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Jorbonyan A, Abolfathi Momtaz Y, Foroughan M, Mehrkian S. Determinants of Continuance Intention to Use Hearing Aids among Older Adults in Tehran (Iran). Healthcare (Basel) 2024; 12:487. [PMID: 38391862 PMCID: PMC10888125 DOI: 10.3390/healthcare12040487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/02/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
The present study seeks to evaluate the factors determining the continuance intention to use hearing aids in older adults. This cross-sectional study was carried out in 2021. The technology post-acceptance model (PAM) framework was used to develop a model for the continuance intention to use hearing aids. In total, 300 hearing aid users aged ≥60 years, who were selected via a randomized stratified sampling method, completed the self-evaluation tools used in this study. With a mean age of 71.38 years (SD = 8), the participants comprised 50.7% and 49.3% females and males, respectively. The path analysis results showed that the continuance intention to use hearing aids was positively and significantly influenced by the actual use of hearing aids, the perceived benefits, satisfaction, confirmation, self-efficacy in using hearing aids, an extraverted personality trait, self-perceived hearing handicap, and perceived social support. The main results of the present study can help hearing care providers develop a better understanding of older users to design effective rehabilitation strategies and ensure their continuance intention to use hearing aids.
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Affiliation(s)
- Abdolhakim Jorbonyan
- Department of Geriatric Health, School of Health, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Yadollah Abolfathi Momtaz
- Iranian Research Center on Aging, The University of Social Welfare and Rehabilitation Sciences, Tehran 19857-13871, Iran
- Malaysian Research Institute on Ageing, University Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Mahshid Foroughan
- Iranian Research Center on Aging, The University of Social Welfare and Rehabilitation Sciences, Tehran 19857-13871, Iran
| | - Saeideh Mehrkian
- Department of Audiology, The University of Social Welfare and Rehabilitation Sciences, Tehran 19857-13871, Iran
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Engdahl B, Aarhus L. Prevalence and predictors of self-reported hearing aid use and benefit in Norway: the HUNT study. BMC Public Health 2024; 24:474. [PMID: 38355451 PMCID: PMC10867996 DOI: 10.1186/s12889-024-17852-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Knowledge on hearing aid use and benefit is important to ensure appropriate and effective treatment. We aimed to assess prevalence and predictors of hearing aid use and benefit in Norway, as well as possible birth cohort changes. METHODS We analyzed two large cross-sectional, population-based hearing surveys of 63,182 adults in 1996-1998 and 2017-2019 (the HUNT study). We used multivariable regression models to examine independent predictors of hearing aid use and benefit, including demography, hearing-related variables, known risk factors for hearing loss and birth cohort. RESULTS The nationally weighted hearing aid use in the adult population increased from 4.2% in 1997 to 5.8% in 2018. The use among individuals with disabling hearing loss (≥ 35 dB HL) increased from 46.3% to 64.4%. Most users reported some (47%) or great (48%) help from their hearing aids. In addition to the level of hearing loss and birth cohort, factors associated with hearing aid use included lower age, tinnitus, childhood-onset hearing loss, higher education, marriage, having children, being exposed to occupational noise or impulse noise, recurrent ear infections, and head injury. In addition to the level of hearing loss, factors related to hearing aid benefit included younger age, female gender, and higher income. Being bothered by tinnitus reduced the benefit. CONCLUSION Our study shows an increase in self-reported hearing aid usage over time in Norway, with lower adoption rates and perceived benefits observed among the elderly. The results suggest that having a spouse and children positively influences the adoption of hearing aids. These findings emphasize the necessity of customized strategies to address demographic disparities and the need for innovative enhancements in hearing rehabilitation programs.
