Currently in Ontario, bearded men cannot wear tight-fitting respirators at work. This can limit job opportunities among workers with beards. The Singh Thattha technique is a new method to modify respiratory use for men with beards. It uses material that is stretched over the bearded area (chin/cheeks) and tied at the top of the head to provide a smooth surface to allow for a better seal. However, little is known about the effectiveness of this method and if the beard covering material influences fit.
Our goal is to recruit at least 200 bearded Sikh men to evaluate respirator fit when using the Singh Thattha technique. We also want to identify overall comfort and possible barriers to using the Singh Thattha technique in the workplace.
This study is funded by the Ontario Ministry of Labour, Immigration, Training and Skills Development. The grant funds are administered through the Occupational Cancer Research Centre (OCRC) at Ontario Health.
The research study is being led by Dr. Tracy Kirkham who is the Associate Director of the Occupational Cancer Research Centre (OCRC) at Ontario Health and an Assistant Professor at the University of Toronto. The research team also includes Mr. Paul Bozek (Associate Professor, University of Toronto), Dr. James Scott (Professor, University of Toronto), Ms. Rachel Tyli (PhD student, University of Toronto & OCRC), and Mr. Diljot Sethi (Research Associate and Study Coordinator, OCRC). Other research staff will be present to assist in fit testing.
The study is being conducted at locations across Ontario. These may include the Gage Building at the University of Toronto’s St. George Campus (223 College St, Toronto), OCRC offices at Ontario Health (525 University Avenue, Toronto), or other pre-selected testing sites in your community. The location of your fit testing session will be shared with you prior to your appointment.
As not all testing sites are known in advance, the research team will provide information including the address, available parking solutions, and detailed instructions on how to access the building where your testing will take place prior to your appointment. If you need additional help, such as directions from your home, the research staff can assist you.
The study will follow the up-to-date procedures required in the University of Toronto COVID-19 policy and local public health directives. You will be notified of the current requirements when you book your fit testing appointment.
Please note: If you are symptomatic or had close contact with a confirmed case, please notify the study coordinator (diljot.sethi@ontariohealth.ca) to reschedule your fit test appointment.
If you agree to take part in this study, you will receive training and education on respirator use with the Singh Thattha technique. You will have an opportunity to receive a copy of your fit test results, if interested. This will provide you with insight on how much protection each respirator may provide you using this technique.
Overall, the findings from this study can help determine the level of protection provided by respirators to bearded men using the Singh Thattha technique and identify what factors may influence respirator fit. The findings will summarize the comfort of the Singh Thattha technique and identify potential barriers that may be faced if this method was implemented in Ontario workplaces.
In the long term, these findings may lead to changes in respirator fit testing and selection policies among bearded men in the workplace.
There are a few risks associated with participation in the study:
Males who identify with the Sikh community, have facial hair (e.g., beard), and are between 18 and 70 years old can participate in this research study. The study will be conducted in English, and participants must be able to communicate in English. If needed, participants may bring someone with them to assist with communication during fit testing.
Participants must be healthy enough to safely wear a respirator. Individuals with chronic health conditions that could make breathing through the respirator difficult – such as asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, congestive heart failure, Amyotrophic Lateral Sclerosis – should not participate. Those who experience claustrophobia or significant anxiety related to enclosed spaces should also not participate.
Additionally, participants should not have significant facial irregularities – such as scars, burns, deformities, or other anatomical differences along the respirator seal – that could affect respirator fit.
On the day of fit testing participants will be asked to refrain from smoking at least 30 mins before testing to be eligible.
Respirator fit is measured by measuring particles inside and outside the respirator. When you smoke, the smoke particles can stay in your lungs and be exhaled for up to 30 minutes after smoking. The exhaled particles will be measured and will cause you to have a lower fit than your true fit.
You must have facial hair on your cheeks/chin that would interfere with the seal of a respirator (i.e., a beard) to participate. We recognize that there is a wide range of facial hair growth patterns and densities, all types of facial hair growth are acceptable. Further, participants may have trimmed or untrimmed beards.
Please review the current eligibility criteria on the website by clicking enrolment link: www.occupationalcancer.ca/project/beard-study/.
If you are eligible, or you have questions about your eligibility, contact the study coordinator, Diljot Sethi (diljot.sethi@ontariohealth.ca) to set up an appointment for testing.
You will be asked questions to confirm your eligibility for the study before you are provided with an appointment date/time.
We do not recommend walk-ins. This is because the research staff are scheduled to be at the study site for specific appointment dates and may not be available at the study site if you show up without an appointment. However, time permitting in the rare occasion, we may be able to take walk-ins.
