A suggested model for decision-making regarding hearing conservation: towards a systems theory approach

Ten-year results of leisure noise exposure among adolescents and young adults-findings from the OHRKAN cohort study

OBJECTIVE

To observe total leisure noise (TLN) exposure and to investigate determinants of risky TLN exposure among adolescents and young adults over a ten-year observation period.

DESIGN

OHRKAN is a longitudinal study with five equidistantly distributed questionnaires (waves) over ten years. Risky TLN exposure was defined as exceeding ≥85dB(A) averaged over 40h per week. To identify determinants of risky TLN exposure longitudinally, generalised estimating equations were applied.

STUDY SAMPLE

A subgroup (n = 661; mean age 25.6 years in the fifth wave; 58.4% female) of the closed cohort study OHRKAN was analysed. Included participants took part in the fifth wave prior to the study break due to COVID-19.

RESULTS

Analysis of participants' data from all five waves showed that risky TLN exposure was highest during the second wave (72.0%), when participants were aged 17-19 years, and thereafter steadily declined. Among young adults, attendance at discotheques and private parties, especially, caused very high exposure. Determinants of risky TLN exposure were wave time point, male gender, a higher level of education, and smoking.

CONCLUSIONS

As TLN exposure is highest among older adolescents, prevention programs should target younger teenagers and be tailored to the identified risk groups. The risk from private parties should be addressed.

Risk-taking propensity as a risk factor for noise-induced hearing loss in the general population

OBJECTIVES

To examine general risk propensity in relation to perceptions of noise, risk behaviour, and hearing loss in the general population.

DESIGN

Participants completed an online survey using the Amazon Mechanical Turk crowdsourcing platform.

STUDY SAMPLE

The sample comprised 1274 adults from the United States.

RESULTS

Higher general risk propensity was associated with an increased likelihood to engage in noise-risk behaviours. Lower general risk propensity was associated with increased knowledge of noise risks and an increased perception of noise as risky. The frequency of self-reported exposures to hazardous noise resulted in estimated annual noise doses exceeding standard hazard limits in 40% of the surveyed population.

CONCLUSIONS

Results revealed limited knowledge of the risks and associated health consequences of noise exposure in the general population Results of this study suggest a high rate of self-exposure to hazardous noise by the general population. Those with higher general risk propensity are more likely to engage in risky noise behaviour. Risky noise behaviour is associated with age, gender, race, ethnicity, and general risk propensity. Intervention programs to modify risky noise behaviour in the general population should focus on both increasing knowledge and establishing accurate perceptions of risk.

Young Adults' Knowledge and Perceptions of Permanent Noise-Induced Tinnitus and its Influence on Behavioural Intentions

Objective

Young adults' music-listening behaviours may put them at risk of developing permanent hearing loss and tinnitus. This study aimed to assess knowledge of permanent tinnitus and whether this knowledge may influence listening behaviours to a greater degree than knowledge of hearing loss.

Materials and Methods

A two-group (between subjects), randomised post-test only, single-factor experimental design was used to determine the effects of health message focus (permanent tinnitus vs. permanent hearing loss) on the main outcome measure of protective behavioural intention. The sample included 109 male and 287 female adults, aged 18 to 25 years, living in the United Kingdom. The young adults' existing knowledge of either permanent hearing loss or permanent tinnitus was measured, and after exposure to a health message, their perceptions and resultant behavioural intentions were assessed and compared. The pooled data were used to test a proposed model of factors influencing hearing protective behavioural intention using path analysis.

Results

Whilst 83% knew about the link with hearing loss, only 75% knew that loud music may cause permanent tinnitus. The participants viewed tinnitus as closer temporally than hearing loss, perceived themselves as equally susceptible to both, but perceived hearing loss as more severe. There was no significant difference in behavioural intention between the groups.

Conclusion

Perceived susceptibility and severity have a positive effect on behavioural intentions. In light of these results, recommendations for future noise-damage prevention campaigns are made.

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.