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Affiliation(s)
- Bo Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Postbox 4404 Nydalen, N-0403, Oslo, Norway.
| | - Lisa Aarhus
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
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Mothemela B, Manchaiah V, Mahomed-Asmail F, Graham M, Swanepoel DW. Factors Associated With Hearing Aid Outcomes Including Social Networks, Self-Reported Mental Health, and Service Delivery Models. Am J Audiol 2023; 32:823-831. [PMID: 37669616 DOI: 10.1044/2023_aja-22-00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study aims to identify and describe factors that influence hearing aid outcomes including social networks, self-reported mental health, and service delivery models. METHOD A prospective cross-sectional online survey was sent to hearing aid users recruited through an online platform (http://www.hearingtracker.com) between October and November 2021. The survey contained questions on patient demographics, audiological variables, general health and social factors, and self-reported hearing aid outcomes using the International Outcome Inventory for Hearing Aids (IOI-HA). Regression models evaluated potential contributing factors of hearing aid outcomes on the IOI-HA. RESULTS Three hundred ninety-eight hearing aid users completed the survey with an average age of 66.6 (SD = 13.0) years, of which 59.3% were male. Positive contributing factors of hearing aid outcomes (IOI-HA total score) were social network of people with hearing loss with hearing aids (p < .010; Exp[B] = 0.03, 95% CI [0.01, 0.1]), self-reported mental health (p < .05; Exp[B] = 0.6, 95% CI [0.01, 1.2]), work situation (p < .001; Exp[B] = 1.9, 95% CI [0.7, 2.8]), quality of life (p < .005; Exp[B] = 1.2, 95% CI [0.3, 1.1]), and self-reported hearing difficulty (p < .02; Exp[B] = 0.8, 95% CI [0.2, 1.5]). Negative contributing factors of hearing aid outcomes included social networks of people with hearing loss without hearing aids (p < .001; Exp[B] = -0.1, 95% CI [-0.2, -0.2]) and service delivery model of private or university clinic compared to big-box retailers (p < .001; Exp[B] = -1.6, 95% CI [-2.7, -0.7]). CONCLUSIONS Novel factors including social network of persons with hearing loss who use hearing aids, self-reported mental health, service delivery model, and work situation are significant contributors to hearing aid outcomes. These newly identified factors can inform public hearing health promotion and individualized audiological care to optimize hearing aid outcomes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24060486.
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Affiliation(s)
- Bopane Mothemela
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Virtual Hearing Lab (a collaborative initiative between the University of Colorado School of Medicine and University of Pretoria), Aurora, CO
| | - Vinaya Manchaiah
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Virtual Hearing Lab (a collaborative initiative between the University of Colorado School of Medicine and University of Pretoria), Aurora, CO
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado School of Medicine, Aurora
- UCHealth Hearing and Balance Clinic, University of Colorado Hospital, Aurora
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, India
| | - Faheema Mahomed-Asmail
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Virtual Hearing Lab (a collaborative initiative between the University of Colorado School of Medicine and University of Pretoria), Aurora, CO
| | - Marien Graham
- Department of Science, Mathematics and Technology Education, University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Virtual Hearing Lab (a collaborative initiative between the University of Colorado School of Medicine and University of Pretoria), Aurora, CO
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado School of Medicine, Aurora
- Ear Science Institute Australia, Subiaco, Western Australia
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Malcolm KA, Suen JJ, Nieman CL. Socioeconomic position and hearing loss: current understanding and recent advances. Curr Opin Otolaryngol Head Neck Surg 2022; 30:351-357. [PMID: 36004788 PMCID: PMC10155234 DOI: 10.1097/moo.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe recent literature examining the relationship between socioeconomic position (SEP) and hearing loss, including the impact of hearing loss on several socioeconomic outcomes over the life course. Additionally, we highlight current policy advances in recent years and review alternative models of hearing care that aim to address disparities related to SEP and hearing healthcare. RECENT FINDINGS Applying a social epidemiologic lens to hearing health gives insight into the role of material and social contexts in understanding and improving hearing health outcomes. Recent studies investigating the intersection of SEP and hearing health highlight the disparities that exist for individuals with low SEP as well as the influence of hearing loss on SEP. Individuals with hearing loss are more likely to be unemployed, have lower educational attainment, lower income, and are less likely to use hearing aids and access hearing care. Legislation addressing cost and access to hearing care as well as transforming the current landscape of hearing care, is essential to creating equitable care for individuals, especially older adults, with low SEP. SUMMARY With the expected rise in prevalence of hearing loss over the next 40 years, hearing care that is affordable and accessible is a public health priority. As hearing loss is associated with negative outcomes for individuals with low SEP, advances in legislation and care delivery models are necessary in order to include populations traditionally unserved by current hearing healthcare.
