Hearing Health at School: analysis of knowledge, behaviors and attitudes of Southern-Brazilian children and adolescents on noise

PURPOSE

to analyze the knowledge, behaviors, and attitudes of students on noise.

METHODS

We used an observational method study, in 32 Schools from Itajaí/Brazil, with a convenience sample, comprising 1,835 students, 45.7% females and 54.3% males, mean age of 11.53 ± 0.8 years, was conducted. The Portuguese version of Dangerous Decibels® questionnaire was applied. For the data analysis, descriptive and inferential statistics were used, significance level of 5%.

RESULTS

A large part of the sample part of the sample had harmful hearing habits; 62.6% reported knowledge on the subject, but only 25.4% answered the questions on the theme correctly; 58.9% reported that they did not know how to protect hearing if necessary. Regarding sex and age: males have more hazardous hearing habits (p < 0.001) and tinnitus complaint (p<0.001) and females have more knowledge (p < 0.001) and the intent to wear hearing protection (p<0.001), greater intention to wear hearing protection among younger students (10 and 11 years old) (p < 0.001), and the older ones (12 to 16 years old) get more exposed to noise (p < 0.001), and there are more tinnitus complaints (p < 0.05) among them.

CONCLUSION

A large part of the students in the study has hazardous noisy habits and scarce knowledge on the theme, with males and older subjects showing the worst attitudes and behaviors in face of the potential hearing risk caused by exposure to high noise levels.

Effectiveness of educational programs in hearing health: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of hearing health education programs aimed at preventing noise-induced hearing loss (NIHL), of recreational and occupational origin, by means of a systematic review and meta-analysis.

DESIGN

The search strategy was carried out in on five electronic databases, as well as referrals from experts. The risk of bias was judged, and the random effects meta-analysis was performed. The certainty of the evidence was assessed.

STUDY SAMPLE

Effectiveness studies that used educational intervention in hearing health and prevention of NIHL were included.

RESULTS

42 studies were included. The Dangerous Decibels program was the only one that could be quantitatively analysed and showed improvement in the post-intervention period of up to one week [SMD = 0.60; CI95% = 0.38-0.82; I2 = 92.5%) and after eight weeks [SMD = 0.45; CI95% = 0.26-0.63; I2 = 81.6%) compared to the baseline. The certainty of evidence was judged as very low.

CONCLUSIONS

The Dangerous Decibels program is effective after eight weeks of intervention. The other programs cannot be quantified. They still present uncertainty about their effectiveness. The level of certainty is still low for this assessment.

The development and evaluation of an online hearing loss prevention program

Recent studies underline the need for research on approaches to encouraging healthy listening habits. This study aims to develop and evaluate an online hearing loss prevention program; and examine its influence on the participants' use of hearing protection, hearing loss prevention knowledge, attitude towards noise, and program useability and adherence. The study was conducted in the county of Västra Götaland, Sweden, from March through October 2021. The program included four modules focused on hearing and hearing loss prevention and was accessible to the participants for four weeks. In total, 75 participants completed the program which was evaluated using the Youth Attitude to Noise Scale and four additional self-designed questionnaires. The questionnaires were deployed before and immediately after program completion. The findings indicate that the program may influence the participants' attitudes toward noise and the use of hearing protection. The participants who completed the program perceived high useability and increased hearing loss prevention knowledge. This program is most needed to promote healthy hearing. Future studies should target specific groups with this program and evaluate its long-term effects.

Dangerous Decibels Program in Elementary and Middle School Students: Effectiveness After a 6-Month Follow-Up

PURPOSE

The purpose of this article was to assess the effectiveness of the Dangerous Decibels (DD) program in students in the short- and medium-term follow-ups (up to 6 months), including an online game.

METHOD

A randomized trial was conducted between two interventions (DD and placebo). The research included 58 participants who were divided into two groups: the study group (SG) and the control group. The following phases were developed: intervention (DD or placebo), post-3-month assessment and availability of the online game, and post-6-month assessment. A questionnaire was administered to assess their performance. Overall total scores and category scores were obtained.

RESULTS

Improved overall scores were found in the SG in the immediate post-intervention (p = .004), post-3-month (p = .022), and post-6-month (p = .002) questionnaires, as well as the knowledge and behavior categories.

CONCLUSIONS

The DD program effectively improved the knowledge and behavior of 10- to 12-year-old children regarding noise in the short- and medium-term follow-ups. However, no significant changes were achieved in terms of barriers only by using the program and the online game. Adding a second intervention (the online game) to the program seems to be a good option to maintain the changes achieved with the interactive class.

Translation, adaptation, and cross-cultural validation into Brazilian portuguese of the hearing protection assessment questionnaire (HPA)

PURPOSE

The aim of the present study is to translate, adapt, and cross-culturally validate the Brazilian Portuguese version of the questionnaire Hearing Protection Assessment Questionnaire (HPA).

METHODS

The original instrument, developed in English, seeks to assess barriers and supports related to the use of hearing protection devices (HPD), as well as workers' knowledge, habits and attitudes towards occupational noise. The translation, adaptation, and cross-cultural validation of the questionnaire consisted of five steps: Translation of the questionnaire from English to Portuguese; 2) Reverse translation from Portuguese to English; 3) Analysis of the instrument by three experts in the field; 4) Pre-test of the questionnaire with ten workers; 5) Application of the instrument to 509 workers in a meatpacking industry after the pre-employment medical exam.

RESULTS

The results indicate the construction and content validity of the Brazilian Portuguese version for use with a working population and its internal consistency.