Attitudes to noise in young adults and associated factors: adaptation of the youth attitude to noise scale into Spanish using item response theory analysis

OBJECTIVE

This study aimed to identify the attitudes to noise in young adults and the possible effects of gender, age, and a positive history of auditory symptoms related to recreational noise exposure on the attitudes to noise in this population.

DESIGN

The Youth Attitude to Noise (YANS) and the hearing symptom description (HSD) scales were adapted into Spanish to be used with young adults. The validity was determined using factor analyses and Item Response Theory (IRT) models. Linear regression models were used to determine whether the YANS scores were associated with gender, age, and auditory symptoms.

STUDY SAMPLE

Both instruments were given to a sample of 728 Chilean young adults. Data obtained from this sample was used to determine the YANS and HSD scales' validity and to assess the effects of gender, age, and auditory symptoms on attitudes.

RESULTS

Our results showed that the YANS and HSD scales had adequate validity and reliability. Differences in the items' capacity to discriminate attitudes to noise were noted using the IRT model. Auditory symptoms were significantly associated with the YANS scores.

CONCLUSIONS

The attitudes to noise in Chilean young adults are influenced by self-perception of auditory symptoms, age, and gender.

Understanding Hearing Health: A Cross-Sectional Study of Determinants in a Metropolitan Area

Hearing health prevention has emerged as a significant public health concern worldwide. With nearly two and a half billion people experiencing some degree of hearing loss, and around seven hundred million requiring medical intervention, the impact on global health is substantial. The economic burden is equally substantial, with estimated health costs reaching 980 billion dollars in the United States alone. To shed light on this issue, we conducted a survey-based cross-sectional study involving 1150 individuals. Utilizing multiple linear regression across three models, we aimed to explore the association between demographic variables and knowledge, attitude, and behaviors related to hearing health. In Model I, we observed a correlation between knowledge and several factors, including age, smoking habits, marital status, and education. In Model II, attitudes were found to associate with non-smoking habits, education, and knowledge. Model III revealed a statistically significant correlation between behaviors and age, gender, parenthood, knowledge, and attitudes. These findings emphasize the importance of targeted public health programs aimed at improving behaviors among the general population. Such interventions can be both effective and relatively inexpensive. By addressing these determinants, we can enhance overall hearing health in the community. Our study contributes valuable information about the knowledge, attitudes, and behaviors related to hearing health in the general population. Understanding these factors is crucial in developing evidence-based strategies to promote hearing health and prevent hearing loss effectively. As we continue to work towards better hearing health, the findings from this study can serve as a cornerstone for informed decision-making and successful intervention implementation.

Identifying Targets for Interventions to Increase Earplug Use in Noisy Recreational Settings: A Qualitative Interview Study

Earplugs can reduce the risk of hearing loss and tinnitus. However, earplug use during noisy recreational activities is uncommon, and methods for increasing uptake and regular use have had limited efficacy. The aim of the present study was to examine barriers and enablers of ever-performers (e.g., people who have used earplugs) and never-performers (e.g., people who have not used earplugs) to identify targets to inform the content of interventions to increase uptake and regular use of earplugs in recreational settings. The Capabilities, Opportunities, and Motivations model of Behaviour (COM-B) informed the outline for 20 semi-structured telephone interviews (ever-performers, N = 8, age range = 20-45 years; never-performers, N = 12; age range = 20-50 years). Thematic analysis was used to identify barriers and enablers to earplug use, which were mapped onto the Theoretical Domains Framework (TDF). Six key domains of the TDF were identified. Ever-performers described being more exposed to 'social influences' (e.g., facilitators such as friends/peers) and were more positive than never-performers concerning 'beliefs about consequences' (e.g., earplug protection outweighs any negative effects on listening/communication). Involvement of 'emotion' (e.g., fear of losing ability to listen to music) and 'reinforcement' tactics (e.g., creating habits/routines) were discussed by ever-performers, but were not mentioned by never-performers. Both groups reported lack of 'environmental context and resources' (e.g., prompts and cues), and their own 'memory, attention, and decision processes' (e.g., deciding when to use earplugs) as barriers to earplug use. The present research identifies the variables that would need to change in order to increase earplug uptake and use in recreational settings among ever-performers and never-performers. Further work is required to translate these findings into testable interventions by selecting appropriate intervention functions (e.g., modelling), policy categories (e.g., communication/marketing), behaviour change techniques (e.g., demonstration of behaviour), and mode of delivery (e.g., face-to-face).

