Gilles_etal_2012_UniversityStudents.pdf

7/25/2019 Gilles_etal_2012_UniversityStudents.pdf

1/8

Prevalence of Leisure Noise-Induced Tinnitus and the

Attitude Toward Noise in University Students

*Annick Gilles, Dirk De Ridder, Guido Van Hal, Kristien Wouters,

*Andrea Kleine Punte, and *Paul Van de Heyning

*University Department of Otorhinolaryngology and Head and Neck Surgery, andTinnitus Research Initiative

Centre, BRAI2N, Antwerp University Hospital, Edegem; Department of Epidemiology and Social Medicine,

Medical Sociology and Health Policy, University of Antwerp, Wilrijk; and Department of Medical

Management, Statistical Analysis, Antwerp University Hospital, Edegem, Belgium

Background: Adolescents and young adults often are exposedto potentially damaging loud music during leisure activities.As a consequence, more and more young adults suffer from tin-nitus, hearing loss, and hyperacusis. The present study providesprevalence numbers for noise-induced tinnitus (NIT) in this group,the attitude toward loud music, and the factors influencing the useof hearing protection (HP).Method: A questionnaire was undertaken to evaluate the influ-ence of permanent/transient tinnitus after loud music, the attitudestoward noise, influence of peers, and the ability to manipulateHP on the use of HP. The questionnaire was completed by 145university students.Results:Approximately 89.5% of the students had experiencedtransient tinnitus after loud music exposure. The prevalence

of transient NIT was higher in female subjects compared withmale students. Permanent NIT was experienced by 14.8%.Nevertheless, few respondents were worried, and the degreeof HP use was low (11%). However, the presence of perma-nent tinnitus was a motivation for HP use. Most respondentsheld a neutral to positive attitude (i.e., pronoise) toward loudmusic and were not fully aware of the risks of too much noiseexposure.Conclusion:NIT is a commonphenomenon among young adults.The lack of knowledge in young adults and the underuse of HPin leisure activities provide useful information to refine preven-tive measures in the future. Key Words: EpidemiologyVHearingprotectionVNoise-induced tinnitusVYoung adults.Otol Neurotol00:00Y00, 2012.

Listening to loud music, whether at concerts, parties,night clubs, or through personal listening devices (PLDs),has become a widespread phenomenon among adolescentsand young adults. Many young adults consciously exposethemselves to potentially damaging loud music duringleisure activities. Although industrial regulations stateactions in the form of hearing protection (HP) and com-pulsory protective actions whenever workers are exposedto noise more than 85 dB(A) for 8 hours a day (1), themean sound levels of PLDs, night clubs, concerts, and

festivals are much higher (2). A Swiss study on the thoughtstoward electronically amplified music of young peopleaged 16 to 25 found that 79% of the adolescents regularly

visited night clubs, of which, a quarter spent 8 hours ormore in a discotheque (3). As discotheque sound levelsrange from 104 to 112 dB(A) (4), permanent hearingdamage can be established within seconds (3). In addi-tion, sound levels in night clubs increase during the nightby 2 dB(A) per hour (5). Another study determined thatthe typical PLD listener sets the volume at a range be-tween 75 and 105 dB(A) (6). In addition, many adoles-cents regularly attend pop and rock concerts indoors orat open air festivals where continuously sound levels of

100 to 115 dB(A) have been reported (7).Because of the evolvement into many leisure activities,young adults between 16 and 25 years old are more likelyto expose themselves to loud music (4,8). As a consequence,the prevalence of noise-induced hearing loss (NIHL) inadolescents and young adults increased tremendously overthe last years. In the Third National Health and NutritionExamination Study (NHANES III), conducted from 1988 to1994, 5,249 US children aged 6 to 19 years received puretone audiometry and compliance testing for both ears.Approximately 12.5% of the children demonstrated a

Address correspondence and reprint requests to Annick Gilles, M.A.,Department of Otorhinolaryngology, University Hospital Antwerp,Wilrijkstraat 10, 2650 Edegem, Belgium; E-mail: [email protected]

This research is financially supported by the Stavros Niarchos Foun-dation for tinnitus research in adolescents and young adults.

The authors have no conflict of interest and are not financially sup-ported by other organizations than the Stavros Niarchos Foundation.

Otology & Neurotology00:00Y00 2012, Otology & Neurotology, Inc.

1

Copyright 2012 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.