CONCLUSION

This study resulted in the translation, cultural adaptation, and validation of the Hearing Protection Assessment Questionnaire (HPA), in order to be used to assess the use of individual hearing protection in the occupational field, called Hearing Protection Assessment Questionnaire (HPA).

Evaluation of the Dangerous Decibels Brazil Program in Workers Exposed to Noise

Introduction

Noise-induced hearing loss can be avoided by taking preventive measures.

Objective

To assess the effectiveness of the Brazilian version of the Dangerous Decibels® program for noise-exposed workers, using the ecological model as an educational intervention plan.

Method

Non-randomized interventional study with a quantitative, experimental trial design, conducted at a meatpacking company. The participants were divided into two groups-the first one (n = 132, divided into 6 subgroups) received the Dangerous Decibels® Brazil educational intervention (DDBEI) adapted to workers while the second group (n = 138, divided into 5 subgroups) received a conventional educational intervention (CEI). The interventions lasted 50 min. The Hearing Protection Assessment Questionnaire (HPA-5) was administered before and after the interventions. The five dimensions (attitude, behavior, knowledge, supports, and barriers) were compared using the Student's t-test for paired data (<0.05).

Results

After both the DDBEI and CEI training, workers improved significantly in barriers, supports, knowledge, attitudes, and behavior around noise. By chance, the CEI group scored lower in all measures than the DDBEI group before training, and though both groups improved, the difference was maintained after training.

Conclusion

The Brazilian version of the Dangerous Decibels® program for noise-exposed workers was effective, influencing positively the factors at different levels of the ecological model. Though the DDBEI was no more effective than the CEI, the CEI participants began at much lower levels, so the effectiveness of the DDBEI may have been underestimated.

Online, Asynchronous Hearing Education and Research Project for Ethnically Diverse Adolescents via Interprofessional Collaboration and Electronic Service-Learning During the COVID-19 Pandemic: A Pilot Study on the Needs and Challenges

Purpose This study discusses the creation of an online, asynchronous presentation to educate adolescents about prevention of noise-induced hearing loss (NIHL) through interprofessional collaborations and electronic service-learning (eSL) during the COVID-19 pandemic. Method The Hearing Education and Research (HEAR) presentation, which included activities and videos to educate a group of ethnically diverse adolescents (n = 100) on NIHL, was created by 11 doctor of audiology (AuD) students through online collaborations toward course-related eSL requirements. Adolescents responded to a baseline survey to assess hearing health-related behaviors prior to reviewing the presentation. A postprogram survey was administered 1 week after the presentation to assess change in knowledge and attitudes toward NIHL prevention. Online collaborations with schoolteachers helped with project implementation. Postreflection papers written by AuD students regarding the eSL activities were analyzed. Lastly, suggestions from a focus group of educators were included that highlight the role of interprofessional collaborations to enhance school-based hearing conservation opportunities. Results The HEAR presentation resulted in changes in knowledge about NIHL among the adolescents. Postreflection papers by the AuD students indicated that the eSL activity served as a high-impact pedagogical assignment, especially during the academic challenges of the pandemic. Feedback from a focus group of schoolteachers helped outline ideas for future implementation of sustainable hearing conservation programs in school settings. Conclusion The pilot data collected in this study serve as a proof of concept for future hearing conservation projects in school-based settings via interprofessional collaborations and by engaging university students via eSL.

Hearing threshold levels of Australian coal mine workers: a retrospective cross-sectional study of 64196 audiograms

OBJECTIVE

This study examined the hearing threshold levels (HTL) of workers commencing employment in Australian coal mines in the State of New South Wales (NSW). The aim was to establish if some degree of hearing loss was identifiable in the mandatory pre-employment audiograms of workers.

DESIGN

This was an observational, retrospective, repeated cross-sectional study.

STUDY SAMPLE

De-identified audiometric records of 64196 employees entering NSW coal mining in three representative five-year periods between 1991-2015 were utilised.

RESULTS

Although HTLs were lower (better) in more recent years, the results showed clinically significant hearing loss (≥25dBHL) for older workers, 45-60 years. Pure tone average (PTA) hearing losses were greater at the higher frequencies associated with excessive noise exposure (3-6 kHz), than at the speech frequencies (0.5-4 kHz). Hearing loss in the left ears were higher compared to the right ears, with higher prevalence of audiometric notches in males.

CONCLUSION

Almost a fifth (14.8-20.1%) of male workers commencing work in NSW coal mines presented with an audiometric notch at 4 kHz. Further research is required to determine if these notches represent true NIHL, and how the residual hearing of workers may be conserved.

Which interventions increase hearing protection behaviors during noisy recreational activities? A systematic review

Background

Hearing loss and tinnitus are global concerns that can be reduced through hearing protection behaviors (e.g., earplug use). Little is known about the effectiveness of interventions to increase hearing protection use in recreational domains. For the first time we review systematically the effectiveness of such interventions.

Methods

Systematic searches of nine databases, as well as grey literature and hand-searching, were conducted. Any study design was included if it assessed quantitatively a purposeful attempt to increase hearing protection in recreational settings. Studies were excluded if they assessed noise exposure from occupational sources and headphones/earphones, as these have been reviewed elsewhere. PROSPERO protocol: CRD42018098573.

Results

Eight studies were retrieved following the screening of 1908 articles. Two pretest-posttest studies detected a small to medium effect (d ≥ 0·3 ≤ 0·5), one a small effect (d ~ =0·2) and two no real effect. Three posttest experimental studies detected small to medium effects (d ≥ 0·3 ≤ 0·5). Studies were rated as “poor quality” and 17 out of a possible 93 behavior change techniques were coded, with the majority targeting the intervention function ‘education’.

