Public Health Commons^™

Perbandingan Faktor Risiko Gangguan Kesehatan Gigi Dan Mulut Pada Usia 20-59 Tahun Berdasarkan Wilayah Di Indonesia: Analisis Survei Kesehatan Indonesia (Ski) Tahun 2023, Khadijah Qurrata Ayun, Asri Adisasmita Prof

Jurnal Epidemiologi Kesehatan Indonesia

Oral and dental health is one of the indicators of health, well- being, and quality of life. In addition, poor oral health can increase the economic burden, including treatment costs, loss of work productivity, and worsen the burden of other diseases. Globally, the average prevalence of dental and oral diseases is around 45%. In 2023, dental and oral health problems in Indonesia reach 57,6%. This study aims to analyze risk factors for dental and oral health disorders among people aged 20-59 years based on regions in Indonesia. This study uses a cross- sectional design. The secondary data used is data …

Mental Health And Beliefs About Abortion Access Following Changes To Reproductive Healthcare Laws In 2022: Findings From Oklahoma, Munjireen S. Sifat, Laili K. Boozary, Tina N. Le, Julia Mcquoid, Brittany Zaring-Hinkle, Sarah Tonkin, Lizbeth Benson, Bingjing Mao, Motolani Ogunsanya, Ruosi Shao, Amy M. Cohn, Allyson Shortle, Darla E. Kendzor

School of Public Health Faculty Publications

INTRODUCTION: A secondary analysis of cross-sectional survey data was conducted to characterize beliefs about abortion access in Oklahoma, measure stress associated with the overturn of Roe vs. Wade (2022), and evaluate the potential relationship between post-Roe stress (PR stress) and mental health. METHODS: From August through September 2022, adult Oklahomans (N = 1793) were surveyed about their sociodemographic characteristics, beliefs about abortion access, frequency of past-month stress related to the overturn of Roe vs. Wade, and mental health. Beliefs about abortion access were characterized overall and within sociodemographic groups. The relationship between PR stress and mental health was evaluated, and …

Knowledge Of Cpr And Code Status Discussions In Traumatically Injured Older Adults: Does Health Literacy Matter, Krislynn Mueck, Gina H Khraish, Aanand Naik, Shreyans Sanghvi, Jessica L Lee, Thaddeus J Puzio

Faculty, Staff and Student Publications

Code Status Discussions (CSDs), CPR understanding, and health literacy is understudied in traumatically injured older adults. We hypothesized that traumatically injured older adults and their families would have limited understanding of CPR and code status, and that lower health literacy would be associated with reduced advance care planning knowledge. We surveyed injured adults ≥65 or their surrogates to assess baseline code status, health literacy, and CPR discussions. Univariate and multivariable analyses were conducted. Among 201 respondents 55% had low health literacy. Only 38% had discussions about CPR, and 21% were asked about code status during admission. Surrogates similarly overestimated CPR …

What Bereaved People Have Found Helpful Following Death Of A Loved One In A Hospital: A Survey Study, Jon Swanson Phd, Mindy Flanagan Phd, Rachel Pfafman Mph, Mba

Other Specialties

Given the individual and public health impact of bereavement, discovering what people perceive as helpful after loss can improve interventions. In contrast to national projects, this project focused on two hospitals in a Midwestern hospital system.

A survey was developed to assess the work of chaplains with next of kin following a death, to assess the awareness and helpfulness of persons and organizations in the community, and to ask what people had done, said, or given that was helpful, or what respondents wished people had done. From a list of 283 people invited to respond, 52 completed the survey.

Survey …

Implementasi Pelaksanaan Program I-Help (Integrated Help Promoting School) Pada Sekolah Menengah Pertama Di Jakarta, Rachma Dhiyaa' Arroyyan, Sarah Handayani

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. The I-HELP (Integrated Help Promoting School Programs) initiative is a school-based behavioural change intervention that integrates health values and belief-related variables into daily school activities. This program was developed as a follow-up to the collaboration between Universitas Muhammadiyah Prof. DR. Hamka (UHAMKA) and SEAMEO RECFON.

Aim. his study aims to describe implementation of the I-HELP (Integrated Help Promoting School Programs) at the junior high school level in Jakarta in 2022.