2/8

noise-induced threshold shift, identified by a noise notchconfiguration on the audiogram (9). Subsequently, theNHANES 2005Y2006 revealed an increase of noise-induced threshold shifts among female youths comparedwith the previous study. Similar findings were found byBerg and Serpanos (2011) (10). Besides hearing loss, othersymptoms such as ear pain, noise sensitivity, and tinnitushave been mentioned as a result of excessive noise expo-sure (8,11Y13). Widen and Erlandsson (2004) (8) founda prevalence of 8.7% of noise-induced permanent tinnitusin high-school students aged 13 to 19 years. Other re-searchers reported that the majority of young adults haveexperienced transient tinnitus after attending concerts andclubs. The prevalence of tinnitus, in the absence of othercomplaints, after loud music exposure in young people isreported by several studies and ranges from 60% to 85%(3,7,8,14Y19). However, tinnitus in the absence of hear-ing loss (HL) often is accompanied by cochlear and/orneural damage, which is not always perceived by the in-dividual nor measurable by a classical audiogram (20). The

experience of transient tinnitus after loud music may thusbe a relevant precursor for future symptoms such as HL,permanent tinnitus, or hyperacusis (20Y22).

Despite the fact that tinnitus after loud music is a resultof overexposure, adolescents do not always take tinnitusinto account as a warning sign. As a consequence, manylack the motivation to wear HP in noisy environments(8,15,16,23Y25). In addition, most adolescents are heed-less of hearing symptoms after loud music. In a study ofWiden and Erlandsson (2004) (8), nearly 25.9% of young-sters experiencing tinnitus after loud music reported to beworried about noise levels in discotheques and at concerts.When experiencing a combination of tinnitus and hyper-acusis, half of the respondents reported to be worried in these

conditions, and 7.9% of participants with no such symptomsreported to be worried about it (8).It is unclear whether making adolescents more aware

of the risks of loud music is sufficient for them to takeprecautions in the future (such as the use of HP). How-ever, a hearing education campaign does not seem toprompt high school students to display hearing-protectivebehavior when attending a discotheque (26) or changetheir noise exposure in general (27). Evaluating the at-titude of young people toward loud music is obligatoryto understand their behavior in noisy situations. Therefore,the Youth Attitude Toward Noise Scale (YANS) was de-veloped (8). This is a 19-item validated scale dealing withdifferent types of common sounds in adolescents envir-

onments. All items are formulated in the form of state-ments and are measured on a five degree Likert Scale,where 1 means totally disagree, and 5 means totallyagree (8,28). Higher scores on the scale imply a pro-noise attitude, which means noise is regarded as some-thing positive where lower scores imply a more antinoiseattitude where noise is regarded as something negative. Itis assumed that adolescents experiencing hearing symp-toms, such as tinnitus, therefore develop more antinoiseattitudes because loud music or environmental sounds areexperienced as unpleasant. A possible effect is that their

self-image may alter, so they perceive themselves as vul-nerable to noise. As a consequence, they would start usingHP, as opposed to individuals who have no hearing symp-toms experiences and, therefore, do not feel the need toprotect themselves (29). Factor analysis showed that theYANS has 4 dimensions: 1) attitudes toward noise as-sociated with youth culture, for example, loud music atconcerts or discotheques; 2) attitudes toward the ability toconcentrate in a noisy environment; 3) attitudes towarddaily noises, for example, traffic noise; and 4) attitudestoward influencing the sound environment (8).

The increase of NIHL in the last 20 years (12) and thefinding that more and more young adults find their wayto the hospital after acoustic trauma with symptoms ofhearing loss, tinnitus, and hyperacusis raise questionswhether young people are well enough informed con-cerning the risks of loud music exposure. Our main goalwas to assess the prevalence of noise-induced tinnitus(NIT) in a young population as a parameter for overex-posure to noise. In addition, the effect of the attitudes

toward noise and HP on the intention to protect theirhearing was assessed. The increase in hearing problemsin this age group might be explained by understandingcertain elements such as the attitude of young peopletoward noise and HP, which should be taken into accountin the attempt to make young adults more aware of the risksof loud music.

METHODS

A survey by questionnaire was undertaken at the otorhino-laryngology (ORL)departmentof the University Hospital Antwerpand theUniversity of Antwerp in March 2011. Demographic data,such as sex and age, were collected. The study was approved bythe University Hospital Antwerp institutional review board.