Conclusions

Hearing loss and tinnitus due to recreational noise exposure are major public health concerns yet very few studies have examined preventive interventions. The present systematic review sets the agenda for the future development and testing of evidence-based interventions designed to prevent future hearing loss and tinnitus caused by noise in recreational settings, by recommending systematic approaches to intervention design, and implementation of intervention functions beyond education, such as incentivization, enablement and modeling.

Drug development for noise-induced hearing loss

INTRODUCTION

Excessive exposure to noise is a common occurrence that contributes to approximately 50% of the non-genetic hearing loss cases. Researchers need to develop standardized preclinical models and identify molecular targets to effectively develop prevention and curative therapies.

AREAS COVERED

In this review, the authors discuss the many facets of human noise-induced pathology, and the primary experimental models for studying the basic mechanisms of noise-induced damage, making connections and inferences among basic science studies, preclinical proofs of concept and clinical trials.

EXPERT OPINION

Whilst experimental research in animal models has helped to unravel the mechanisms of noise-induced hearing loss, there are often methodological variations and conflicting results between animal and human studies which make it difficult to integrate data and translate basic outcomes to clinical practice. Standardization of exposure paradigms and application of -omic technologies will contribute to improving the effectiveness of transferring newly gained knowledge to clinical practice.

Evaluating the implementation fidelity of a community-based intervention to promote hearing conservation among farm and rural youth

Noise-induced hearing loss is common among farm and rural youth. There is a lack of programs preparing this high-risk population to use hearing conservation strategies. Safety Days are 1-day workshops that teach 100,000 rural children safe farm practices in 400 sites across the USA annually. As part of a larger study for fourth graders, a hearing conservation lesson was delivered at 25 sites nationwide. However, the fidelity to the study-designed curriculum and quality of instruction was unknown. We examined whether community volunteers are capable of delivering, with adequate fidelity and quality, a planned intervention designed to increase use of hearing conservation strategies among farm and rural youth. We invited instructors (n = 22) to deliver a health lesson to fourth graders and provide lesson recordings. We developed instruments rating (i) fidelity of the teaching to the curriculum and (ii) quality of instruction. Initial instruments were modified based on the review for clarity, relevance, and conceptual fit; inter-rater reliabilities were .90 (content fidelity) and 1.00 (quality of instruction). Of seven recordings reviewed, mean fidelity to the planned curriculum was 1.51 (max score = 2), with nearly four fifths of lesson items fully addressed. Overall mean of rating of quality of instruction was 1.97 (out of 2). Fidelity to both content and quality of instruction was high. Results provide a model and support for use of community volunteers (with no special educational or experiential background) and fidelity testing as cost-effective strategies to provide sustainable programming for hearing conservation among farm and rural youth.

Community-based program to increase use of hearing conservation practices among farm and rural youth: a cluster randomized trial of effectiveness

BACKGROUND

Noise exposure and associated hearing loss affects an estimated 2 million farm youth who are exposed as farm residents, farm family workers, hired workers, children of migrant or seasonal workers, and farm visitors. Risk factors for farm youth include frequent exposure to high farm noise; farm work from an early age, and exposure to high recreational noise (e.g., firearms, ATVs, and personal listening devices).

METHODS

This study compared the effectiveness of two interventions and control. The programs included a community-based interactive youth educational program alone (Group A), a community-based interactive youth educational program followed by an Internet-based booster (Group B), and a no-interaction control (Group C). The study used a cluster randomized control design, with equal allocation ratio to each cluster, without blinding. Inclusion criteria included enrollment in grade 4, parental consent, English speaking, and attending a community-based educational event included in the cluster sampling. A total of 1979 youth were enrolled at 36 sites distributed across the 3 study arms in the following distribution: N = 662 in 13 sites (Group A), N = 680 in 12 sites (Group B), and N = 637 in 11 sites (Group C).

RESULTS

Comparison with pre-intervention data showed no difference in intent to use hearing conservation strategies in experimental groups. However, knowledge and attitudes toward hearing conservation were improved in the groups receiving the Internet-based booster. Participants reported frequent exposure to sources of hazardous noise (e.g., loud sporting events, firecrackers, personal listening devices).

CONCLUSIONS

It is feasible and acceptable to incorporate hearing health education into an already existing system designed to deliver health and safety educational programming to farm and rural youth. The program was adopted by the partner agency for dissemination to up to 100,000 youth annually. Results of this study inform future intervention studies, interventions aimed at farm youth, and interventions to increase use of hearing conservation strategies, as well as offer a base for developing programs for non-English speaking children.

TRIAL REGISTRATION

Clinicaltrials.gov registration CT02472821. Date of trial registration: 06/09/2015 (retrospectively registered).

Noise exposure limit for children in recreational settings: Review of available evidence

It is universally recognized that prolonged exposure to high levels of non-impulsive noise will lead to noise-induced hearing loss. These high levels of noise have traditionally been found in an occupational setting, but exposure to high levels of noise is increasingly common in recreational settings. There is currently no established acceptable risk of hearing loss in children. This review assumed that the most appropriate exposure limit for recreational noise exposure in children would be developed to protect 99% of children from hearing loss exceeding 5 dB at the 4 kHz audiometric test frequency after 18 years of noise exposure. Using the ISO 1999:2013 model for predicting hearing loss, it was estimated that noise exposure equivalent to an 8-h average exposure (L_EX) of 82 dBA would result in about 4.2 dB or less of hearing loss in 99% of children after 18 years of exposure. The 8-h L_EX was reduced to 80 dB to include a 2 dB margin of safety. This 8-h L_EX of 80 dBA is estimated to result in 2.1 dB or less of hearing loss in 99% of children after 18 years of exposure. This is equivalent to 75 dBA as a 24-h equivalent continuous average sound level.