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Affiliation(s)
- Kelly A. Malcolm
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
| | - Jonathan J. Suen
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
- Johns Hopkins School of Nursing
| | - Carrie L. Nieman
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
- Johns Hopkins School of Nursing
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Seguya A, Bajunirwe F, Kakande E, Nakku D. Maternal knowledge on infant hearing loss and acceptability of hearing aids as an intervention at a Referral Hospital in southwestern Uganda. Int J Pediatr Otorhinolaryngol 2021; 145:110722. [PMID: 33933987 DOI: 10.1016/j.ijporl.2021.110722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 04/15/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Infant hearing screening enables early detection and management of hearing loss (HL) so that speech and language development delays are minimized. Parents play a critical role in successful screening and management of Infant Hearing loss (IHL) but there is limited data from resource limited settings on parental knowledge about HL and acceptability of IHL interventions. This study was aimed at exploring the maternal knowledge on the various causes of IHL and their acceptability of hearing aids as an intervention for IHL. METHODS A cross-sectional study was conducted at a referral hospital in southwestern Uganda. A semi-structured questionnaire was used to interview postpartum mothers to assess their knowledge on causes of IHL and acceptability of a hearing aid if prescribed. Logistic regression was used to calculate odds ratio (OR) for the factors associated with hearing aid refusal. RESULTS 401 mothers with a mean age of 25 years (Standard Deviation = 5.6 years) were recruited. Half of the mothers correctly identified at least five causes of IHL. The most well-known causes were measles (63.3%) and a positive family history of HL (61.6%). 60% of mothers held at least one superstitious belief as a cause of IHL. Majority of mothers (86%) would accept a hearing aid as an IHL intervention. Mothers with a positive family history of HL (OR = 0.42, p = 0.04), in middle or higher socioeconomic class (OR = 0.45, p = 0.01) and those with more than 3 antenatal visits in their recent pregnancy (OR = 0.44, p = 0.01) were less likely to refuse a hearing aid while mothers that were either widowed or separated from their spouses (OR = 15.64, p = 0.01) were more likely to refuse a hearing aid. CONCLUSION Although mothers had limited knowledge on some causes of IHL, there was a high acceptability of hearing aids as an intervention for IHL. Marital status, family history of hearing loss, socioeconomic status and antenatal care attendance are factors that could be used to identify mothers that might accept or refuse a hearing aid for their infant. There is need to increase awareness about causes of hearing loss to improve knowledge as well as dispel any non-biological beliefs held by communities.
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Affiliation(s)
- Amina Seguya
- Department of ENT Surgery, Mulago National Referral Hospital, Kampala, Uganda.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Uganda
| | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Doreen Nakku
- Department of ENT Surgery, Mbarara University of Science and Technology, Uganda
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The Prevalence of Hearing, Vision, and Dual Sensory Loss in Older Canadians: An Analysis of Data from the Canadian Longitudinal Study on Aging. Can J Aging 2020; 40:1-22. [DOI: 10.1017/s0714980820000070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
ABSTRACTThe purpose of this study was to describe the prevalence of hearing loss (HL), vision loss (VL), and dual sensory loss (DSL) in Canadians 45–85 years of age. Audiometry and visual acuity were measured. Various levels of impairment severity were described. Results were extrapolated to the 2016 Canadian population. In 2016, 1,500,000 Canadian males 45–85 years of age had at least mild HL, 1,800,000 had at least mild VL, and 570,000 had DSL. Among females, 1,200,000 had at least mild HL, 2,200,000 had at least mild VL, and 450,000 had DSL. Among Canadians 45–85 years of age, mild, moderate, and severe HL was prevalent among 13.4 per cent, 3.7 per cent, and 0.4 per cent of males, and among 11.3 per cent, 2.3 per cent, and 0.2 per cent of females, respectively. Mild and moderate, or severe VL was prevalent among 19.8 per cent and 2.4 per cent of males, and among 23.9 per cent and 2.6 per cent of females, respectively. At least mild DSL was prevalent among 6.4 per cent of males and 6.1 per cent of females.