QuestionnaireThe survey contained questions about the occurrence of tem-

porary tinnitus after loud music and the duration of tinnitus. Theloudness of tinnitus was evaluated by a Visual Analogue Scale(VAS) going from 0 (no tinnitus) to 10 (extremely loud, unbear-able tinnitus). The presence of permanent tinnitus was evaluatedby a yes-no question:Do you permanently experience tinnitus?Two questions assessed tinnitus and hearing problems: After Ispent minimum 30 minutes in a noisy environment (e.g., dis-cotheque, party, iPod etc.)I: 1) I have the feeling my hearingdecreased. 2) Im afraid the tinnitus will not disappear. Answerpossibilities were always, often, sometimes, andnever. Frequency of discotheque attendance was evaluated byasking whether one visits a discotheque daily, weekly, monthly,

or yearly. A possibility of not applicable was included forthose who never attend night clubs. To evaluate the thoughts andattitudes of young people toward loud music, a Dutch adaptedvalidated version of the Youth Attitude to Noise Scale (8,30)was included in this study. All 19 items of the YANS werescored on a 5-point Likert scale going from totally agree tototally disagree.

The intention to wear HP in the future, the influence of peersand the behavior toward HP was evaluated by the items givenin Table 1. All items presented were scored, analogous to theYANS scoring, on a 5-point Likert scale going from totallyagree to totally disagree.

2 A. GILLES ET AL.

Otology & Neurotology, Vol. 00, No. 00, 2012



3/8

Participants and ProcedureThe questionnaire was distributed to 160 university students

completing a Bachelor or Master degree in medicine at theUniversity of Antwerp. Fifteen students did not return or com-plete the questionnaire and, thus, were considered as internal

dropouts (response rate, 90.6%). The group was composed of44 male students and 101 female students. The age of thestudents ranged from 19 to 26 with a mean age of 20.77 ( T1.54)years. The questionnaires were administered at a lecture andcompleted immediately. It was instructed that the classroomremained silent while completing the questionnaire.

Statistical AnalysisFor the statistical analysis a Statistical Software package

(SPSS 17.0, Inc., Chicago, IL, USA) was used to performdescriptive statistics and Spearman correlations. In addition, acumulative logit model was used to verify the relationshipbetween the different parts (YANS, influence of peers, behaviortoward HP, and knowledge) of the survey and the intention towear HP. Values were considered significant when p e 0.05.

RESULTS

The experience of permanent tinnitus in 1 or both earswas reported by 21 respondents, corresponding to 14.8%

of the total study group. No significant sex differencesin prevalence of permanent tinnitus were found. Most stu-dents experiencing permanent tinnitus scored their tinnitusloudness low on the VAS as the mean score was 1.86(T1.25) as a consequence of 17 of 21 students rating theirtinnitus as 1 (very silent, just detectable). Four respon-dents rated their tinnitus loudness 3 or more including1 individual scoring 6 on the VAS. Transient tinnituswas experienced by 89.5% for at least once after beingexposed to loud music. Transient tinnitus was significantlymore prevalent in female students opposed to male stu-dents, with respective prevalence numbers of 92.9% and81.8%. Female respondents also scored significantlyhigher on the VAS for transient tinnitus compared withmale students with mean VAS scores, respectively, 3.78(T2.18) and 2.98 (T2.34).

Most university students frequently visit night clubs orparties. The prevalence of discotheque visits on yearly,monthly, weekly, and daily basis were 33.1%, 26.2%,9.7%, and 27.6%, respectively. The remaining 3.4%

ticked the not applicable answer. The attitude towardloud music was evaluated by the YANS; 25.9% of allstudents showed a pronoise attitude, whereas 27.3%showed an antinoise attitude. The remaining students(46.8%) had a neutral attitude toward noise, meaning theywere neither positive nor negative. There was no corre-lation between the score of the entire YANS and thepresence of neither permanent nor temporary tinnitus.Furthermore, the results of the YANS were analyzed bysex. Mean scores of the factors separately and the entireYANS are presented in Table 2, by sex and for the totalgroup. No sex differences were present except for factor3 where female students scored significantly lower thanthe male subjects (p= 0.013; >= 0.05). In addition, female

subjects scored significantly (p= 0.016) lower on the firstitem (I think that the sound level at discos, dances, rockconcerts and sporting events, in general, is too loud).One hundred students corresponding with 68.5% of therespondents judged the statement Exposure to loudmusic can damage my hearing as totally agree. This

TABLE 1. Questions concerning hearing protection

Intentions to wear HP in the future- I will use hearing protection in the future.

