Noise exposures of rural adolescents

Noise Exposure and Use of Hearing Protection Among Adolescents in Rural Areas

PURPOSE

Noise-induced hearing loss (NIHL) has been found in rural children, potentially due to occupational and recreational noise exposure without consistent use of hearing protection devices (HPDs). However, questions remain regarding the specifics of rural adolescents' noise exposure and use of hearing protection around different types of noise. As such, the purpose of the current study was to provide preliminary results on rural adolescents' noise exposure and use of hearing protection for gunfire, heavy machinery, power tools, all-terrain vehicles (ATVs), and music.

METHOD

A questionnaire was administered to 197 students (seventh to 12th grade) from rural schools in West Texas. Questions were related to noise exposure and use of HPDs for specific categories of noise. Testing was performed at the schools, with an investigator recording each student's responses.

RESULTS

Approximately 18%-44% of adolescents reported exposure 12 or more times a year to gunfire, heavy machinery, power tools, and ATVs. Only 1%-18% of the adolescents reported never being exposed to such noise sources. Almost half of rural adolescents never used hearing protection around gunfire, and 77%-91% reported never wearing hearing protection when exposed to heavy machinery, power tools, and ATVs.

CONCLUSIONS

The current study revealed that rural adolescents are exposed to noise sources that could damage their hearing. However, the majority of rural adolescents do not consistently wear hearing protection. Additional research is now needed to extend these findings by assessing rural adolescents' duration of exposure to different noise sources, in addition to investigating prevention of NIHL in this population. Supplemental Material https://doi.org/10.23641/asha.17139335.

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).

Current State of Child Health in Rural America: How Context Shapes Children's Health

PURPOSE

Children's health is influenced by the context in which they live. We provide a descriptive essay on the status of children in rural America to highlight features of the rural environment that may affect health.

DESCRIPTION

We compiled information concerning components of the rural environment that may contribute to health outcomes. Areas addressed include the economic characteristics, provider availability, uniquely rural health risks, health services use, and health outcomes among rural children.

ASSESSMENT

Nearly 12 million children live in the rural United States. Rural counties are economically disadvantaged, leading to higher rates of poverty among rural versus urban children. Rural and urban children are approximately equally likely to be insured, but Medicaid insures a higher proportion of children in rural areas. While generally similar in health, rural children are more likely to be overweight or obese than urban children. Rural parents are less likely to report that their children received preventive medical or oral health visits than urban parents. Rural children are more likely to die than their urban peers, largely due to unintentional injury.

CONCLUSION

Improving rural children's health will require both increased public health surveillance and research that creates solutions appropriate for rural environments, where health care professionals may be in short supply. Most importantly, solutions must be multisectoral, engaging education, economic development, and other community perspectives as well as health care.

Efficacy of technology-based interventions to increase the use of hearing protections among adolescent farmworkers

OBJECTIVE

Adolescent farmworkers are exposed to loud noise during farm activities. We present a prospective study that evaluated the efficacy of low-cost, technology-based intervention approaches in high schools to enhance the use of hearing protection among adolescent farmworkers.

DESIGN

Six high schools in Iowa that agreed to participate in the study were divided into three equal groups through cluster-randomisation with each group receiving one of the three formats of hearing protection intervention: (a) classroom training, (b) classroom training coupled with smartphone app training and (c) computer training. Participants completed baseline (pre-training) and six-week post-intervention surveys for assessing hearing protection knowledge, attitudes and behaviour.

STUDY SAMPLE

Seventy participants from six schools were initially enrolled but 50 completed both pre- and post-intervention surveys.

RESULTS

In most cases, all three groups showed significant improvement in hearing protection knowledge, attitude and frequency of use from pre- to post-intervention. However, changes between groups were statistically non-significant.

CONCLUSIONS

Although all three formats led to improvements on hearing protection knowledge, attitude and behaviour, the findings of the study, perhaps due to the small sample size, did not allow us to detect whether technology-based hearing protection interventions were more effective than the traditional face-to-face training for adolescent farmworkers.