Method. This qualitative research employed a case study design conducted at SMP Muhammadiyah 4 and SMP Muhammadiyah 36 Jakarta. Data collection techniques included in-depth interviews, focus group discussions (FGDs), …

Social Learning Theory Dan Status Merokok Pelajar Smp Negeri, Alya Putri Ansyari, Nur Rohmah, Lies Permana, Annissa Nurrachmawati, Rina Tri Agustini

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. The prevalence of adolescent smokers aged 10–18 in Indonesia increased from 7.2% in 2013 to 9.1% in 2018. Approximately 70 million people in the country are active smokers, with 7.4% of them aged 10–18 years.

Aim. This study aims to investigate the association between knowledge, attitude and subjective norms with smoking status among students at a public junior high school in Samarinda.

Method. This study uses a cross-sectional design with a quantitative approach. A total of 159 respondents were randomly selected using proportionate stratified random sampling. Data were collected through interviews using a structured questionnaire and …

Efikasi Diri Dalam Melakukan Diet Sehat Pada Masyarakat Desa Cipacing, Sumedang, Hilmi Khairun Nisa, Neti Juniarti, Adelse Prima Mulya

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Noncommunicable diseases (NCDs) account for 57 million deaths (71%) worldwide and 73% of all deaths in Indonesia. Eating habits are one of the factors contributing to the incidence of NCDs. In the process of improving a healthy lifestyle, including a healthy diet, self-confidence or self-efficacy in maintaining a healthy diet is necessary.

Objective. This study aims to identify the level of self-efficacy in maintaining a healthy diet among the community in Cipacing Village, Sumedang.

Methods. This study was conducted using a quantitative descriptive research design among the community of Cipacing Village, Sumedang Regency, West Java. The sample was …

Perbedaan Faktor Lingkungan Sosial Dan Perilaku Seksual Pranikah Pada Siswa Sma Perkotaan Dan Perdesaan Di Samarinda, Syaniah Syaniah, Annisa Nur Rachmawati, Lies Permana, Nur Rohmah, Rina Tri Agustini

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Based on the 2023 GSHS data, 7.1% of adolescents aged 13–17 in Indonesia have had sexual intercourse, of which 66.2% are male and 33.8% are female. Adolescent premarital sexual behaviour is influenced by internal and external factors. Differences in social determinants may lead to behavioural variations between groups within a population.

Aim. To identify differences in peer influence, parental roles, and mass media (as social environmental factors), as well as premarital sexual behaviour among urban dan rural high school students in Samarinda

Method. This comparative cross-sectional study involved 274 respondents, consisting of 206 respondents from three urban high schools …

Mental Health And Beliefs About Abortion Access Following Changes To Reproductive Healthcare Laws In 2022: Findings From Oklahoma, Munjireen Sifat, Laili K. Boozary, Tina N. Le, Julia Mcquoid, Brittany Zaring-Hinkle, Sarah Tonkin, Lizbeth Benson, Bingjing Mao, Motolani Ogunsanya, Ruosi Shao, Amy M. Cohn, Allyson Shortle, Darla E. Kendzor

Department of Medical Oncology Faculty Papers

INTRODUCTION: A secondary analysis of cross-sectional survey data was conducted to characterize beliefs about abortion access in Oklahoma, measure stress associated with the overturn of Roe vs. Wade (2022), and evaluate the potential relationship between post-Roe stress (PR stress) and mental health.

METHODS: From August through September 2022, adult Oklahomans (N = 1793) were surveyed about their sociodemographic characteristics, beliefs about abortion access, frequency of past-month stress related to the overturn of Roe vs. Wade, and mental health. Beliefs about abortion access were characterized overall and within sociodemographic groups. The relationship between PR stress and mental health was evaluated, and …

Kejadian Luar Biasa Gondongan Di Sd Islam X Samarinda, 2024, Rudy Agus Riyanto, Irfansyah Baharuddin Pakki, Mela Sabena, Meli Pasiakan, Erlina Erlina, Rima Andriani

Jurnal Epidemiologi Kesehatan Indonesia

Mumps outbreaks are a public health issue that still frequently occur in elementary school settings, particularly among children with low immunization coverage. Therefore, a comprehensive epidemiological understanding is needed as a basis for control. This research aims to describe the epidemiological picture and causative factors of the mumps outbreak that occurred at Islamic Elementary School X in Samarinda City in 2024, using a case series design. The outbreak occurred from April to October 2024, while epidemiological data collection and case verification were conducted from December 2nd to 8th, 2024. The analysis uses surveillance data, field observations, and questionnaires administered to …

