Bockstael, Annelies

Botteldooren, Dick

Desloover, Tessa

Keppler, Hannah

English

Ghent University Academic Bibliography

Hearing conservation campaigns for adolescents:visibility and effects reported by universitystudentsAnnelies Bockstael, Hannah Keppler, Tessa Desloover, Dick Botteldooren1 IntroductionLeisure time sound exposure is nowadays regarded as a potential threat for hearing he-alth [13]. Excessive music exposure might as such be linked to noise-induced hearingdamage (NIHL). In this regard, adolescents are a particular vulnerable group, oftenfrequenting entertainment venues [7] and listening personal music players [11, 8].The first step in hierarchic risk control would be an overall reduction of leisuretime exposure levels [1]. In the last years, the Flemish government has taken actionby imposing exposure limits for electronically amplified music at events and venues[2]. However essential, this kind of legislation does not fully control the noise doseat an individual level. People can still accumulate noise exposure, for instance byconsecutively visiting different events or by listening to their personal music players atelevated levels [12].Health promotion and eduction have in principle the potential to raise awarenessof the link between noise exposure and hearing damage, and to motivate adolescentsto act accordingly [7]. Positive effects are seen in focused interventions where child-ren/teenagers are directly addressed in smaller groups [4], although other researchersare more skeptical [12]. Nevertheless, also after broader information campaigns, forinstance at a regional level, more negative attitudes towards noise are reported, as wellas the reported (intention to) use hearing protectors [5].However, the positive effects are rarely seen for all domains necessary for succes-sful hearing conservation [12]. In addition, changes do not always persist over longertime periods, especially when an ‘older’ teenage/adolescent population is addressed.Furthermore, broader campaigns might go by unnoticed by the targeted population.In the Flemish part of Belgium, considerable resources have been spend on cam-paigns to promote safe leisure time noise exposure, especially since the design of thelegislation for electronically amplified music levels around 2011. Various campaignshave been launched for the whole Flemish region, per province, and also by healthinsurance organizations. Those campaigns all provide on-line information on risk ofexcessive noise exposure and preventive measures. Some add extra features such as aself-test for risk assessment and/or application for sound level measurement. In addi-tion, most of the campaigns also provide classroom material.The young adults now starting university (on average between 17 and 19 years old)belong to the target audience of hearing health campaigns. The current study aims toinvestigate whether beneficial effects on hearing conservation can be seen. Three majorquestions are addressed (1) the visibility of the campaigns among young adults, (2) thefactional knowledge of adolescents in preventing NIHL, and (3) their reported behaviorwith respect to hearing conservation.2 Methodology2.1 QuestionnaireThe data presented in this paper are selected from a larger survey addressing attitudesand knowledge of adolescents with respect to music exposure, hearing loss, and hearingprotection. The content of the questionnaire has been based on existing examples inliterature [9, 3].To assess whether the participants are familiar with recent campaigns on leisuretime noise exposure, the logos of seven campaigns are depicted. Participants are askedto mark all campaigns they have heard of, and they are invited add any extra campaignthemselves.Subsequently, nine multiple choice questions are asked, addressing factual know-ledge on hearing damage and hearing protection. The questions are based on the tipsand tricks to avoid noise-induced hearing loss given in the different campaigns. Foreach question, four possible answers are given with one correct.Finally, a list of six possible measures to prevent noise-induced hearing loss isgiven: wearing hearing protectors, taking breaks in a more quiet environment, moni-toring the environmental noise level, moving away from the loudspeakers, avoidingplaces where loud music is played, and lowering the level of the personal music player.On a ten point-scale between the extremes ‘never’ and ‘always’ participant have toindicate how often they apply those measures. An example (not related to hearingprotection) is given to illustrate the scale for scoring.2.2 CampaignsSeven recent campaigns have been included in this study. They all address the potentialrisks of exposure to loud music, trying to motivate teenagers and/or adolescents toadopt a hearing-healthy lifestyle.As expected, all campaigns are visible on the internet, using a website, social