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Xu J, Galster J, Galster E, Gruhlke A, Wolfe A. Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids. Int J Audiol 2018; 57:584-591. [PMID: 29621924 DOI: 10.1080/14992027.2018.1449972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The device-oriented subjective outcome (DOSO) is a device-oriented questionnaire, intended to minimise the influence of personality on self-reported measures. The aim of this study was to provide normative data with 2015-era hearing aid technologies. DESIGN This retrospective study evaluated data from records of three clinical trials. The DOSO was administered for the participants' own devices as a part of the intake and after using research devices in the field. STUDY SAMPLE The DOSO data were collected from 132 experienced bilateral hearing aid wearers who participated in the clinical trials. RESULTS The DOSO data collected with the participants' own devices were compared to the interim normative data collected between 2004 and 2005. The DOSO subscale scores from the participants' own devices were significantly higher than those from the interim norms, except Listening Effort subscale. To demonstrate the utility of the new norms, a separate set of DOSO data collected from the same participants after using research hearing aids were contrasted to the new normative data. After accounting for possible placebo effects, the DOSO data with research devices revealed additional self-reported benefit of technological advancements. CONCLUSIONS Norms for the DOSO are recommended for evaluating hearing aids with more recent technologies.
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Affiliation(s)
- Jingjing Xu
- a Starkey Hearing Technologies , Eden Prairie , MN , USA
| | - Jason Galster
- a Starkey Hearing Technologies , Eden Prairie , MN , USA
| | | | - Alyson Gruhlke
- a Starkey Hearing Technologies , Eden Prairie , MN , USA
| | - Amanda Wolfe
- a Starkey Hearing Technologies , Eden Prairie , MN , USA
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Scholes S, Biddulph J, Davis A, Mindell JS. Socioeconomic differences in hearing among middle-aged and older adults: cross-sectional analyses using the Health Survey for England. BMJ Open 2018; 8:e019615. [PMID: 29391384 PMCID: PMC5829909 DOI: 10.1136/bmjopen-2017-019615] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hearing loss impacts on cognitive, social and physical functioning. Both hearing loss and hearing aid use vary across population subgroups. We examined whether hearing loss, and reported current hearing aid use among persons with hearing loss, were associated with different markers of socioeconomic status (SES) in a nationally representative sample of community-dwelling middle-aged and older adults. METHODS Hearing was measured using an audiometric screening device in the Health Survey for England 2014 (3292 participants aged 45 years and over). Hearing loss was defined as >35 dB HL at 3.0 kHz in the better-hearing ear. Using sex-specific logistic regression modelling, we evaluated the associations between SES and hearing after adjustment for potential confounders. RESULTS 26% of men and 20% of women aged 45 years and over had hearing loss. Hearing loss was higher among men in the lowest SES groups. For example, the multivariable-adjusted odds of hearing loss were almost two times as high for those in the lowest versus the highest income tertile (OR 1.77, 95% CI 1.15 to 2.74). Among those with hearing loss, 30% of men and 27% of women were currently using a hearing aid. Compared with men in the highest income tertile, the multivariable-adjusted odds of using a hearing aid nowadays were lower for men in the middle (OR 0.50, 95% CI 0.25 to 0.99) and the lowest (OR 0.47, 95% CI 0.23 to 0.97) income tertiles. Associations between SES and hearing were weaker or null among women. CONCLUSIONS While the burden of hearing loss fell highest among men in the lowest SES groups, current hearing aid use was demonstrably lower. Initiatives to detect hearing loss early and increase the uptake and the use of hearing aids may provide substantial public health benefits and reduce socioeconomic inequalities in health.