Hubungan Kehamilan Usia Remaja Dengan Kelahiran Prematur Di Rsud Cengkareng Jakarta Barat Tahun 2022: Sebuah Studi Kohort Retrospektif, Anna Triana, Sudarto Ronoatmodjo

Jurnal Epidemiologi Kesehatan Indonesia

Premature birth is leading causes of neonatal mortality. According to the World Health Organization (WHO), global premature birth rates reached 9.9% in 2020, it’s rising compared to preterm birth rates in 2010. One of the risk factors for preterm birth is the mother's age, which pregnant adolescents are more at risk of giving birth to preterm babies due to physiological, psychological, and socioeconomic immaturity. This study is an analytical study with a retrospective cohort design to determine the relationship between adolescents pregnancy and preterm birth. This study was conducted in Cengkareng General Hospital West Jakarta using patient’s medical record data. …

Assessing The Impact Of Substance Abuse On Occupational Injuries Using Workers Compensation Claims In Ohio, Samson Agboola

Walden Dissertations and Doctoral Studies

Occupational injuries remain prevalent across various industries, resulting in significant financial burdens for both organizations and employees through increased workers’ compensation claims. One potential contributing factor is substance use in the workplace, which has been linked to decreased productivity, impaired judgment, and workplace conflict. Despite these risks, the relationship between substance use and occupational injuries remains underexplored. As such, grounded in constructivism and interpretivism, this study investigated the extent to which substance use influences injury outcomes and whether its role is underestimated in workplace incident reporting by analyzing worker’s compensation claims in Ohio. A mixed-methods approach was employed, combining a …

Hurricane Helene, One Year Later: Lived Experience, Geraldine A. Miller

Journal of Appalachian Health

Ashe County is located in the northwestern corner of North Carolina (NC), bordered by Virginia and Tennessee. The county is isolated, mountainous, and historically has lacked good highway access. Hurricane Helene, a category 4 hurricane at landfall, struck Western NC on September 27, 2024, resulting in flooding and wind damage that destroyed local communities in terms of land, homes, bridges, water, electricity, etc. with a damage of $59.6 billion.⁶ One year later, the recovery from the hurricane continues draining individuals and communities of their time, energy, and money. Geri Miller reflects on her hurricane impact experiences a year later. …

Associations Between Social Media Usage, Physical Activity And Flourishing In Rural University Students, Anna Dysart, Minu Sara Thomas

Journal of Appalachian Health

Introduction: Most adolescents and young adults report significant use of social media.^1-3 However, there is limited research on the effect of social media use, specifically on physical activity and flourishing.

Purpose: This pilot research study examines the correlation between social media usage and the physical activity and flourishing levels of college students at a rural university in Appalachia.

Methods: The authors conducted a survey including the validated Secure Flourishing Index and Stanford Leisure-Time Activity Categorical Item, containing questions on social media use and demographics. Spearman’s rho was used for nonparametric correlations. Pearson’s correlation was used to determine the correlation …

Impact Of West Virginia Abortion Ban On West Virginia Physician Trainee Practice Intentions, Rebecca Wald, Kristy Ward, Sarah Dotson

Journal of Appalachian Health

In June 2022, the Dobbs v Jackson Women’s Health Organization overturned the constitutional right to abortion established by Roe vs. Wade. Shortly after, West Virginia (WV) began enforcing a near total ban on abortion. Statewide restrictions on access to reproductive health care have important implications for the recruitment and retention of physicians. This project aimed to determine overall awareness of the 2022 changes in abortion laws among physician trainees, and whether the law influenced the intention of resident/fellow physicians to practice medicine in the state following completion of their medical training. A total of 178 resident and fellow physicians at …

Leveraging Community Health Worker’S Deep Community Knowledge To Address Food And Nutrition Security In Appalachia, Alexis Kimbro Scott, Melissa D. Olfert, Dawn Brewer, Makenzie Barr, Julie Plasencia

Journal of Appalachian Health

Introduction: Community health workers (CHWs) are trusted professionals in communities because of the deep understanding and cultural insights learned from their lived experiences. In Appalachia, CHWs are embedded in the community, giving them a unique understanding of how social determinants, like food and nutrition security, impact health outcomes.