me-dia, and most of the time combining both. The websites do vary between campaigns,some clearly designed to attract the population of teenagers and young adults, otherspresenting more factual information. One initiative addresses a broader audience, notonly adolescents, but also teachers, and event organizers.Apart from online information, most campaigns use other ways of communication,such as posters and advertisement on radio. One campaign even presents a short movieabout tinnitus.All campaigns present factual information together with tips and tricks to preventnoise-induced hearing loss. Three campaigns also add some kind of online self-test,addressing the risk of hearing loss, and one offers an smartphone application to measurethe environmental noise level.Geographically, two campaigns are presented by the Flemish government and assuch cover the whole of Flanders. Four other campaigns are more regional, each ofthem addressing one particular Flemish province. Finally, one campaign is made byone of the major health insurance organizations.2.3 ParticipantsParticipants are selected from students in the first or second year of university, themajority of these students is between 18 and 20 years old. Three different disciplineshave been included; bachelor of science in bioscience engineering, bachelor of sciencein psychology, and bachelor of science in logopaedic and audiological sciences.The questionnaires have been distributed on paper at the beginning of several lec-tures. All lectures took place in the first weeks of the academic year. The studentswere invited to complete the questionnaire during the break and to hand them in at theend of the lecture. Every participant received immediately a pair of foam earplugs as areward.3 ResultsFrom the 477 participants, 60.6 % had already heard of at least one campaign addres-sing hearing protection. The possible underlying variables for familiarity with cam-paigns accounted for in the current study are age, gender and study field.With respect to age, little effect is expected to be seen as participants have beenrecruited in the first and second year of university, hence the majority of the data isconcentrated between 18 and 19 years. Nevertheless, in this data set the ‘older’ students(over 20) seem to be more unfamiliar with the campaigns (Figure 1). Dividing thedataset in participants over 20 versus 20 years old or younger reveals that in the groupover 20 only 32.1 % has heard about the campaigns, compared to 62.6 % in the othergroup. This difference is significant (χ2 test p < 0.01).In the group of 20 or younger, the familiarity with campaigns does not depend onstudy field (psychology, engineering or speech therapy; χ2 test p > 0.1) or on gender(χ2 test p > 0.1). For the total test sample, in psychology slightly more participantsare unfamiliar with the campaigns compared to engineering and speech therapy (χ2 test0.01 < p < 0.05). However, this is most likely due to the age effect reported above.In the current dataset, psychology has a clearly higher percentage of students over 20than the other two disciplines (χ2 test p < 0.0001).With respect to the different campaigns, one campaign clearly stands out with43.8 % of the participants having heard of it. This campaign was launched in 2012by the Flemish government and is still maintained today with links to social media,an on-line self-test assessing the risk of hearing loss and a smart phone application tomeasure personal noise dose. In addition, a short movie ‘Noise’ (‘Ruis’ in Dutch) hasbeen broadcast linked to this campaign. The other campaigns have reached far lessparticipants, around 10 % or even below 5 %. This can be (partially) explained by thegeographical covering of the campaigns, five campaigns have been launched by thefive different provinces of Flanders and hence are not expected to be known outsidethis area. Another campaign has been launched by one of the three major health insu-rance organizations and has reached 7.34 % of the respondents. Again, this campaignis expected to addresses a specific part of the test group, namely the members of thisparticular health insurance. However, there is another campaign also launched by the18 20 22 24 26 28050100150Age (years)Frequency(counts)yesnoFiguur 1: Histogram of the participants’ age is a function of familiarity with campaignsaddressing hearing conservation (yes or no).Flemish government in 2011, only known by 3.35 % of and despite its general distri-bution. This campaign is somewhat older, but at the time it was targeting the youthbetween 14 and 18 years old, matching exactly the population under study.With respect to knowledge, answers to nine factual questions are compared forthe group not familiar with any campaign and those who have at least heard of one.The question address broad hands-on knowledge concerning the prevention of noise-induced hearing loss