Efficacy of hearing conservation education programs for youth and young adults: a systematic review

BACKGROUND

Many youth and young adults experience high noise exposure compounded by lack of access to hearing health education. Although the need for hearing health education programs is evident, the efficacy of these programs for youth is unclear. We evaluated the literature for efficacy of various hearing conservation programs aimed at youth and young adults, and analyzed their strengths and limitations.

METHODS

Studies reporting results of hearing conservation or hearing loss prevention programs with youth or young adults, using randomized controlled trials, quasi-experimental designs, experimental design, or qualitative research, and published in peer-reviewed journals in English between 2001 and 2018 were included. Studies were found through searches of selected literature databases (i.e., PubMed, Google Scholar, NIOSH Toxline, and Scopus). Identified publications were assessed for relevance, and data were extracted from the studies deemed relevant.

RESULTS

A total of 10 studies were included. Very little evidence of efficacy of hearing conservation educational programs was found in these studies. Several methodological limitations including lack of rigorous study designs, inadequate power, and application of inappropriate statistical analysis were noted. Some use of technology in programs (e.g., smartphone apps, mobile phone text messages, and computers) was observed, but conclusions as to the effectiveness of these tools were limited by the small number of studies and small sample sizes.

CONCLUSIONS

The number of studies of educational hearing conservation programs for youth and young adults was low. The efficacy of the program was not reported in most studies, and it is difficult to draw public health conclusions from these studies due to their multiple methodological limitations. While use of technology in hearing conservation educational programs offers promise, its effectiveness has not been studied.

CDC Grand Rounds: Promoting Hearing Health Across the Lifespan

Globally, one in three adults has some level of measurable hearing loss, and 1.1 billion young persons are at risk for hearing loss attributable to noise exposure. Although noisy occupations such as construction, mining, and manufacturing are primary causes of hearing loss in adults, nonoccupational noise also can damage hearing. Loud noises can cause permanent hearing loss through metabolic exhaustion or mechanical destruction of the sensory cells within the cochlea. Some of the sounds of daily life, including those made by lawn mowers, recreational vehicles, power tools, and music, might play a role in the decline in hearing health. Hearing loss as a disability largely depends on a person's communication needs and how hearing loss affects the ability to function in a job. The loss of critical middle and high frequencies can significantly impair communication in hearing-critical jobs (e.g., law enforcement and air traffic control).

The Impact of Annual Audiograms on Employee's Habits and Awareness Regarding Hearing Protection and Noise Induced Hearing Loss, On and Off the Job

Noise-induced hearing loss occurs among workers across a wide spectrum of industries. The purpose of this study was to investigate whether annual hearing testing contributed to a change in employees' habits and awareness and aimed to evaluate the use of hearing protection at work and at home. Employees enrolled in a university's hearing conservation program (HCP) were anonymously surveyed regarding their hearing protection habits and awareness of noise exposures on and off the job using a Likert-type scale. Approximately half were "very much" concerned about hearing loss over time. Evidence supports that annual testing, part of the workplace HCP, also led over half of participants to change their habits at work and at home. Awareness of noise exposures increased both at home and at work with annual testing. Overall, the HCP in this particular setting was associated with improved on-the-job and home hearing protection use.

Understanding Why People Enjoy Loud Sound

Sounds at levels that can injure the ear are regarded as enjoyable by many people. In many societies, a common form of this behavior is listening to loud music, either via personal audio systems or at music venues. Drawing on theory from the literature around loud sound and emotional responses to music, and combining it with concepts of physiological sound adaptation and classical conditioning, we developed a model of the process that may underlie people's enjoyment of loud sound, particularly loud music in nightclubs. The Conditioning, Adaptation, and Acculturation to Loud Music (CAALM) model proposes that the benefits associated with loud sound, alongside other desirable aspects of nightclubs, provide the unconditioned stimuli. Over time regular clubbers become conditioned to enjoy loud sound in itself. Exposure to loud sound also causes adaptation within the auditory system, so there is both a desire for, and tolerance of, loud sound during leisure time. This sets up an expectation of loud music as a cultural norm, and staff of leisure venues, who are themselves part of that culture, set music levels to meet customer expectations; and a cycle is perpetuated. This theory may be a useful consideration for health promotion and hearing conservation interventions.

Why Do People Like Loud Sound? A Qualitative Study

Many people choose to expose themselves to potentially dangerous sounds such as loud music, either via speakers, personal audio systems, or at clubs. The Conditioning, Adaptation and Acculturation to Loud Music (CAALM) Model has proposed a theoretical basis for this behaviour. To compare the model to data, we interviewed a group of people who were either regular nightclub-goers or who controlled the sound levels in nightclubs (bar managers, musicians, DJs, and sound engineers) about loud sound. Results showed four main themes relating to the enjoyment of loud sound: arousal/excitement, facilitation of socialisation, masking of both external sound and unwanted thoughts, and an emphasis and enhancement of personal identity. Furthermore, an interesting incidental finding was that sound levels appeared to increase gradually over the course of the evening until they plateaued at approximately 97 dBA Leq around midnight. Consideration of the data generated by the analysis revealed a complex of influential factors that support people in wanting exposure to loud sound. Findings were considered in terms of the CAALM Model and could be explained in terms of its principles. From a health promotion perspective, the Social Ecological Model was applied to consider how the themes identified might influence behaviour. They were shown to influence people on multiple levels, providing a powerful system which health promotion approaches struggle to address.