Leisure Noise Exposure and Associated Health-Risk Behavior in Adolescents: An Explanatory Study among Two Different Educational Programs in Flanders

Adolescents frequently engage in noisy leisure activities which can result in hearing-related problems. However, the effect of leisure noise exposure is liable to an individual's risk-taking behavior. Identifying leisure noise activities and relevant factors related to risk-taking behavior in adolescents, are important to optimize hearing conservation programs targeting youngsters. The purpose of the study was to explore the presence of hearing-related symptoms, as well as noise exposure during various activities, and the use of hearing protector devices (HPDs) in adolescents in two educational programs in Flanders. In addition, their attitudes and beliefs towards noise, hearing loss, and HPDs were investigated. The final sample consisted of 247 adolescents. The most important hearing-related symptoms after noise exposure were tinnitus and noise sensitivity. With regard to leisure noise exposure, listening to PMPs was most frequently reported. The use of HPDs during most noisy activities was limited, in accordance with the presence of hearing-related symptoms, considering noise as unproblematic, and having worse scores on subscales of the beliefs about hearing protection and hearing loss scale. In the future, hearing conservation programs should target adolescents specifically for a more health-orientated behavior towards noise exposure, hearing loss, and HPDs.

Personal Listening Device Use Habits, Listening Belief, and Perceived Change in Hearing Among Adolescents

PURPOSE

This study aimed to identify personal listening device (PLD) usage habits, listening belief, and perceived change in hearing, and to investigate how the variables related to perceived change in hearing among adolescents.

METHODS

The participants were 183 middle school students and 233 high school students from Ulsan. Data were collected by self-reported questionnaires from August 1, 2019, to October 22, 2019, and analyzed with descriptive statistics, χ² test, Mann-Whitney U test, and hierarchical multiple logistic regression.

RESULTS

Most students started to use PLDs from elementary school, and mean preferred listening level was 70.13 dB. Mean perceived susceptibility to music-induced hearing loss (MIHL) and perceived barriers to prevent MIHL were 5.18 and 3.40, respectively. Perceived change in hearing was reported on 14.2% of middle school students and 32.2% of high school students, and as the average score of perceived barriers to prevent MIHL increases by one point, the odds of decrease in hearing increase by 2.05 times (p < .001) and 1.35 times (p < .05), respectively.

CONCLUSION

Considering that most adolescents are exposed to PLD in elementary schools and about a quarter experienced a decrease in hearing after PLD use, educational programs on hearing conservation are required to start as early as in schools. Particularly, knowledge and skills to overcome barriers to prevent MIHL should be emphasized in educational programs.

Applying the Hierarchy of Hazard Control to Regulation of Sound Levels in Entertainment Venues

Excessive sound levels at events where amplified music is a central element pose a risk to hearing. Whereas noise exposure in the workplace has been recognized as a hazard for over a century, the potential harm resulting from recreational sound exposure has only become apparent in recent years. In occupational settings where sound levels are high, employers are required to implement risk-mitigation strategies to reduce sound exposure and protect employees in accordance with the hierarchy of controls. In principle, this same risk management approach can be applied to entertainment venues. In this paper we discuss how the measures stipulated in various policies and regulations aimed at protecting the hearing of audience members at entertainment venues fit within the hierarchy of controls. We compare the relative likely effectiveness of each of the measures and outline how the particular characteristics of entertainment venues impact on the practical application of these measures.