Noise levels of amusement ride operators

One of the leading causes of noise-induced hearing loss is occupational noise exposure; however, little attention has been given to the exposure among amusement ride operators. According to the International Association of Amusement Parks and Attractions, 600,000 ride operators are employed in the U.S. The first objective of this descriptive study was to evaluate if ride operators were exposed to noise levels over 85 dB. The second objective was to classify the ride features that led to the highest noise levels. 136 rides were measured at 17 total amusement parks, county fairs, and festivals in southern Wisconsin and northern Illinois during summer 2015. A sound level meter recorded noise measurements as close in proximity to the ride operator as possible. Each ride was measured for two or three complete ride cycles, which included loading and operating the ride. The sound level meter was programmed to measure noise as recommended by the American Conference of Governmental Industrial Hygienists and with no threshold. 18% of rides measured had projected noise levels greater than American Conference of Governmental Industrial Hygienists recommendation of 85 dB. A repeated measures model was used to analyze the complete ride cycle decibel levels. The model found that traveling carnival rides had significantly higher levels compared to the stationary amusement park rides (p < 0.001), the rides operated near midway music had significantly higher levels than those without midway music (p < 0.001), and the type of ride was also significant. Tukey-Kramer multiple comparison test was used to determine differences in type of ride. According to the data, 18% of the amusement ride operators would be at risk for noise induced hearing loss and would require a hearing conservation program if the 8-hr time weighted averages were to follow the same trends as the complete ride cycle levels.

Noise exposure assessment among groundskeepers in a university setting: A pilot study

Approximately 870,000 U.S. workers are employed as landscaping and groundskeeping workers who perform various tasks and use a variety of tools that expose them to high noise levels, increasing their risk to noise-induced hearing loss (NIHL). Several studies on noise exposure and NIHL in other job sectors have been published, but those on groundskeepers are very limited. This study aims to characterize the noise exposure of groundskeepers. Participants were monitored over their entire work shift for personal noise exposure by wearing noise dosimeters at shoulder level, 4 in from the ear. Using two different dosimeter settings (OSHA and NIOSH), the time-weighted averages (TWAs) and 1-min averages of noise exposure levels in decibels (dBA) were obtained. The participants were also asked to fill out an activity card daily to document their tasks, tools used, location and noise perception. Sound pressure levels (SPLs) produced by various groundskeeping equipment and tools were measured at full throttle near the ear of the operator using a sound level meter. These measurements were used to assess worker noise exposure profiles, particularly the contributing source of noise. The overall mean OSHA and NIOSH TWA noise exposures were 82.2±9.2 (range of 50.9-100 dBA) and 87.8±6.6 dBA (range of 67.2-102.9 dBA), respectively. Approximately 46% of the OSHA TWAs exceeded the OSHA action limit of 85 dBA. About 76% of the NIOSH TWAs exceeded 85 dBA, and 42% exceeded 90 dBA. The SPLs of equipment and tools measured ranged from 75- 106 dBA, most of which were at above 85 dBA and within the 90-100 dBA range. Hand-held power tools and ride-on equipment without enclosed cab may have contributed significantly to worker noise exposure. This study demonstrates that groundskeepers may be routinely exposed to noise levels above the OSHA and NIOSH exposure limits, and that the implementation of effective hearing conservation programs is necessary to reduce their risk to NIHL.

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.

Social Desirability Bias in Self-Reporting of Hearing Protector Use among Farm Operators

OBJECTIVE

The purposes of this study were (i) to examine the relationship between reported hearing protector use and social desirability bias, and (ii) to compare results of the Marlowe-Crowne social desirability instrument when administered using two different methods (i.e. online and by telephone).

METHODS

A shortened version of the Marlowe-Crowne social desirability instrument, as well as a self-administered instrument measuring use of hearing protectors, was administered to 497 participants in a study of hearing protector use. The relationship between hearing protector use and social desirability bias was examined using regression analysis. The results of two methods of administration of the Marlowe-Crowne social desirability instrument were compared using t-tests and regression analysis.