Perceptions of public primary school teachers regarding noise-induced hearing loss in South Africa

Background

Noise-induced hearing loss (NIHL) is an increasingly growing problem in young children. This is attributed to recreational noise being the most common cause of this problem. In young children, hearing problems can delay language development and reduce academic achievements. South Africa, in particular, has limited information and protective measures regarding the conservation of hearing in school-aged children.

Objectives

The main aim of the study was to determine the perception of primary school teachers regarding NIHL. The study also aimed to determine if any hearing conservation programmes are being implemented in schools and the need for training of primary school teachers regarding NIHL.

Method

A survey was conducted. In order to cover the population of interest, the sampled schools in Pretoria were clustered into urban, semi-urban and rural areas.

Results

The majority of the teachers included in this study are aware of NIHL and its effects. They, however, lack the necessary resources and knowledge to effectively use this information. Most (67.5%) of the teachers indicated that they have never been exposed to children with NIHL in a school setting. It was also found that the majority (84%) of the schools included in the study do not implement hearing screening and conservation programmes.

Conclusion

Although the sample size was limited, the results correlate with other research in this field indicating a need for planning and implementation of hearing conservation programmes in schools, including training of teachers in order for these programmes to be effective.

Program Sustainability: Hearing Loss and Tinnitus Prevention in American Indian Communities

INTRODUCTION

An important goal of any health promotion effort is to have it maintained in delivery and effectiveness over time. The purpose of this study was to establish a community-based noise-induced hearing loss and tinnitus prevention program in three different types of American Indian communities and evaluate them for evidence of long-term sustainability.

METHODS

The target population was fourth- and fifth-grade students from three different models of American Indian communities. The evidenced-based Dangerous Decibels^® program was adapted to include local media, classroom education, family and community outreach, and web-based activities. Sustainability was attempted by promoting funding stability, political support, partnerships, organizational capacity, program adaptation, program evaluation, communications, public health impacts, and strategic planning.

RESULTS

Currently, there is evidence suggesting that the hearing health promotion program is self-sustaining in all three American Indian communities. The intervention was effective at changing knowledge, attitudes, beliefs, and behaviors in the target population, but program adoption and self-sustenance faced challenges that required patience, persistence, and creativity by the program team. Components of the intervention continue to be delivered by local members of each community.

CONCLUSIONS

Critical factors that led to self-sustaining programs included approval of community leaders and engagement of community members in the design, administration, and evaluation of the effort; use of a well-developed, evidence-based intervention; and high-level training of local participants who could confidently and effectively continue delivering the program following a gradual transition to independence.

An ecological approach to hearing-health promotion in workplaces

OBJECTIVE

To develop and assess use, acceptability and feasibility of an ecological hearing conservation programme for workplaces.

DESIGN

A school-based public health hearing preservation education programme (Dangerous Decibels®) was adapted for workplaces using the Multi-level Approach to Community Health (MATCH) Model. The programme was delivered in small manufacturing companies and evaluated using a questionnaire before the training and at one week and two-months after training.

STUDY SAMPLE

Workers (n = 56) from five small manufacturing companies were recruited.

RESULTS

There was a significant improvement in knowledge, attitudes and behaviour of workers at the intrapersonal level; in behaviour motivation and safety culture at the interpersonal and organisational levels; and an overall improvement in hearing-health behaviour after two months post-intervention.

CONCLUSIONS

The developed programme offers a simple, interactive and theory-based intervention that is well accepted and effective in promoting positive hearing-health behaviour in workplaces.

Educating teenagers about hearing health by training them to educate children

OBJECTIVE

We investigated the change in hearing-health behaviour amongst teenagers trained to deliver the Dangerous Decibels programme to younger children.

DESIGN

The Dangerous Decibels programme uses a two-stage process to train 8-12 year-old children to protect their hearing from noise: (1) a team of experts train 'Educators' who (2) give classroom training to children in schools. Training teenagers as Educators may add a second level of benefit if teenagers internalize the hearing-health messages that they present and thus protect their own hearing better. They were assessed before training, immediately after, and three months later (after all had presented the classroom training) using a questionnaire. In addition, a focus group was conducted with a subgroup of the Educators to assess their subjective experience.

STUDY SAMPLE

We trained 44 Educators aged 14-17 years.

RESULTS

Results were generally positive: there were significant and sustained improvements in knowledge, self-reported behaviour, and perceived supports towards protecting hearing, and trends but not significant changes in attitudes or perceived barriers to hearing protection.

CONCLUSIONS

Providing training to teenagers had benefits beyond the delivery of training to younger children, but improvements in the delivery model may increase the uptake and impact on the teenagers.

Testing the effects of a message framing intervention on intentions towards hearing loss prevention in adolescents

Adolescent hearing loss is a public health problem that has eluded effective intervention. A persuasive message strategy was tested for its effectiveness on adolescents' intention to listen to music at a reduced volume. The messages manipulated both type of message frame [positive consequences of listening to music at a reduced volume (gain-framed) versus negative consequences of not listening to music at a reduced volume (loss-framed)] and type of temporal context (short-term versus long-term consequences). Participants were recruited from four vocational and secondary education schools in the Netherlands and message exposure took place online during class hours. Two weeks prior to message exposure, adolescents provided data on intention and risk perception towards hearing loss and use of (digital) music players. After message exposure, 194 adolescents (mean age = 14.71 years, SD = 1.00, 37.8% males) provided immediate follow-up data on intention. Results revealed that intention to listen to music at a reduced volume increased in those exposed to a loss-framed message with short-term consequences. No changes were found in the other conditions. Messages that emphasize negative short-term consequences of not listening to music at a moderate volume have the ability to influence adolescents' intention towards hearing loss prevention.