The test-retest reliability of questionnaires regarding attitudes and beliefs toward noise, hearing loss, and hearing protector devices in young adults

Context:

Young people expose themselves to high noise levels during leisure activities, and might thus be at risk of acquiring hearing-related problems. Therefore, information regarding risk-taking behavior is necessary to prevent future hearing problems and to optimize future preventive campaigns.

Aim:

This study evaluated the test–retest reliability of the Youth Attitude to Noise Scale (YANS) and beliefs about hearing protection and hearing loss (BAHPHL) instrument.

Settings and Design:

Forty-three young adults between 18 and 29 years filled in a questionnaire at two test moments.

Materials and Methods:

The YANS and BAHPHL instrument were used to evaluate the attitudes toward noise, hearing loss, and hearing protection. Each participant completed the retest within 21–55 days after the first administration of the questionnaire.

Results:

Paired Student’s t-tests showed no significant differences in mean scores between test and retest for both the entire YANS and BAHPHL instrument as well as their factors. Furthermore, a good agreement between test and retest scores was seen by Bland–Altman analyses. Intraclass correlation coefficients were above 0.70 for the entire YANS and the factor related to youth culture as well as for the entire BAHPHL and all the factors of the BAHPHL instrument, except for the factor related to the severity of the consequences of hearing loss.

Conclusion:

Reliable test–retest measurements of the YANS and BAHPHL instrument can be performed. Hence, these questionnaires can be used in longitudinal studies to explore young adults’ changes in attitudes toward noise, hearing loss, and hearing protection, with or without an educational intervention.

Assessment of Safe Listening Intentional Behavior Toward Personal Listening Devices in Young Adults

Recreational noise-induced hearing loss (RNIHL) is a highly preventable disorder that is commonly seen in teenagers and young adults. Despite the documented negative effects of RNIHL, it is still challenging to persuade people to adopt safe listening behaviors. More research is needed to understand the underlying factors guiding listeners’ intentions to engage in safe listening habits. We used the Theory of Planned Behavior (TPB) to identify attitudes, social norms, and behavioral control in 92 young adults toward two intentional behaviors related to safe listening habits while listening to their personal listening devices: (1) lowering the intensity of loud music, and (2) shortening the listening duration of loud music. Using a Qualtrics survey, the major factors of the TPB model as they relate to the participants’ intention to engage in risk-controlling behavior were assessed. Behavioral intentions to turn the music down and listen for shorter durations were thought to be predicted by the TPB factors (attitudes, social norms, and perceived behavioral control). Linear regression findings indicated that the overall TPB models were significant. Positive attitudes toward turning the music down and shortening the durations were significantly associated with intentions to engage in non-risky behavior, more so for the former behavior.

Young Adults' Knowledge and Attitudes Regarding "Music" and "Loud Music" Across Countries: Applications of Social Representations Theory

Exposure to loud music, especially by young people, has significantly increased in recent years as a result of (a) advancements in technology in terms of personal music players and smart mobile phones, and (b) streaming of music through these devices. The World Health Organization (WHO) estimates that some 1.1 billion teenagers and young adults are at risk of developing hearing loss due to exposure to recreational noise such as music. It is suggested that knowledge and attitude of young adults toward music has bearing upon their music listening habits and thereby influences who is at risk of developing music induced hearing loss. Hence, researchers from various fields have tried to understand the knowledge and attitude of young adults regarding loud music. However, there is some criticism of attitude studies as there is little relation between expressed attitude and behavior. Some recent studies have explored the social representations of music and loud music using the Social Representations Theory (SRT). It has been suggested that social representation is more fundamental than attitude (or in other words social representation informs attitude), hence, it has a better relation to behavior. The current paper: (1) provides an overview of studies on knowledge and attitude of young adults toward loud music, (2) discusses the limitations of attitude theories and introduces SRT, and (3) provides a summary of social representation studies on “music” and “loud music” in young adults from different countries.