Purpose: This study aimed to examine the professional characteristics and knowledge of CHWs while identifying culturally sensitive practices around food insecurity.

Methods: This cross-sectional, mixed-methods study used an online survey and in-depth phone interviews with CHWs in the Appalachian Region to examine their professional characteristics and knowledge on food security in their …

Stigmatization And Healthcare Inequity Perceived By Individuals Served By Homeless Shelters In An Appalachian City, Molly Powney, James M. Mears, Reagan Sharp, Lisa Calderwood

Journal of Appalachian Health

Introduction: People experiencing homelessness are medically vulnerable and suffer disproportionately from chronic physical and mental health conditions. Evidence-based standards to inform decisions surrounding care would be valuable for this population. Studies exploring how homeless individuals in Appalachia perceive their interactions with the healthcare system remain limited, however.

Purpose: The purpose of this study is to assess perceptions of the healthcare system among homeless individuals served by temporary housing shelters in an Appalachian city.

Methods: A voluntary anonymous survey was administered to residents at three shelters in Charleston, West Virginia (WV) from September 2023 – March 2024. Responses were collected utilizing …

Geospatial Analysis Of Breast Cancer Incidence, Mortality, And Access To Screening In Rural And Appalachian Virginia, Jennifer Osher, Caleb Brown, Phillip Nichols, Tariq Ayubi, Jeremy Powers

Journal of Appalachian Health

Introduction: Breast cancer is the most common malignancy among women in the United States (U.S.), despite recent survival rates improving nationally. However, rural and Appalachian regions have experienced slower mortality declines. These communities face unique health care-related challenges that may contribute to observed disparities.

Purpose: The purpose of this study is to assess differences in breast cancer incidence, mortality, and mortality-to-incidence ratio (MIR) between Appalachian and non-Appalachian counties, as well as rural and non-rural counties in Virginia (VA). Furthermore, we aim to evaluate whether availability of mammography is associated with these differences.

Methods: County-level breast cancer incidence and mortality data …

Influence Of Family Health History And Parental Education On Body Mass Index, Blood Pressure, And Lipid Levels In 5th Grade Children: A Secondary Data Analysis Of The Cardiac Project, Madha Rani Das, Lee A. Plyes, Eloise Elliott, Christa L. Lilly

Journal of Appalachian Health

Introduction: Childhood obesity and related cardiovascular risks reflect the interplay of genetic predispositions and socioeconomic adversity. Appalachia’s poverty, limited health care, and educational gaps worsen family health risks, driving early cardio-metabolic problems in children, highlighting the need for effective interventions.

Purpose: The purpose of this study is to examine the association of family health history and parental education with BMI, BP, and lipid profiles among 5^th grade children in West Virginia (WV).

Methods: The study used WV CARDIAC data from 2006–2009. Outcomes were BMI, SBP/DBP, and fasting lipids (HDL, LDL, TG). Predictors were parental education and family health history …

Understanding Breastfeeding Practices In Tennessee: Goals, Duration, And Reasons For Discontinuation, Amir Alakaam, Chia-Lin Chang, Hannah Jeffery

Journal of Appalachian Health

Introduction: Breastfeeding is widely recognized as the optimal source of infant nutrition, offering many health benefits.

Purpose: The purpose of this study was to examine goals, exclusivity, and duration of breastfeeding and explore factors that influence breastfeeding practices among individuals in Tennessee (TN).

Methods: A cross-sectional study was conducted among individuals (N = 1,249). Participants were recruited and data were collected from June – September 2021. The data were entered and analyzed from September 2022 – March 2023. Descriptive statistics, chi-square test, and ANOVA were used to analyze the data and identify associations between variables.