Reducing the risk of music-induced hearing loss from overuse of portable listening devices: understanding the problems and establishing strategies for improving awareness in adolescents

Hearing loss from the overuse of portable listening devices (PLDs), such as MP3 players or iPods, is of great concern in the popular media. This review aims to discuss the current state of scientific knowledge about music-induced hearing loss from PLD use. This report evaluates the literature on the risk to hearing from PLD use, the individual and psychological factors that influence PLD usage, and strategies for reducing exposure to music through PLDs. Specific interventions are reviewed, and several recommendations for designing interventions and for individual intervention in clinical practice are presented. Clinical recommendations suggested include the “80–90 rule” and the use of isolator-style earphones to reduce background noise.

Impact of socio-economic status on ear health and behaviour in children: A cross-sectional study in the capital of India

INTRODUCTION

Socio-economic differences in the society have been a major cause for the discrepancy in disease and behavioural patterns in society. With 360 million people (32 million children) in the world suffering from disabling hearing losses, it is imperative to gain an insight into the impact of differences in socio-economic strata on children's ear health issues, their knowledge of ear ailments and attitude towards ear health so as to suggest policies addressing ear health issues.

METHODS

The study was carried out in two different school types namely government schools and private schools which represent wide difference in the socio-economic status of the students studying there. A questionnaire was administered to students aged 10 to 13 years to assess the current ear care practices, knowledge regarding ear ailments, attitude towards hearing and their adaptability to reform.

RESULTS

The children belonging to higher socio-economic status were found to have lesser incidence of ear diseases and ear abuse, more referrals for ear ailments, lesser indulgence in risky ear health behaviours, better knowledge pool, positive attitude towards ear health and hearing and were more adaptable to change for better hearing.

CONCLUSION

Structures of social disparity are essential determinants of ear health acting both independently and through their influence on behavioural determinants of health. Increasing awareness of ear health issues at the school level itself should be one of the goals of health care providers.

Protocol of a test of hearing health education programs for farm and rural youth

BACKGROUND

Farm and rural youth have frequent exposure to hazardous noise on the farm and recreationally, and have an increased prevalence of noise-induced hearing loss. There is a lack of programs to prepare this high-risk population to use hearing conservation strategies.

METHODS

The purpose of this project is to test innovative hearing health education programs delivered to a large target group and to determine the effectiveness and sustainability of these programs in promoting hearing health among farm and rural youth. Specifically, this project includes: a) an interactive face-to-face informational program alone, b) an interactive face-to-face informational program followed by an Internet-based booster, and c) a no-intervention control. Sites will include selected affiliates of a major farm youth safety education organization. Data will be collected at baseline, 3, and 12 months. A linear mixed model will be used to compare the effectiveness of the three interventions over time. Descriptive statistics will be used to compare program costs and sustainability ratings.

DISCUSSION

Outcomes of this project will provide knowledge necessary to implement quality and cost-effective services to farm and rural youth, a high-risk and underserved population, that can be implemented and sustained after the study is completed.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02472821 Registered 09 Jun, 2015.

Farm and rural adolescents' perspective on hearing conservation: reports from a focus group study

This study explored the attitudes, beliefs, and behaviors of rural and farm adolescents regarding hearing conservation strategies. This qualitative study took place at two high schools in rural Michigan. Twenty-five adolescents living and working on farms or living in rural areas participated in one of two focus groups. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded and analyzed by two researchers and checked by an additional researcher to ensure reliability. Noise exposure was ubiquitous among participants, both in farm-related (e.g., equipment, livestock) and non-farm-related (e.g., music, firearms) activities. Perceived barriers to use of hearing protection devices outweighed perceived benefits, resulting in uncommon use of protection. When hearing protection was used, it was usually earmuffs or earplugs. Participants indicated a lack of training in noise hazards and protective strategies. Despite their acknowledged risk of hearing loss, participants did not associate their use of hearing protection today with their hearing ability later in life. Categories emerging that relate to hearing protector use included: Barriers, benefits, self-efficacy, situational influences, impersonal influences, cues to action, susceptibility, and severity. Farm and rural adolescents are at risk for noise exposure and hearing loss. The findings stress the significance of work environment and adult modeling in facilitating hearing conservation behaviors. As indicated by the youths' recommendations, school-based interventions may be an effective approach to address this health concern. Intervention studies are needed to test various approaches that can effectively promote use of hearing conservation strategies among rural and farm adolescents.