Attitudes, Risk Behavior, and Noise Exposure among Young Adults with Hearing Problems: Identifying a Typology

This study explored attitudes toward leisure noise, use of hearing protection, and perceived susceptibility to leisure-noise damage in young adults with hearing problems. Twelve participants aged between 18 and 35 years took part in a semistructured interview. Data were analyzed using framework analysis. The results showed that a positive attitude to noise, a passion for loud music, a lack of knowledge of the consequences of noise damage, and perceived low risk of hearing problems were associated with people not using earplugs. The aesthetics, comfort, perceived effects on music quality and attitude of others were all barriers to earplug use. Of those who had used earplugs, previous hearing-related symptoms and concern about future hearing damage were the main motivators for use. Four types of people were identified to describe the variation in attitudes and behaviors: those who had no change in behavior or concern about damage; those who were concerned and used earplugs; those who were concerned and avoided loud venues; and those who were concerned about communication difficulties only. Considering the wide variability, it may be more effective to shift attention from trying to change individual attitudes and behaviors to considering systemic changes to protect hearing, through ensuring the music industry and relevant authorities take greater responsibility.

Epidemiology and Risk Factors for Leisure Noise-Induced Hearing Damage in Flemish Young Adults

CONTEXT

Young people regularly expose themselves to leisure noise and are at risk for acquiring hearing damage.

AIMS

The objective of this study was to compare young adults' hearing status in relation to sociodemographic variables, leisure noise exposure and attitudes and beliefs towards noise.

SETTINGS AND DESIGN

A self-administered questionnaire regarding hearing, the amount of leisure noise exposure and attitudes towards noise and hearing protection as well as an audiological test battery were completed. Five hundred and seventeen subjects between 18 and 30 years were included.

SUBJECT AND METHODS

Hearing was evaluated using conventional audiometry, transient evoked and distortion product otoacoustic emissions. On the basis of their hearing status, participants were categorised into normal hearing, sub-clinical or clinical hearing loss.

STATISTICAL ANALYSIS USED

Independent samples t-tests, chi-square tests and multiple regression models were used to evaluate the relation between groups based on hearing status, sociodemographics, leisure noise and attitudes towards noise.

RESULTS

Age was significantly related to hearing status. Although, the subjects in this study frequently participated in leisure activities, no significant associations between leisure noise exposure and hearing status could be detected. No relation with subjects' attitudes or the use of hearing protection devices was found.

CONCLUSIONS

This study could not demonstrate clinically significant leisure noise-induced hearing damage, which may lead to more non-protective behaviour. However, the effects of leisure noise may become noticeable over a long-term use since age was found to be related with sub-clinical hearing loss. Longitudinal studies are needed to evaluate the long-term effects of noise exposure.

Influence of Hearing Risk Information on the Motivation and Modification of Personal Listening Device Use

PURPOSE

The purpose of this study was (a) to investigate the behaviors, knowledge, and motivators associated with personal listening device (PLD) use and (b) to determine the influence of different types of hearing health risk education information (text with or without visual images) on motivation to modify PLD listening use behaviors in young adults.

METHOD

College-age students (N = 523) completed a paper-and-pencil survey tapping their behaviors, knowledge, and motivation regarding listening to music or media at high volume using PLDs. Participants rated their motivation to listen to PLDs at lower volume levels following each of three information sets: text only, behind-the-ear hearing aid image with text, and inner ear hair cell damage image with text.

RESULTS

Acoustically pleasing and emotional motives were the most frequently cited (38%-45%) reasons for listening to music or media using a PLD at high volume levels. The behind-the-ear hearing aid image with text information was significantly (p < .0001) more motivating to participants than text alone or the inner ear hair cell damage image with text.

CONCLUSIONS

Evocative imagery using hearing aids may be an effective approach in hearing protective health campaigns for motivating safer listening practices with PLDs in young adults.

Knowledge, attitudes, behaviors, and noise exposure of baristas

OBJECTIVE

To examine the daily noise exposure of baristas working in cafés, and to measure their knowledge, attitudes, and behaviors regarding hearing conservation and perceptions of noise in their work environment.