Influence of peers- My friends never wear hearing protection.- My friends think it is a good idea to wear hearing protection.

Behavior toward HP

- Hearing protection puts too much pressure on my ears.- I know how to use hearing protection.- Wearing hearing protection is uncomfortable.- I am not sure when hearing protection needs to be replaced.- I know in which situations I should use hearing protection.- Hearing protection reduces my ability to communicate with others.- Wearing hearing protection is annoying.

Knowledge about the consequences of loud music- Exposure to loud music can damage my hearing

TABLE 2. Mean scores for the entire Youth Attitude Toward Noise Scale and the 4 factors separately for male and female students,including indications whether the difference between male and female scores were significant

Mean Standard deviation p value

F1: attitudes toward noise associated with elements of youth culture Total 2.60 0.48Men 2.67 0.48

Women 2.58 0.47 NSF2: Attitudes toward the ability to concentrate in noisy environments Total 3.05 0.99

Men 3.11 1.00Women 3.05 0.97 NS

F3: attitudes to daily noises Total 2.79 0.64Men 2.73 0.80

Women 2.81 0.56 NSF4: attitudes toward influencing the sound environment Total 2.19 0.60

Men 2.44 0.60Women 2.09 0.56 0.002

Entire Youth Attitude Toward Noise Scale score Total 2.61 0.33Men 2.70 0.30 NS

Women 2.58 0.32

NS indicates not significant.

3PREVALENCE OF LEISURE NOISE-INDUCED TINNITUS




4/8

means that one would expect that young adults are wellaware of the risks of loud music, and there is sufficientknowledge of the risks concerning loud music. Table 3reports on the answers to the questions after having spentat least 30 minutes in loud music I I 1) have the feelingmy hearing decreased; 2) fear that the tinnitus will notdisappear. Approximately 66.2% of the students reportto experience decreased hearing after loud music some-times, often, or always. Nevertheless, 66.4% never fearsfor permanent tinnitus. Table 4 shows the results of thecumulative logit model with intention to wear HP as

dependent variable and attitudes (YANS), items ques-tioning the influence of peers, behavior toward HP, andknowledge as covariates (predictors). The items of beha-vioral toward HP and peers influence had a significantinfluence; the attitudes were almost significant, and knowl-edge was not significant. The model suggests that peersinfluence and behavior toward HP have the most influenceontheintentionstowearHP.

DISCUSSION

The percentage of young adults with permanent tin-nitus is rather high. However, other studies also found a

relatively high prevalence of tinnitus in a young popu-lation. Figure 1 illustrates the results of the present studycompared with previous research (3,7,8,14,15,17,19,31).The results of these studies show a lot of resemblanceswith the present article as many also found a high pre-valence of NIT in a young population, but a few differ-ences should be highlighted. The results of Widen andErlandsson (8) show the greatest difference with the pre-sent article. This is because of the narrower definition oftemporary tinnitus used by Widen and Erlandsson as tin-nitus should persist for more than 24 hours. Approximately21.6% of the respondents (n = 1285) reported transienttinnitus under these circumstances, and most hearingproblems and tinnitus were present after conce rts and

discotheque visits. In the present study, the duration of

temporary tinnitus was not defined, so also tinnitus per-

sisting for a few minutes was included. The purpose of thiswide definition was to include those individuals whoclearly have been exposed to loud music, which is notalways objectively measurable (20) but does translate intosubjective temporary tinnitus. Hearing symptoms, such astinnitus, are more common among older adolescents thanyounger adolescents, probably because of the longer per-iod of noise exposure (8,19). The present study focused ona group of university students, with a higher mean agecompared with study B, E, F, and G presented in Figure 1,which might also explain the greater prevalence of per-manent and transient tinnitus found in the present study.

A 3-fold increase of tinnitus report in subjects withsignificant social noise exposure (Q97 dB NIL) also was

previously reported (32). The discotheque and party at-tendance in the present study group was rather large.Therefore, these students are frequently exposed to harmfulnoise levels resulting in an increase of permanent and tem-porary tinnitus. In contrast, students who regularly visitnight clubs or parties rarely wear HP. Nevertheless, dis-cotheque attendance has repeatedly been reported as themain cause of symptoms such as tinnitus, ear pain, andhearing loss (8,14,15,17) after loud music exposure. Ex-periencing otologic symptoms as a cause of loud musicdoes not seem a determining factor for the use of HP.Possibly ones personal attitude toward loud music is amore adequate precursor for the use of HP. Nevertheless,an individuals behavior is not solely dependent on ones

attitudes toward a particular behavior.