Providing earplugs to young adults at risk encourages protective behaviour in music venues

For some young people, nightclubs and other music venues are a major source of noise exposure, arising from a combination of very high noise levels; relatively long attendance duration; and frequent, sustained participation over several years. Responsibility for hearing protection is largely left to individuals, many of whom choose not to wear earplugs. In order to encourage earplug use in these settings, a new approach is needed. The aim of the study was to examine whether presentation of hearing health information would result in increased use of earplugs, or whether provision of earplugs alone would be sufficient to change behaviour. A total of 51 regular patrons of music venues were allocated to either a low-information (lo-info) or high-information (hi-info) group. Both groups completed a survey about their current noise exposure, earplug usage and perceived risk of hearing damage. Both groups were also provided with one-size-fits-all filtered music earplugs. The hi-info group was also provided with audio-visual and written information about the risks of excessive noise exposure. After 4 weeks, and again after an additional 12 weeks, participants were asked about their recent earplug usage, intention to use earplugs in the future, and perceived risk of hearing damage. The results showed that after 4 weeks, the hi-info group's perceived personal risk of hearing damage was significantly higher than that of the lo-info group. After 16 weeks, these differences were no longer evident; however, at both 4 and 16 weeks, both the lo- and hi-info groups were using the earplugs equally often; and both groups intended to use earplugs significantly more often in the future. This suggests that the information was unnecessary to motivate behavioural change. Rather, the simple act of providing access to earplugs appears to have effectively encouraged young at-risk adults to increase their earplug use.

Cultural and demographic factors influencing noise exposure estimates from use of portable listening devices in an urban environment

PURPOSE

This study examined listening levels and duration of portable listening devices (PLDs) used by people with diversity of ethnicity, education, music genre, and PLD manufacturer. The goal was to estimate participants' PLD noise exposure and identify factors influencing user behavior.

METHOD

This study measured listening levels of 160 adults in 2 New York City locations: (a) a quiet college campus and (b) Union Square, a busy interchange. Participants completed a questionnaire regarding demographics and PLD use. Ordinary least squares regression was used to explore the significance of demographic and behavioral factors.

RESULTS

Average listening level was 94.1 dBA, with 99 of 160 (61.9%) and 92 of 159 (57.5%) exceeding daily (L A8hn) and weekly (L Awkn) recommended exposure limit, respectively. African American participants listened at the highest average levels (99.8 dBA).

CONCLUSIONS

A majority of PLD users exceeded recommended exposure levels. Factors significant for higher exposure were ethnicity and age; factors not significantly associated with exposure were gender, education, location, awareness of possible association between PLD use and noise-induced hearing loss, mode of transportation, device manufacturer, and music genre. Efforts to effect behavior changes to lessen noise-induced hearing loss risk from PLD use should be sensitive to the cultural differences within the targeted population.

Hearing loss prevention education using adopt-a-band: changes in self-reported earplug use in two high school marching bands

PURPOSE

Hearing loss prevention has always been an important issue for audiologists. The importance of hearing loss prevention education for young musicians is now recognized by the National Association for Music Education as well as the National Association of Schools of Music. Adopt-a-Band is a commercial program designed to foster hearing loss prevention behavior in young musicians.

METHOD

This study assessed changes in earplug use, measured using self-report surveys, after Adopt-a-Band training. Participants were members of 2 high school marching bands who viewed an informational DVD and reviewed fact sheets. Flat-attenuation earplugs were distributed, and training was provided. In addition, study participants engaged in discussion of hearing loss with a doctor of audiology student.

RESULTS

Before training, 23% of participants reported they had previously used hearing protection. Immediately after training, 94% of participants reported they planned to use hearing protection at least occasionally. In a final end-of-season survey, earplug use had reliably increased; 62% of participants reported they used earplugs at least occasionally.

CONCLUSIONS

Earplug use increased, but self-reported behavioral change was not as robust as predicted from self-reported participant intentions. Participant comments regarding factors that influenced their earplug use decisions suggest opportunities to improve training.

Extended high-frequency thresholds in college students: effects of music player use and other recreational noise

BACKGROUND

Human hearing is sensitive to sounds from as low as 20 Hz to as high as 20,000 Hz in normal ears. However, clinical tests of human hearing rarely include extended high-frequency (EHF) threshold assessments, at frequencies extending beyond 8000 Hz. EHF thresholds have been suggested for use monitoring the earliest effects of noise on the inner ear, although the clinical usefulness of EHF threshold testing is not well established for this purpose.

PURPOSE

The primary objective of this study was to determine if EHF thresholds in healthy, young adult college students vary as a function of recreational noise exposure.

RESEARCH DESIGN

A retrospective analysis of a laboratory database was conducted; all participants with both EHF threshold testing and noise history data were included. The potential for "preclinical" EHF deficits was assessed based on the measured thresholds, with the noise surveys used to estimate recreational noise exposure.

STUDY SAMPLE

EHF thresholds measured during participation in other ongoing studies were available from 87 participants (34 male and 53 female); all participants had hearing within normal clinical limits (≤25 HL) at conventional frequencies (0.25-8 kHz).

RESULTS

EHF thresholds closely matched standard reference thresholds [ANSI S3.6 (1996) Annex C]. There were statistically reliable threshold differences in participants who used music players, with 3-6 dB worse thresholds at the highest test frequencies (10-16 kHz) in participants who reported long-term use of music player devices (>5 yr), or higher listening levels during music player use.

CONCLUSIONS

It should be possible to detect small changes in high-frequency hearing for patients or participants who undergo repeated testing at periodic intervals. However, the increased population-level variability in thresholds at the highest frequencies will make it difficult to identify the presence of small but potentially important deficits in otherwise normal-hearing individuals who do not have previously established baseline data.

Preferred listening levels of personal listening devices in young teenagers: self reports and physical measurements

OBJECTIVE

To assess the potential risk of hearing loss to young listeners, due to the use of personal listening devices (PLDs).

DESIGN

The study included two parts: (1) A self-report questionnaire on music listening habits, and (2) Physical measurements of preferred listening levels, in quiet and in everyday background noise.