DESIGN

Fifteen baristas from six cafés in Portland completed the Knowledge, Attitudes and Behaviors questionnaire, a sound disturbance survey, and a structured interview to document perceptions of noise in the work environment. To measure daily noise exposure, a subset of eight participants wore a personal dosimeter for three different work shifts.

STUDY SAMPLE

A total of 11 females and four males, aged between 19 and 36 years old (mean: 26.3, SD: 4.6) recruited from independently owned cafés in the Portland metro area.

RESULTS

Dosimetry measurements revealed Leq measurements between 71 and 83 dBA, with noise doses ranging from 4% to 74%, indicating that baristas are not exposed to sound levels above the regulatory criterion. Questionnaire results indicated that baristas have low awareness about the hazards of noise, are not opposed to hearing conservation, and rarely use hearing protection when engaged in noisy activities.

CONCLUSIONS

Baristas here lacked the pertinent education and motivation to commit to invaluable hearing conservation practices.

Hearing in young adults. Part I: The effects of attitudes and beliefs toward noise, hearing loss, and hearing protector devices

There is great concern regarding the development of noise-induced hearing loss (NIHL) in youth caused by high sound levels during various leisure activities. Health-orientated behavior of young adults might be linked to the beliefs and attitudes toward noise, hearing loss, and hearing protector devices (HPDs). The objective of the current study was to evaluate the effects of attitudes and beliefs toward noise, hearing loss, and HPDs on young adults’ hearing status. A questionnaire and an audiological test battery were completed by 163 subjects (aged 18-30 years). The questionnaire contained the Youth Attitude to Noise Scale (YANS) and Beliefs about Hearing Protection and Hearing Loss (BAHPHL). A more positive attitude or belief represented an attitude where noise or hearing loss is seen as unproblematic and attitudes and beliefs regarding HPDs is worse. Hearing was evaluated using (high frequency) pure tone audiometry (PTA), transient evoked and distortion product otoacoustic emissions. First, mean differences in hearing between the groups with different attitudes and beliefs were evaluated using one-way analysis of variance (ANOVA). Second, a χ² test was used to examine the usage of HPDs by the different groups with different attitudes and beliefs. Young adults with a positive attitude had significantly more deteriorated hearing and used HPDs less than the other subjects. Hearing conservation programs (HCPs) for young adults should provide information and knowledge regarding noise, hearing loss, and HPDs. Barriers wearing HPDs should especially be discussed. Further, those campaigns should focus on self-experienced hearing related symptoms that might serve as triggers for attitudinal and behavioral changes.

ICBEN review of research on the biological effects of noise 2011-2014

The mandate of the International Commission on Biological Effects of Noise (ICBEN) is to promote a high level of scientific research concerning all aspects of noise-induced effects on human beings and animals. In this review, ICBEN team chairs and co-chairs summarize relevant findings, publications, developments, and policies related to the biological effects of noise, with a focus on the period 2011-2014 and for the following topics: Noise-induced hearing loss; nonauditory effects of noise; effects of noise on performance and behavior; effects of noise on sleep; community response to noise; and interactions with other agents and contextual factors. Occupational settings and transport have been identified as the most prominent sources of noise that affect health. These reviews demonstrate that noise is a prevalent and often underestimated threat for both auditory and nonauditory health and that strategies for the prevention of noise and its associated negative health consequences are needed to promote public health.

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.

Effectiveness of a preventive campaign for noise-induced hearing damage in adolescents

OBJECTIVES

Many studies have documented a high incidence of hearing loss and tinnitus in adolescents after recreational noise exposure. The prevalence of noise-induced symptoms is in contradiction to the low preventive use of hearing protection. The effects of preventive campaigns on the attitudes toward noise in young people are under debate. The aim of the present study is to investigate whether a preventive campaign can alter attitudes toward noise in adolescents and whether this results in an increase of hearing protection use in this population.