Results: About 32% of the …

Innovative Philanthropy And Community-Based Approaches: Bridging Access To Sustainable Solutions In Low-Infrastructure Settings, Stephanie Zabriskie

Journal of Nonprofit Innovation

Nonprofits operating in remote or low-infrastructure environments often encounter structural barriers that undermine social impact, especially for women and girls. These barriers are frequently attributed to funding shortages or lack of innovation. However, evidence from practice suggests that many social problems in these contexts persist not because solutions do not exist, but because they do not reach the communities who need them. This thought paper examines the role of nonprofit organizations as bridging agents that connect existing solutions to underserved communities, using women’s health access in East Africa as a case example. The analysis highlights the limitations of episodic philanthropic …

Utilization Review Pada Jaminan Kesehatan Nasional: Implementasi, Tantangan Dan Komponen Essensial, Luh Putu Sinthya Ulandari, Putu Ayu Indrayathi

Jurnal Ekonomi Kesehatan Indonesia

Indonesia has implemented the National Health Insurance (JKN) program since 2014; however, various forms of fraud continue to be found. According to regulations, BPJS Kesehatan, as the national social security agency, is required to conduct Utilization Review (UR) as an effort to control costs and improve the quality of healthcare services. The effectiveness of UR remains questionable due to several implementation challenges. This study aims to explore the implementation of UR, identify its challenges, and examine the essential components required for its effective implementation. The study was conducted in August 2023 using a qualitative approach through in-depth interviews. Samples were …

Work-Related Musculoskeletal Disorders: Epidemiology, Risk Factors, Socioeconomic Impact And Prevention - A Narrative Review, Swarna Radhakrishnan, Harini Ramendran, Priyanga Thirunavukkarasu

Digital Journal of Clinical Medicine

Abstract

Work-related musculoskeletal disorders (WMSDs) represent one of the most pervasive and costly occupational health challenges worldwide. Affecting muscles, tendons, ligaments, nerves, joints, and supporting blood vessels, these conditions arise from a complex interplay of physical, psychosocial, organizational, and individual risk factors present across diverse work environments. From factory floors and construction sites to offices and healthcare settings, WMSDs contribute substantially to pain, disability, reduced productivity, absenteeism, and diminished quality of life. This narrative review synthesizes existing literature on the epidemiology, pathophysiology, risk factors, and socioeconomic impact of WMSDs, with particular attention to high-risk occupational sectors. It further discusses prevention …

Is It Rape Or Consent? College Men Just Don’T Know, Stephanie A. Navarro Silvera, Eva S. S. Goldfarb, Amanda S. Birnbaum, Lisa D. Lieberman

Department of Public Health Scholarship and Creative Works

Introduction: Women and LGBTQ+ undergraduates face higher rates of sexual assault and rape compared to cisgender male peers—the overwhelming majority of perpetrators. Federal policies have aimed to curb campus sexual violence, yet questions remain about the efficacy of consent education, particularly among cisgender heterosexual men. Methods: This study surveyed 1567 undergraduate students at a large Northeastern public university in 2017 and 2022. Responses to a nine-item consent scale were analyzed by gender, sexuality, and demographic factors. Results: Cisgender heterosexual (cis-het) men had poorer understanding of consent compared to women and LGBTQ+ students, both in 2017 and 2022. Cis-het men’s consent …

Community And Academic Synergy For Cancer Survivorship Care Delivery Enhancement (Project Cascade): A Study Protocol For A Pragmatic, Stepped-Wedge, Cluster-Randomized Trial In Texas Primary Care Community Health Centers, Rebecca Eary, Suja S Rajan, Hilary Y Ma, Samiran Ghosh, Benjamin F Crabtree, Simon J Craddock Lee, Bijal A Balasubramanian

Faculty, Staff and Student Publications

Background: In the United States, over 18 million individuals are living with cancer. The majority of these cancer survivors also manage other chronic conditions and receive care from multiple specialists, including oncology, cardiology, and primary care clinicians. However, it remains unclear who holds primarily responsibility for coordinating their care across specialties. Because of its generalist nature, primary care is uniquely suited to deliver whole-person and coordinated care for all conditions for cancer survivors. However, primary care teams experience many challenges delivering high-quality survivorship care. While integrating care for all conditions including cancer is a core principle of high-quality primary care, …

Sex Differences In The Association Of Vascular Risk And Apoe Genotype With Cognitive Decline And Dementia: Evidence From A U.S. Longitudinal Study, Longjian Liu, Jintong Hou, Saishi Cui, Xiaopeng Zhao, Zuolu Liu, J. Craig Longenecker, Nathalie S May, Jin Jun Luo, Rose Ann Dimaria-Ghalili, Howard J. Eisen

Division of Cardiology Faculty Papers

BACKGROUND: Sex differences in the association between vascular factors and cognitive outcomes remain unclear. We aimed to investigate the associations of blood pressure metrics (hypertension, systolic blood pressure [SBP), pulse pressure, ankle and brachial pressures, and ankle to brachial pressure index [ABI]) with the risk of cognitive decline and dementia.

