Speech Intelligibility; D013067:Speech Perception; D013177:Sports; D013663:Teaching; D013997:Time Factors; D014832:Voice Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D014833:Voice Quality; D017132:Workplace; D055815:Young Adult
keywords: Voice Handicap Index; prevalence of vocal problems; professional voice use; risk factors; sports and fitness instructors