METHODS

A cohort of 547 Flemish high school students, aged 14 to 18 years old, completed a questionnaire prior to and after a governmental campaign focusing on the harmful effects of recreational noise and the preventive use of hearing protection. At both occasions the attitudes toward noise and toward hearing protection were assessed by use of the youth attitudes toward noise scale (YANS) and the beliefs about hearing protection and hearing loss (BAHPHL), respectively. These questionnaires fit into the model of the theory of planned behavior which provides a more clear insight into the prediction of a certain behavior and the factors influencing that behavior.

RESULTS

The score on the YANS and the BAHPHL decreased significantly (p < 0.001) implying a more negative attitude toward noise and a more positive attitude toward hearing protection. The use of hearing protection increased significantly from 3.6% prior to the campaign to 14.3% (p = 0.001) post campaign in students familiar with the campaign.

CONCLUSIONS

Measurable alteration of all the variables in the theory of planned behavior caused an increase of the intentions to use hearing protection as well as the actual use of hearing protection. The present study shows the usefulness of the theory of planned behavior to change and guide adolescents' preventive actions toward noise damage. In addition, preventive campaigns can establish attitude and behavioral adjustments. However, the long term effects of preventive campaigns should be investigated in future research.

Development and evaluation of a questionnaire to assess knowledge, attitudes, and behaviors towards hearing loss prevention

OBJECTIVE

To develop and evaluate a questionnaire assessing knowledge, attitudes, and behaviors (KAB) as they pertain to hearing conservation, using the constructs of the health belief model (HBM).

DESIGN

The KAB was completed by 235 participants. Relationships between knowledge and attitudes about hearing and hearing conservation, participation in noisy activities, and use of hearing protection were examined.

STUDY SAMPLE

117 males and 118 females aged between 18 and 80 years (mean = 42.3, SD = 4.1) recruited from the Portland VA Medical Center, local universities, and a community college.

RESULTS

Knowledge scores ranged from 15.6% to 93.8%. Factor analyses revealed six attitude factors, interpreted as measuring perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and cues to action. Over 95% of participants routinely participated in at least one noisy activity but few used hearing protection while doing so. The attitude scores of individuals who used hearing protection differed significantly from the scores of those who did not.

CONCLUSIONS

Significant relationships between use of hearing protection and scores on the KAB provide validation that the HBM is a valuable framework for understanding hearing health behaviors, and evidence that the KAB is a valid tool for assessing these attitudes and behaviors.

Epidemiology of noise-induced tinnitus and the attitudes and beliefs towards noise and hearing protection in adolescents

Background and objectives

Previous research showed an increase of noise-induced symptoms in adolescents. Permanent tinnitus as a consequence of loud music exposure is usually considered as noise-induced damage. The objective was to perform an epidemiological study in order to obtain prevalence data of permanent noise-induced tinnitus as well as temporary tinnitus following noise exposure in a young population. In addition the attitudes and beliefs towards noise and hearing protection were evaluated in order to explain the use/non-use of hearing protection in a young population.

Methods

A questionnaire was completed by 3892 high school students (mean age: 16.64 years old, SD: 1.29 years). The prevalence of temporary and permanent tinnitus was assessed. In addition the ‘Youth Attitudes to Noise Scale’ and the ‘Beliefs About Hearing Protection and Hearing Loss’ were used in order to assess the attitudes and beliefs towards noise and hearing protection respectively.

Results

The prevalence of temporary noise-induced tinnitus and permanent tinnitus in high school students was respectively 74.9% and 18.3%. An increasing prevalence of temporary tinnitus with age was present. Most students had a ‘neutral attitude’ towards loud music and the use of hearing protection was minimal (4.7%). The limited use of hearing protection is explained by a logistic regression analysis showing the relations between certain parameters and the use of hearing protection.

Conclusions

Despite the very high prevalence of tinnitus in such a young population, the rate of hearing protection use and the knowledge about the risks of loud music is extremely low. Future preventive campaigns should focus more on tinnitus as a warning signal for noise-induced damage and emphasize that also temporary symptoms can result in permanent noise-induced damage.