RESULTS

Reliability (using Cronbach's alpha) for the shortened seven-item scale for this sample was 0.58. There was no evidence of a relationship between reported hearing protector use and social desirability reporting bias, as measured by the shortened Marlowe-Crowne. The difference in results by method of administration (i.e. online, telephone) was very small.

CONCLUSIONS

This is the first published study to measure social desirability bias in reporting of hearing protector use among farmers. Findings of this study do not support the presence of social desirability bias in farmers' reporting of hearing protector use, lending support for the validity of self-report in hearing protector use in this population.

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.

Agricultural occupational health and safety perspectives among Latino-American youth

Agricultural work is one of the most dangerous jobs for adolescents. Through a university-community partnership, the authors surveyed young primarily acculturated Latino-American farmworkers 14 to 18 years of age regarding their agricultural work experience. Topics included occupational health and safety education, work history, and information sources. The authors also evaluated the Rapid Clinical Assessment Tool (RCAT), a pictorial tool for identifying agricultural tasks to enhance discussion with clinical providers. One hundred forty youth with farmwork experience completed the survey; 6% reported a previous work-related injury or illness and 53% reported receiving some workplace health and safety training. Correct identification of legally restricted duties for youth varied but were generally low: participants identified working alone past 8 pm (57%), driving a forklift (56%), doing roofing work (39%), working in freezers (34%), and driving a delivery vehicle (30%). The Internet was identified as the most likely and reliable place youth would go to find information on workplace health and safety. Few (15%) reported clinician-initiated conversations on occupational health; however, a high proportion responded positively to questions regarding the usefulness of the RCAT for this purpose. This study highlights the need for workplace health and safety guidance for youth employed in agriculture. The results support Internet-based outreach and use of the RCAT to help facilitate occupational health discussions in clinical settings.

Assessment of Noise Exposure to Children: Considerations for the National Children's Study

Evidence has been accruing to indicate that young children are vulnerable to noise in their physical environment. A literature review identified that, in addition to hearing loss, noise exposure is associated with negative birth outcomes, reduced cognitive function, inability to concentrate, increased psychosocial activation, nervousness, feeling of helplessness, and increased blood pressure in children. While increasing attention has been given to the health effects of noise in children, research about noise exposure is sparse and often the measure of exposure is simply proximity to a noise source. The U.S. National Children's Study (NCS) provides a unique opportunity to investigate noise exposures to pregnant women and children using a number of assessment modalities at different life stages. Measurement of noise levels in homes and other environments, personal dosimetry measurements made over a period of days, and questionnaires addressing sources of noise in the environment, annoyance to noise, perceived noise level, use of head phones and ear buds, noisy activity exposures, and occupational exposures, are planned for evaluation within the NCS Vanguard pilot study. We describe the NCS planned approach to addressing noise exposure assessment in study visits over a child's lifetime.

Typical noise exposure in daily life

OBJECTIVE

Identify the distribution of typical noise levels present in daily life and identify factors associated with average sound levels.

DESIGN

This was an observational study.

STUDY SAMPLE

Participants (N = 286) were 20 to 68 year old men and women, drawn from the general population of Kalamazoo County, Michigan. A total of 73 000 person-hours of noise monitoring were conducted.

RESULTS

Median overall daily average levels were 79 and 77 dBLeq(A,8,equiv), with average levels exceeding EPA recommended levels for 70% of participants. Median levels were similar between the hours of 9 a.m. and 9 p.m., and varied little across days of the week. Gender, occupational classification, and history of occupational noise exposure were related to average noise levels, but age, educational attainment, and non-occupational noise exposures were not.

CONCLUSIONS

A large portion of the general population is exposed to noise levels that could result in long-term adverse effects on hearing. Gender and occupation were most strongly related to exposure, though most participants in this study had occupations that are not conventionally considered noisy.