METHODS: We conducted a population-based longitudinal analysis using data from the Atherosclerosis Risk in Communities (ARIC) study (begun in 1987-1989) in the United States. We analyzed a total of 12,268 participants aged 45-64 years who had validated exposure measurements, cognitive function tests (first administrated 1990-1992), and followed up for incidence …

Pengaruh Video Edukasi Unsafe Action Terhadap Tingkat Pengetahuan Dan Perilaku Pekerja Weaving Di Pt X, Ajay Abdiel Ferrall, Maria Paskanita Widjanarti, Jihan Faradisha

National Journal of Occupational Health and Safety

The textile industry is one of the leading sectors in Indonesia, playing a crucial role in providing employment and driving economic growth. However, this industry also carries significant potential for occupational safety and health hazards, particularly due to unsafe actions. Observations at PT X revealed that workers' level of knowledge and behavior regarding unsafe actions remained low. This study was conducted with the aim of analyzing the effectiveness of an educational video intervention on unsafe actions on workers' knowledge and behavior. This quantitative research employed a quasi-experimental design using a non-equivalent control group model. The study was carried out at …

Efektivitas Pemberian Buah Pisang Raja Untuk Menurunkan Kelelahan Kerja Pada Operator Sewing Umkm Garmen X Karanganyar, Virginia Bernardine Gavra Prachristma Sujudi, Tyas Lilia Wardani, Rizqy Kartika Sari

National Journal of Occupational Health and Safety

Work fatigue is a common problem that can reduce productivity and increase the risk of workplace accidents. At UMKM Garmen X Karanganyar, the lack of supplementary food intake causes energy deficits and fatigue among workers. This condition underlies the research to analyze the effectiveness of giving banana raja (Musa paradisiaca L.) as an additional snack in reducing work fatigue among sewing operators at UMKM Garmen X Karanganyar. The research was conducted using a true experimental method with a pre-test and post-test design with a control group. 42 sewing operators were selected from 47 workers using simple random sampling, divided into …

Evaluasi Keselamatan Alat Permainan Edukatif (Ape) Dan Penataan Area Bermain Outdoor Di Dua Taman Kanak-Kanak, Auri Willyado, Novrikasari Novrikasari, Mona Lestari, Dina Waldani, Desheila Andarini

National Journal of Occupational Health and Safety

Educational Play Equipment (APE) is one of the facilities provided by Early Childhood Education (PAUD) institutions to support the learning process through play. This study aims to assess the compliance of APE and the arrangement of outdoor play areas with the 2018 Guidelines for Managing PAUD Classroom Space, SNI 9169:2023, the Ministry of Education and Culture’s 2021 Safe APE Guidelines for Early Childhood, and Ministerial Regulation No. 3 of 2022. The study employs a qualitative design with a descriptive approach through facility observations, interviews with teaching staff, and a review of school documents. The data analysis process includes data reduction, …

Efektivitas Dan Keberterimaan Madcom Noise Protection Sebagai Alat Pelindung Pendengaran Berbasis Perlindungan Ganda, Ahmad Athif Wahyu Ramadhan, Yamtana Yamtana, Naris Dyah Prasetyawati, Sigid Sudaryanto

National Journal of Occupational Health and Safety

Industrial environments often generate high noise levels due to the continuous operation of machinery and production equipment. Persistent exposure to workplace noise exceeding the Threshold Limit Value (TLV) can lead to noise-induced hearing loss. According to the World Health Organization, an estimated 430 million people worldwide require rehabilitation for hearing impairment, with 109.4 million of these cases occurring in Southeast and Central Asia. As a critical component of Occupational Health and Safety (OHS) management, noise control is often implemented using Hearing Protection Devices (HPDs). This study aims to evaluate the effectiveness of an earplug-earmuff combination, developed as Madcom Noise Protection, …