STUDY SAMPLE

Young teenagers aged 13 to 17 years. Part 1 included 289 participants with mean age of 14 years. Part 2 included 11 and 74 participants (2A and 2B) with a mean age of 15 years. Eleven listened to PLDs in quiet conditions (2A) and 74 in everyday background noise (2B).

RESULTS

Questionnaire main findings indicated that most of the participants reported high or very high volume settings and demonstrated low awareness towards loud music listening consequences. Physical measurements corrected for diffuse field indicated mean preferred listening levels of: 82 (SD = 9) dBA in quiet, and 89 (SD = 9) dBA in the presence of background noise. The potential risk to hearing of PLDs users was calculated using the 8 hour equivalent level.

CONCLUSION

More than 25% of the participants in the noisy condition were found to be at risk according to occupational damage risk criteria NIOSH, 1998.

Targeting hearing health messages for users of personal listening devices

PURPOSE

To summarize the literature on patterns and risks of personal listening device (PLD) use, which is ubiquitous among teenagers and young adults. The review emphasizes risk awareness, health concerns of PLD users, inclination to take actions to prevent hearing loss from exposure to loud music, and specific instructional messages that are likely to motivate such preventive actions.

METHOD

We conducted a systematic, critical review of the English-language scholarly literature on the topic of PLDs and their potential effects on human hearing. We used popular database search engines to locate relevant professional journals, books, recent conference papers, and other reference sources.

CONCLUSIONS

Adolescents and young adults appear to have somewhat different perspectives on risks to hearing posed by PLD use. Messages designed to suggest actions they might take in avoiding or reducing these risks, therefore, need to be targeted to achieve optimal outcomes. We offer specific recommendations regarding the framing and content of educational messages that are most likely to be effective in reducing the potentially harmful effects of loud music on hearing in these populations, and we note future research needs.

Adolescents risky MP3-player listening and its psychosocial correlates

Analogue to occupational noise-induced hearing loss, MP3-induced hearing loss may be evolving into a significant social and public health problem. To inform prevention strategies and interventions, this study investigated correlates of adolescents' risky MP3-player listening behavior primarily informed by protection motivation theory. We invited 1687 adolescents (12- to 19-year old) of Dutch secondary schools to complete questionnaires about their MP3-player listening, sociodemographic characteristics and presumed psychosocial determinants of MP3-player listening. Of all participants, 90% reported listening to music through earphones on MP3 players; 28.6% were categorized as listeners at risk for hearing loss due to estimated exposure of 89 dBA for ≥1 hour per day. Compared with listeners not at risk for hearing loss, listeners at risk were more likely not to live with both parents, to experience rewards of listening to high-volume levels, to report a high habit strength related to risky MP3 listening, and were less likely to be motivated to protect their hearing. Habit strength was the strongest correlate of risky listening behavior, suggesting that voluntary behavior change among adolescents might be difficult to achieve and that a multiple strategy approach may be needed to prevent MP3-induced hearing loss.

Noise exposure estimates of urban MP3 player users

PURPOSE

To examine the sound level and duration of use of personal listening devices (PLDs) by 189 college students, ages 18-53 years, as they entered a New York City college campus, to determine whether noise exposure from PLDs was in excess of recommended exposure limits and what factors might influence exposure.

METHOD

Free-field equivalent sound levels from PLD headphones were measured on a mannequin with a calibrated sound level meter. Participants reported demographic information, whether they had just come off the subway, the type of PLD and earphones used, and duration per day and days per week they used their PLDs.

RESULTS

Based on measured free-field equivalent sound levels from PLD headphones and the reported PLD use, per day 58.2% of participants exceeded 85 dB A-weighted 8-hr equivalent sound levels (L(Aeq)), and per week 51.9% exceeded 85 dB A-weighted 40-hr equivalent continuous sound levels (L(Awkn)).

CONCLUSIONS

The majority of PLD users exceeded recommended sound exposure limits, suggesting that they were at increased risk for noise-induced hearing loss. Analyses of the demographics of these participants and mode of transportation to campus failed to indicate any particular gender differences in PLD use or in mode of transportation influencing sound exposure.

Prevalence and Risk Factors of Hearing Impairment Among Primary-School Children in Shebin El-Kom District, Egypt

Purpose

This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students.

Method

A total of 555 children (6–12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools.

Results

The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice.

Conclusions

The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.

Survey of College Students' MP3 Listening: Habits, Safety Issues, Attitudes, and Education

Purpose

To survey listening habits and attitudes of typical college students who use MP3 players and to investigate possible safety issues related to MP3 player listening.

Method

College students who were frequent MP3 player users ( N = 428) filled out a 30-item online survey. Specific areas probed by the present survey included frequency and duration of MP3 player use, MP3 player volume levels used, types of earphones used, typical environments in which MP3 player was worn, specific activities related to safety while listening to MP3 players, and attitudes toward MP3 player use.

Results

The majority of listeners wore MP3 players for less than 2 hr daily at safe volume levels. About one third of respondents reported being distracted while wearing an MP3 player, and more than one third of listeners experienced soreness in their ears after a listening session. About one third of respondents reported occasionally using their MP3 players at maximum volume levels. Listeners indicated willingness to (a) reduce volume levels, (b) decrease listening duration, and (c) buy specialized earphones to conserve their hearing.

Conclusion

The study found concerns regarding the occasional use of MP3 players at full volume and reduced environmental awareness among some college student users.

Back-to-School Health Promotion

This review discusses school-based health promotion, including evidence-based perspectives on the school's feasibility as a venue for lifestyle risk reduction and disease prevention efforts. Future directions for inquiry and implications for empirically driven public policy initiatives are addressed.