Prior to coming to a testing site for your appointment you will be asked to watch a brief study video (~10 minutes) that will provide an overview of what to expect during your fit testing appointment. The video will include a description of why we are conducting the study, how respirator fit is measured, and what you will be asked to do during your appointment. The video will also demonstrate how to put on the Singh Thattha, put on and take off respirators, and how to conduct a fit check.
You are asked to watch this video before you come to help you prepare for your appointment. Although the video will provide demonstrations, the staff will assist you during the fit testing whenever needed.
No further information will be asked of you once your appointment is over.
You will be able to watch the study video at the test site if you have not watched it before your appointment.
You do not need to bring anything with you to the fit testing appointment. You will be provided with all equipment and supplies needed.
The study will have clips/pins to assist in securing your beard for the Singh Thattha; however, you may prefer to bring your own clips or pins (or to not use clips/pins) that you typically use to secure your beard.
This study will require you to visit the agreed-on testing site. The appointment will take approximately 2 hours. During this visit you will be asked to:
1. Have several measurements taken to assist with respirator selection and to identify what may influence the effectiveness of the Singh Thattha technique. These include:
Please Note: All photos are optional, and you can review the photos at any time and request that they be deleted if you prefer.
2. Complete up to eight quantitative fit tests following the Canadian Standards Association (CSA) Group fit testing protocol. This protocol includes seven simple exercises such as normal breathing, turning your head side to side, and bending at the waist.
Fit tests will be conducted with multiple respirators with different levels of protection to evaluate if the effectiveness changes based on the type of respirator. Additionally, different Singh Thattha materials will be used during testing. The Singh Thattha materials include three non-latex exercise resistance bands with different levels of stretch, which may influence your comfort and fit.
3. Complete a questionnaire that asks about your background, your beard characteristics, your experience with respirators in the workplace, and your opinions on the Singh Thattha technique. The questionnaire will take approximately 30 to 45 minutes, depending on your answers.
Anthropometric measurements are measurements of different body parts.
Body measurements like weight and height are standard measures taken to describe participants in research studies and are sometimes used as health measures. We will also investigate if these measurements influence if someone passes/fails a fit test.
Facial measurements such as facial width and face length are taken to help select the appropriate size of respirator. Facial measurements such as face depth and circumference are taken to help select the appropriate size of resistance band.
Beard measurements such as length and density are taken to understand how these factors influence respirator fit and the effectiveness of the Singh Thattha technique.
The questionnaire collects information about you, your beard, your experience with respirators, the impacts that your beard may have had on work opportunities and personal safety. We will use your answers to these questions to describe the study population, summarize the impact of not being able to wear a beard has had on the Sikh community, and investigate what factors may influence respirator fit (e.g., age, beard maintenance).
You will also be asked for your opinions of the Singh Thattha technique (e.g., comfort, barriers to use and training needs). This information will be used to identify how comfortable the Singh Thattha technique is, what influences comfort, and how this may impact the long-term use of the Singh Thattha technique in workplaces. The information will also be used to identify the main barriers that would need to be overcome and what training resources would be needed for the method to be successfully implemented in Ontario.
There are several different types of respirators that provide a range of protection (e.g., from least to most protective: disposable N95 respirators, ½-face tight-fitting elastomeric respirators, and full-face tight-fitting respirators). These respirators fit differently, sit on different areas of the face, and have different straps that may interfere with the Singh Thattha. Currently little information is available on whether each of these respirators will work with the Singh Thattha and if adequate protection will be provided. By testing different types of respirators the study may be able to identify what respirators will or will not work with the Sing Thattha to provide adequate protection.
The study is testing three different resistance strength bands, which reflects how “stretchy” the band is. The researchers think the stretchiness of the material used for the Singh Thattha may influence the comfort while wearing the band AND/OR the fit of the respirator. Testing three levels will provide insight into the comfort and effectiveness of the bands, which may be used to provide recommendations to policy makers.
All fit tests will follow the protocol outlined by the Canadian Standards Association Group (i.e., CSA standard Z94.4-18 protocol), which is required for all Canadian workplaces. This protocol includes a series of seven simple exercises in the following sequence:
Nothing happens if you do not pass one of your fit tests, you will continue to your next fit test as initially planned. Typically in the CSA fit testing procedure the test is repeated; however, the study is not repeating as we anticipate there may be a high failure rate for some fit tests, and we are being respectful of participants’ and study time. If there is additional time, and you are interested you can request to repeat some of the tests.
There are many types of respirators. Respirators are often separated by how they provide clean air and are classified as air-purifying or air-supplying respirators.