due to music exposure. In general, the difference in factual know-ledge between both groups appears to be limited, if any.An encouraging finding is that a vast majority (over 90 % in both groups) knowsthat repeated exposure to loud noise does not protect from further noise-induced da-mage. In addition, over 80 % in both groups cites either 12 hours or 24 hours as anadvisable rest period in-between exposure. It should be noted that both figures (12 aswell as 24) are mentioned throughout the different campaigns.By contrast, none of the groups seems very aware of the danger of combined ef-fects. In both groups more than 50 % believes that smoking has no influence on the riskof noise-induced hearing loss. For alcohol, more than 40 % thinks that alcohol has noinfluence, and about one-third assumes that alcohol might actually help to prevent hea-ring damage. Furthermore, only one-fourth of the participants in both groups managesto estimate the safe exposure duration for a given noise level.A slight difference in responses as a function of (un)familiarity with campaignsis found for identifying potential risky situation based on the necessity to raise theirvoice. In the group familiar with campaigns, only 6.62 % of the participants fasly thinksthat the need to shout at 0.5 m does not imply elevated exposure levels. In the groupunfamiliar with campaigns, this is 13.9 %. This difference is far from overwhelming,but marginally statistically significantly (χ2 test 0.05 < p < 0.1). Finally, in bothgroups more than half of the participants know that acquired noise-induced hearing lossis permanent, but in the group unfamiliar with campaigns 41.2 % believes that hearingdamage only becomes permanent after continuing exposure, whereas this is 31.4 %in the group familiar with campaigns. This difference is again marginally statisticallysignificant (χ2 test 0.05 < p < 0.1).Taking measures to protect hearing is in general not very differently reported forparticipants familiar with campaigns and those who are not. The use of measures hasbeen assessed on a ten-point scale where participants had to indicate the percentageof the time they actually applied a certain measure. The most popular actions are re-latively feasible ways of lowering music exposure, such as lowering the volume oftheir personal music player (median reported time applied of 70 %), moving a bit fur-ther away from the loudspeakers (median reported time 60 %), or taking a break in amore quiet environment (median reported time 60 %). Contrary, checking the noiselevel themselves is rarely reported; 10 % of the time (median) in the group familiarwith the campaigns and 0 % in the other group. Comparing the rating (ordinal scale)between the two groups showed no significant difference for any of the above measu-res(Wilcoxon test α = 0.05).The use of hearing protectors as such is also not extremely popular, but here asignificant difference is found. Participant who are familiar with campaigns report ahigher use rate than participants who are not (median 40 % of the time versus 30 %;Wilcoxon test 0.05 < p < 0.1).4 DiscussionWhen discussing the risks of noise-induced hearing loss (NIHL), the most obvioussolution lies in an overall reduction of the noise levels. In this regard, the Flemishgovernment has taken action by imposing exposure limits of electronically amplifiedmusic [2]. However, especially for leisure time exposure, there is not one single risksource. By contrast, part of the problem is the subsequent exposure to different sources,such as personal music players, computer games, music at concert halls, and so on.Hence, to protect the hearing of teenagers and (young) adults, correct attitudes andpersonal behavior remain crucial factors.In an unsupervised context – which applies for most leisure time conditions – cor-rect information and knowledge are necessary, although not sufficient, for correct be-havior. Educational campaigns can provide the necessary information. [6] point outthat campaigns should not only provide factual information, but also focus on perso-nal factors such as individual susceptibility. Several campaigns in this study provideindeed self tests assessing the risk of NIHL.The campaigns included here are all launched broadly, addressing the public viawebsite and/or social media. The first question with this kind of strategy is whetherthe campaigns are actually noticed by their target audience. In this study, 60.6 % ofthe respondents have heard of at least one campaign. This figure is clearly higher thanwhat was found in previous work [5], but it also means that still a substantial part doesnot recall any of the campaigns. The participants here are all university students, sothere is little reason to believe that the rates of people familiar with campaigns wouldbe higher in a more diverse population.Comparing the awareness between the different