By Rohima Badri, Ph.D.

As the prevalence of noise-induced hearing loss (NIHL) among the younger population rises, it is critical to not only raise awareness of NIHL but also encourage positive behavioral changes in their hearing habits, such as limiting loud noise exposure and using hearing protection devices. However, simply educating and raising awareness about NIHL does not guarantee a positive shift toward safe hearing habits in this population.

In order to reform and sustain healthy hearing practices in youth, an in-depth understanding of their attitudes, beliefs, and behaviors toward loud noise and the use of hearing protection devices is needed. Young adults with more problematic attitudes and beliefs about loud noise and wearing hearing protection had significantly worse hearing (as measured by pure tone audiometry and otoacoustic emissions) than those with neutral or negative attitudes about loud noise, according to research in Noise & Health. 

Finding answers to fundamental questions—such as, “Why does this age group enjoy loud sounds?,” “What impact does hearing damage have on this age group?,” “What will truly motivate them to use hearing protection devices?”—will help develop effective and sustainable hearing conservation programs. Based on research into the factors that influence youth hearing practices, here are three lessons that hearing conservation programs can use to raise awareness of and prevent NIHL in the younger population.

1. Conservation efforts should target and reform group behaviors and social norms, in addition to focusing on changing individual behaviors.

Particularly among the younger generation, we are drawn to loud-noise activities because they are known to enhance entertainment, mood, and socialization, among other things. The guidance on how to behave toward noise and hearing protection is shaped not only by individual attitudes and preferences but also by peer group/youth culture norms, New Zealand researchers reported in the journal Seminars in Hearing. 

According to a separate Noise & Health study, students typically viewed loud noise exposure from non-leisure activities such as lawn mowing as unwanted and unacceptable, and reported using hearing protection without hesitation, but viewed loud noise exposure from leisure and group activities such as rock concerts and sporting events as acceptable, even desirable, and reported using hearing protection as awkward.

This social acceptance and expectation of loud music as a part of youth culture is one of the most significant barriers to achieving healthy and safe hearing practices among the younger population. 

Hearing conservation programs must address and reform the social influences on hearing practices among young people, in addition to continuing to work on changing individual behavior through training and education. Some strategies for breaking the youth culture and social norms that encourage dangerous hearing practices are:

• Educate and appeal to "arbiters of loud noise culture," such as the staff and managers of noise-friendly establishments like nightclubs, concerts, and sports arenas, about safer hearing practices.

• Employ influential and well-known individuals who appeal to a younger audience, such as musicians, athletes, and social media influencers, to promote safe hearing practices and counteract the normalization of loud noise in youth culture.

• Involve student groups as a team in promoting and educating their peers about the dangers of loud noise and how to prevent them. For example, start a club, put on a play, or have open discussions about existing knowledge, attitudes, and experiences toward loud noise. 

2. Conservation programs should raise awareness of noise-induced tinnitus in addition to hearing loss as an early indicator/warning sign of NIHL. 

According to a survey of nearly 4,000 Belgian high school students published in PLoS ONE, three-quarters report noise-induced tinnitus as an immediate result of loud noise exposure. And the presence of such phantom sounds after loud noise exposure, even in the absence of hearing loss, may reflect the early onset of hearing damage. 

Interestingly, research increasingly shows that immediate, self-experienced symptoms such as tinnitus and sound sensitivity often alert young people to change their attitudes and behavior toward healthy hearing practices rather than changes in hearing thresholds, as shown in an International Journal of Audiology study surveying U.S. college students and Swedish research in Noise & Health. Adolescents and young adults who had experienced symptoms such as tinnitus were not only more likely to have a negative attitude toward loud noise exposure but also more likely to use hearing protection devices than those who had no symptoms, according to a Noise & Health paper. 

Noise-induced tinnitus is highly prevalent among young people, and such self-perceived auditory symptoms are likely to improve this age group's attitude and behavior toward healthy hearing practices. As a result, conservation programs should place a strong emphasis on educating and raising awareness of noise-induced tinnitus and other self-experienced auditory symptoms, in addition to NIHL.

Hearing conservation campaigns can: 

• Educate people on how noise-induced tinnitus, no matter how transient or temporary, often indicates an early stage of noise-induced hearing damage and serves as an early warning signal. 

• Engage students to gain firsthand experience of tinnitus through simulations or even by "walking around for a week with an MP3-player constantly playing a high-pitched pure tone," as suggested in the PLoS ONE research, to induce rapid changes in the attitudes and behaviors of youth. (Check with your hearing healthcare professional first if you really want to go the MP3 route—simply playing a high-pitched tone, such as a teakettle, can help get across the same point.)

3. Conservation efforts should target populations as young as elementary and middle school students, in addition to teenagers and young adults.

As children are increasingly becoming exposed to loud sounds at younger ages, the importance of providing appropriate education and tools during their formative years cannot be overstated. It's even more critical when it comes to instilling safe and healthy hearing practices because we not only adapt and become conditioned to enjoying loud sounds over time—but we also conform to the culture of loud noise as a form of entertainment, says the Seminars in Hearing report. 

Younger children were found to be more receptive to interventions aimed at improving hearing protection behaviors in noisy environments than older children, and the effects of such interventions lasted longer in the former group, as reported in the American Journal of Audiology.. Because younger age groups are less likely to be deeply conditioned or acculturated and are more open to new ideas, raising awareness of loud noise exposure at a young age can prevent noise-induced hearing damage in the future. 

Hearing conservation programs can encourage and motivate the younger generation about the importance of safe hearing practices by:

• Employing their older peers or college students to deliver interactive, interpersonal NIHL prevention programs.

• Including hearing conservation education programs specifically designed for elementary and middle school students, such as Dangerous Decibels, It's a Noisy Planet, Listen to Your Buds, and Turn It to the Left (which also includes a rap album), to name a few. For more resources grouped by age, check out the Hearing Loss Prevention Research Guide by the Educational Audiology Association. While this was created in 2014, there are many “evergreen” (for any time) ideas there.

And finally, follow Hearing Health Foundation’s Keep Listening campaign for additional ideas, social media assets to share, news and views, and more.

New Jersey resident Rohima Badri, Ph.D., received her doctorate in audiology and hearing sciences from Northwestern University. In an earlier article, she shares ways to raise youth awareness of NIHL. For more, see hhf.org/keeplistening. 

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