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Affiliation(s)
- Shaun Scholes
- Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Jane Biddulph
- Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Adrian Davis
- UCL Ear Institute, University College London (UCL), London, UK
| | - Jennifer S. Mindell
- Department of Epidemiology and Public Health, University College London (UCL), London, UK
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He P, Wen X, Hu X, Gong R, Luo Y, Guo C, Chen G, Zheng X. Hearing Aid Acquisition in Chinese Older Adults With Hearing Loss. Am J Public Health 2017; 108:241-247. [PMID: 29267059 DOI: 10.2105/ajph.2017.304165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the prevalence and associated factors of hearing aid acquisition in Chinese older adults. METHODS We obtained data from a population-based survey on ear and hearing disorders, which was conducted in 4 provinces of China in 2014 to 2015. Trained examiners conducted pure tone audiometry and audiologists further ascertained for hearing loss. We relied on hearing conditions and audiologists' recommendations to identify 1503 participants who needed to wear hearing aids. RESULTS Among those 1503 participants, the estimated prevalence of hearing aid acquisition was 6.5% (95% confidence interval = 5.3%, 7.8%). Urban residency, having severe hearing loss, understanding hearing aid function, and receiving a hearing test in the past 12 months were associated with elevated prevalence of hearing aid acquisition. The top-3 reported reasons for not acquiring a hearing aid were not understanding its function (25.4%), not needing it (22.3%), and not being able to afford it (21.3%). CONCLUSIONS Hearing aid use, as a widespread rehabilitation and treatment of hearing loss, remains a big challenge in China. Apart from providing low-cost hearing aids, more efforts should focus on improving hearing knowledge and disseminating information about hearing aid function among older adults.
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Affiliation(s)
- Ping He
- Ping He, Xu Wen, Yanan Luo, Chao Guo, Gong Chen, and Xiaoying Zheng are with the Institute of Population Research, Peking University, Beijing, China. Ping He is also with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Xiangyang Hu and Rui Gong are with China Rehabilitation Research Center for Deaf Children, Beijing. Xiaoying Zheng is also with APEC Health Science Academy, Peking University, Beijing
| | - Xu Wen
- Ping He, Xu Wen, Yanan Luo, Chao Guo, Gong Chen, and Xiaoying Zheng are with the Institute of Population Research, Peking University, Beijing, China. Ping He is also with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Xiangyang Hu and Rui Gong are with China Rehabilitation Research Center for Deaf Children, Beijing. Xiaoying Zheng is also with APEC Health Science Academy, Peking University, Beijing
| | - Xiangyang Hu
- Ping He, Xu Wen, Yanan Luo, Chao Guo, Gong Chen, and Xiaoying Zheng are with the Institute of Population Research, Peking University, Beijing, China. Ping He is also with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Xiangyang Hu and Rui Gong are with China Rehabilitation Research Center for Deaf Children, Beijing. Xiaoying Zheng is also with APEC Health Science Academy, Peking University, Beijing
| | - Rui Gong
- Ping He, Xu Wen, Yanan Luo, Chao Guo, Gong Chen, and Xiaoying Zheng are with the Institute of Population Research, Peking University, Beijing, China. Ping He is also with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Xiangyang Hu and Rui Gong are with China Rehabilitation Research Center for Deaf Children, Beijing. Xiaoying Zheng is also with APEC Health Science Academy, Peking University, Beijing
| | - Yanan Luo
- Ping He, Xu Wen, Yanan Luo, Chao Guo, Gong Chen, and Xiaoying Zheng are with the Institute of Population Research, Peking University, Beijing, China. Ping He is also with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Xiangyang Hu and Rui Gong are with China Rehabilitation Research Center for Deaf Children, Beijing. Xiaoying Zheng is also with APEC Health Science Academy, Peking University, Beijing
| | - Chao Guo
- Ping He, Xu Wen, Yanan Luo, Chao Guo, Gong Chen, and Xiaoying Zheng are with the Institute of Population Research, Peking University, Beijing, China. Ping He is also with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Xiangyang Hu and Rui Gong are with China Rehabilitation Research Center for Deaf Children, Beijing. Xiaoying Zheng is also with APEC Health Science Academy, Peking University, Beijing
| | - Gong Chen
- Ping He, Xu Wen, Yanan Luo, Chao Guo, Gong Chen, and Xiaoying Zheng are with the Institute of Population Research, Peking University, Beijing, China. Ping He is also with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Xiangyang Hu and Rui Gong are with China Rehabilitation Research Center for Deaf Children, Beijing. Xiaoying Zheng is also with APEC Health Science Academy, Peking University, Beijing
| | - Xiaoying Zheng
- Ping He, Xu Wen, Yanan Luo, Chao Guo, Gong Chen, and Xiaoying Zheng are with the Institute of Population Research, Peking University, Beijing, China. Ping He is also with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Xiangyang Hu and Rui Gong are with China Rehabilitation Research Center for Deaf Children, Beijing. Xiaoying Zheng is also with APEC Health Science Academy, Peking University, Beijing
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