Hearing Health To Create a

To Create a CULTURE SHIFT Around Healthy Hearing, Start Young

And other key strategies to encourage safe listening habits, for life. By Rohima Badri, Ph.D.

As the younger population is exposed to ever more noise, such as through the use of personal listening devices, the risk of hearing damage from loud sounds is growing. So it is critical to not only raise awareness of noise-induced hearing loss and tinnitus but also effect positive changes in listening habits, such as limiting noise exposure and using hearing protection.

But simply educating and raising awareness about NIHL does not guarantee a positive shift toward safe hearing habits among tweens and teens. I believe that to reform and sustain healthy hearing practices in youth, we need to better understand their attitudes, beliefs, and behaviors toward loud noise and the use of hearing protection such as earplugs.

According to Belgian research in Noise & Health in 2015, 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.

This is an opportunity for change. 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, and what will truly motivate them to use hearing protection devices?—will help us develop effective and sustainable hearing conservation programs.

Based on research into the factors that influence youth hearing practices, here are three approaches.

1. Target and tweak group behaviors and social norms, in addition to focusing on changing individual behaviors.

We (and especially young people) are drawn to loud 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 in 2017.

According to another 2015 Noise & Health study, students in North Carolina typically viewed loud noise exposure from non-leisure activities such as lawn mowing as unwanted and unacceptable, and used hearing protection without hesitation. But they saw loud noise exposure from leisure activities such as rock concerts and sporting events as acceptable and even desirable, and using hearing protection in these situations was 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.

We must address larger social influences in addition to continuing to work on changing individual behavior. Some strategies are: >> Educate and appeal to “arbiters of loud noise culture,” such as the staff and managers of traditionally loud establishments—such as nightclubs, concerts, sports arenas, even venues that host weddings and other celebrations—about safer hearing practices, advises the Seminars in Hearing report. This may require repeated messaging about how hearing loss is permanent and, left untreated, is tied to worse overall health outcomes. >> 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, use social media, and in general have open discussions about existing knowledge, attitudes, and experiences toward loud noise.

2. 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 in 2013, three-quarters reported noise-induced tinnitus as an immediate result of loud noise exposure. The presence of phantom sounds after loud noise exposure, even in the absence of hearing loss, is linked to early hearing damage.

Interestingly, research shows that immediate, selfexperienced symptoms such as tinnitus and sound sensitivity often lead young people to change their attitudes and behavior toward healthy hearing practices rather than hearing loss, as shown in an International Journal of Audiology study surveying U.S. college students back in 2009 and 2013 Swedish research in Noise & Health.

Young people who 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 the Belgium paper.

Noise-induced tinnitus is highly prevalent among young people, and being aware of these symptoms is likely to improve their attitude and behavior regarding healthy hearing practices. We can place a strong emphasis on educating and raising awareness of noise-induced tinnitus and other self-experienced, noise-related auditory symptoms such as muffled hearing following a loud concert.

Noise-induced tinnitus, no matter how transient or temporary, often indicates an early stage of hearing damage and serves as a warning. Hearing Health Foundation’s Keep Listening campaign has posed the question on social media: “Walking out of a concert with your ears ringing is normal, right? But walking out of something with your vision blurry would be scary, right?”

3. Engage with younger age groups such as elementary and middle school students.

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, according to 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 the dangers of loud noise exposure among young children can prevent noiseinduced hearing damage in the future. Young people’s attitudes toward recycling, for example, have been shaped by early exposure to prosocial messaging.

We can encourage and motivate the younger generation about the importance of safe hearing practices by recruiting older peers to deliver the message of healthy hearing, and, with educators, devising classroom lessons that illustrate the importance of healthy hearing.

If we were able to convince young people about the dangers of cigarette smoking and excess sun exposure, I am hopeful that we can also create a culture shift around hearing and hearing protection.

Rohima Badri, Ph.D., lives in New Jersey. She is a hearing healthcare adviser for HHF’s Keep Listening prevention campaign. For more, see hhf.org/keeplistening. For references, see hhf.org/fall2022-references.

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