Lifestyle Factors and Vocal Health in Professional Theater Actors: Associations with Vocal Fatigue and Reflux Symptoms.

OBJECTIVE: This exploratory cross-sectional study aimed to characterize lifestyle habits and investigate the association between modifiable behavioral factors and vocal fatigue and reflux-related symptoms in professional theater actors. METHODS: A total of 95 professional theater actors from four musical theater companies participated in this study. Participants completed a structured questionnaire assessing professional vocal demand, lifestyle habits, vocal recovery practices, vocal symptoms, the Voice Handicap Index (VHI-10), and the Reflux Symptom Index (RSI). Variables were categorized into clinically relevant groups. Associations were assessed using Pearson's chi-square test, and variables significant in bivariate analysis were further evaluated using univariate logistic regression. Statistical significance was established at P < 0.05. RESULTS: Vocal fatigue was reported by 91% of participants, while 61% presented inadequate hydration and 78% reported high coffee consumption (≥3 cups/day). Reflux-related symptoms were present in 63% of the cohort. Perceived stress emerged as the strongest predictor of vocal fatigue (OR = 7.2; P < 0.001), followed by inadequate hydration (OR = 4.6; P = 0.002) and absence of vocal cool-down routines (OR = 4.1; P = 0.004). High coffee consumption was independently associated with reflux-related symptoms (OR = 3.9; P = 0.006). CONCLUSION: Modifiable behavioral factors, particularly stress, hydration, coffee consumption, and vocal recovery practices, play an important role in vocal health among professional theater actors. These findings support a broader understanding of vocal health in which behavioral factors interact with occupational vocal demands to influence symptom burden, highlighting the importance of preventive strategies incorporating hydration, stress management, dietary counseling, and structured vocal recovery.