Air-purifying respirators use a filtering mechanism to clean “dirty” air before the worker breathes it in. For particles and bioaerosols this involves using HEPA filters, called cartridges, or disposable respirators made of HEPA material (e.g., N95). These respirators can be non-powered (i.e., worker required to breathe through filters) or powered (i.e., a power source pushes air through the filters for the worker). The study will be testing air-purifying respirators.
Air-supplying respirators provide a source of clean air that is delivered to the wearer. This is done by carrying an air tank where the worker moves (i.e., self-contained breathing apparatus) or by being connected to an airline that provides clean air from an area away from the hazard.
Tight-fitting respirators are respirators that require a tight seal between the respirator and the wearer’s face to work properly. Some examples include filtering face-piece respirators like N95s, elastomeric half and full face-piece respirators, tight-fitting powered-air purifying respirators, self-contained breathing apparatus.
Respirator fit testing measures how well a respirator fits a wearer and verifies if the respirator provides the wearer with the expected level of protection. There are two kinds of fit tests:
A fit check, also known as a user seal check, is a test done to determine if the respirator has been put on correctly by the wearer and if the respirator has a good seal. This is conducted every time a respirator is put on (i.e., donned) and does not require chemicals or equipment. There are two checks to be performed:
The study video illustrates how to do these tests and research staff will provide detailed instructions on how to perform these checks during the fit test appointment.
There are strict rules researchers must follow to protect your privacy. To protect your privacy:
All of your information/data will be held for at least five years after the completion of the study on Ontario Health’s secure government network. Current Ontario Health policies to protect data and confidentiality will be followed when study data is destroyed (e.g., shredding all paper documents).
An informed consent form is used to provide participants with information about the study including the risks and benefits of participating in the study before they volunteer. You sign the consent form to ensure that you have received the information and understand your rights as a participant of this study and possible risks that the study may involve.
If you decide to participate, the informed consent form will be given to you at least 24 hours before your appointment so you can have time to review the form and ask questions. A signed copy of your consent will be provided to you before testing for your records.
No, you cannot email the signed consent form. All informed consent forms must be signed at the study site in front of a research staff member. This is a requirement from research ethics to ensure you are aware of your rights and it allows the research staff the opportunity to ask you if you have any questions/concerns before signing.
Your participation is voluntary, and you can withdraw from the study at any time with no consequences. To withdraw, tell a research team member that you no longer wish to participate.
You can request to have your data destroyed and the research team will do so where possible. However, it may not be possible to withdraw your data if it is no longer identifiable, if it has been merged with other data, or if de-identified data has been made publicly available (i.e., released in a presentation, report, or scientific article).
Yes, you will be provided with a written copy of your results from all your fit tests immediately after completing the fit testing protocols if you are interested in having them.
At the end of the study, a summary of the results will be posted for participants on the study website. Reports prepared for the different stakeholders will be made available on the study website for broad access. All results will be in aggregate form and not identify individual workers under any circumstances.
No. Currently workers are not allowed to wear a respirator without a CSA fit test, which requires a person to be clean shaven so the fit tests conducted in this study would not qualify. Therefore, you will not be able to use your results to wear a respirator in your workplace. The information from the fit test will provide you with knowledge on how much protection you are provided.
No, the Singh Thattha technique is not currently an approved method for respirator use in Ontario workplaces. Currently, workers in Ontario must be clean-shaven in order to wear a tight-fitting respirator.
There is no cost to you for any research-related activities (respirator fit tests and questionnaires).
Unfortunately we are unable to pay people for their time or travel/parking costs; however, participants will be offered a $25 gift card as a thank you (honorarium) for participating in our study.
You can withdraw from the study at any time. If you withdraw after informed consent and starting your fit testing appointment, you will still receive the honorarium. If you withdraw before your appointment or you do not show up for your appointment, you will not receive the honorarium.
Please email the study coordinator, Diljot Sethi (diljot.sethi@ontariohealth.ca).
If you have concerns about your rights as a participant or want to make a complaint about the study regarding your rights or concerns, you may contact the research ethics manager at the University of Toronto’s Office of Research Ethics by email. Please reference the study number [47843] for better assistance.
Please contact the study coordinator, Diljot Sethi (diljot.sethi@ontariohealth.ca or (289)-497-2068), as soon as possible.
You may also be provided with additional contact information after your appointment is scheduled.
Your participation is voluntary, and you can withdraw from the study at any time with no consequences. To withdraw, tell a research team member that you no longer wish to participate or email the study coordinator, Diljot Sethi (diljot.sethi@ontariohealth.ca).
After your appointment is set, you will be sent a reminder email a few days before your scheduled appointment to confirm the date/time of your appointment. You may also be contacted in the event of cancellation. In the event you are exposed to someone with COVID-19 at the testing site during your visit, you will be notified following University policies. Feel free to check our website for study updates.