campaigns is difficult because oftheir differences in geographical target. Nevertheless, the most known campaign laun-ched by the Flemish government is also the campaign that has been launched in abroader framework – i.e. the new legislation about electronically amplified music [2]– and uses the most multi-medial approach, with not only online material, but also ashort movie and smartphone applications for noise level monitoring.The results on factual knowledge are somewhat mixed. Some facts are clearly ge-nerally known – such as the fact that repeated exposure does not protect against furtherdevelopment of NIHL – but others are less clear, for instance the risks of combinedexposure of noise and alcohol or smoking. The latter facts are explicitly covered bymost of the campaigns, but even the group familiar with the campaigns scores low here.For risk assessment of environmental noise levels, results are slightly but significantlybetter in the group familiar with campaigns, but here as well there is still clearly roomfor improvement.The reported behavior to reduce noise exposure are encouraging. Actions to reducethe exposure such as moving away from the loudspeakers or taking a break in morequiet area are frequently reported. Moreover, in 2009 [10] has found that experts dee-med these actions as effective, but unlikely to be actually done by adolescents. Forthe use of personal hearing protectors, a slightly positive effects of the campaigns isseen. [5] also reported a higher (reported) rate of usage after launching one particularcampaign. However, the figures of reported usage found here and in previous work [5]remain quite low to fully count on personal hearing protection as measure to preventNIHL in a leisure time context.Referenties[1] PM Arezes and AS Miguel. Hearing protectors acceptability in noisy environ-ments. Ann. Occup. Hyg., 46(6):531, 2002.[2] B.S.29/03/2012. Besluit van de Vlaamse Regering tot wijziging van het besluitvan de Vlaamse Regering van 12 december 2008 tot uitvoering van titel XVI vanhet decreet van 5 april 1995 houdende algemene bepalingen inzake milieubeleid,wat betreft het maximaal geluidsniveau van muziek in inrichtingen. (Decision ofthe Flemish Government to change the decision of the Flemish Government ofdecember 12, 2008 to apply title XVI of the decree of april 5, 1995 concerningthe maximal soud level of music at venues). Published: Staatsblad.[3] Jeannie H Chung, Catherine M Des Roches, John Meunier, and Roland D Ea-vey. Evaluation of noise-induced hearing loss in young people using a web-basedsurvey technique. Pediatrics, 115(4):861–867, 2005.[4] Shawna M Dell, Alice E Holmes, et al. The effect of a hearing conservationprogram on adolescents’ attitudes towards noise. Noise and Health, 14(56):39,2012.[5] Annick Gilles and Van de Heyning Paul. Effectiveness of a preventive campaignfor noise-induced hearing damage in adolescents. International Journal of Pedi-atric Otorhinolaryngology, 78(4):604–609, April 2014.[6] Megan Gilliver, Elizabeth Francis Beach, and Warwick Williams. Noise withattitude: Influences on young people’s decisions to protect their hearing. Interna-tional Journal of Audiology, 52(S1):S26–S32, 2013.[7] Megan Gilliver, Elizabeth Francis Beach, and Warwick Williams. Changing be-liefs about leisure noise: Using health promotion models to investigate youngpeople’s engagement with, and attitudes towards, hearing health. Internationaljournal of audiology, (0):1–9, 2014.[8] H. Keppler, I Dhooge, and B Vinck. Hearing in young adult. part ii: The effectsof recreational noise exposure. Noise and Health, submitted.[9] Hannah Keppler. Optimization of the diagnosis of noise-induced hearing losswith otoacoustic emissions. PhD thesis, Ghent University. Faculty of Medicineand Health Sciences, 2010.[10] I Vogel, J Brug, CPB Van der Ploeg, and H Raat. Prevention of adolescents’music-induced hearing loss due to discotheque attendance: a delphi study. HealthEducation Research, 24(6):1043–1050, 2009.[11] Ineke Vogel, Hans Verschuure, Catharina PB van der Ploeg, Johannes Brug, andHein Raat. Estimating adolescent risk for hearing loss based on data from alarge school-based survey. American journal of public health, 100(6):1095–1100,2010.[12] Viktor Weichbold and Patrick Zorowka. Can a hearing education campaign foradolescents change their music listening behavior? International Journal of Au-diology, 46(3):128–133, January 2007.[13] Fei Zhao, Vinaya KC Manchaiah, David French, and Sharon M Price. Musicexposure and hearing disorders: An overview. Int. J. Audiol., 49(1):54–64, 2009.

Hearing conversation campaigns for adolescants: visibility and effects reported by university students

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Hearing conversation campaigns for adolescants: visibility and effects reported by university students

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