TABLE 3. Reported hearing decrement and fear of perma-nent tinnitus

After having spent 30 minutesin loud music I I

Never(%)

Sometimes(%)

Often(%)

Always(%)

think my hearing is decreased 33.6 43.8 15.8 6.2am afraid the tinnitus will not

disappear

66.4 24.0 3.4 2.7

TABLE 4. Cumulative logit model

95% Wald confidence interval Hypothesis test

Parameter B Standard error Lower Upper Wald W2 Significance

Youth Attitude Toward Noise Scale 0.997 0.5219 -0.026 2.020 3.647 0.056Peers influence 0.959 0.2093 0.549 1.369 20.990 0.000Behavior toward hearing protection 0.911 0.,3208 0.283 1.540 8.073 0.004Knowledge risks -0.464 0.3713 -1.192 0.263 1.565 0.211

FIG. 1. Summary of prevalence numbers of transient and tem-porary tinnitus in previous research (B to I) compared with thepresent article (A).

4 A. GILLES ET AL.




5/8

Azjens theory of planned behavior (TPB) (33) is oneof the most influential models for the prediction of humansocial behavior (34). The TBP states that ones attitudetoward performing a specific behavior is a predictor of anintention (33). Intention is influenced by attitudes, sub-jective norms, and perceived behavioral control towardthe behavior. Attitudes are regarded as beliefs about theoutcome determined by positive or negative evaluationof self-performance of the particular behavior. A sub-jective norm is the extent to which an individuals per-ception about the particular behavior is influenced bysignificant others (parents, peers, teachers, etc.) weigh-ted by the compliance with such influence. Such a sub-jective norm might be the advice of peers to wear HP innoisy situations. Perceived behavioral control is an indi-viduals belief about the presence of factors that facilitateor impede the performance of the health-related behavior(35). The analysis performed in the present study can beplaced in the vision of the TPB where attitudes wereevaluated through the YANS, subjective norms by the

items concerning peers influence and the perceivedbehavioral control by the items scoring behavior towardHP. Analyses of the YANS showed that most studentshad a neutral-to-positive attitude toward noise. Studentswith an antinoise attitude, where loud music is regardedas something dangerous, showed a significantly higherdegree of HP use compared with the positive group.Therefore, the multinomial logit model, performed in thepresent article, confirms the influence of attitudes on HPuse. However, thep value was not so strong (p = 0.054).This in contrast to earlier research implementing the TPBconstructs where attitudes toward a certain health-relatedbehavior had the strongest effect on intentions (33,36).This might be due to the fact that young adults are still

quite unaware of the consequences of loud music. Althoughmost respondents claimed loud music can cause damage totheir hearing, the degree of worrying about tinnitus anddecreased hearing after loud music is low, suggesting thatyoung adults are notso well informed after all. Therefore,the lack of attitude change might be a result of inadequateknowledge. As being well informed is a prerequisite foreffective action to produce desired outcomes (37), thisopens perspectives for future educational programs con-cerning this theme.

The finding that most students are quite neutral towardnoise-induced symptoms is confirmed by earlier researchof Quintanilla-Dieck et al. (14) who analyzed a total of2500 surveys completed by visitors of the MTV web site.

In this survey, several health issues that involve youngpeople (drug/alcohol use, cigarette smoking, sexuality,nutrition/weight loss, depression, acne, and sports-relatedinjuries) were believed to be a more important concerncompared with hearing loss. Moreover, all categories wererated to be more of a concern to the general population thanas a personal threat. Another study found that merely 8%of the respondents defined hearing loss as a big problemcompared with other health issues (15). During the past fewyears, there has been a lot of media attention to the problemof NIHL and other ear-related symptoms such as tinnitus

in an attempt to increase the awareness among adolescents.In the past, adolescents have indicated to be willing to useHP if they would be more aware of the risks of loud musicor advised by a medical professional (14,15). In the presentstudy, also, 24.7% of the students declared they will useHP in the future, whereas another 35.6% is consideringdoing so. This means that more than half of the studentsclaim to have the intention to protect their hearing, whichis in extreme contrast to the percentage of those actuallyusing HP (11%). The analysis showed that the influenceof peers and the behavior toward HP are strong predictorsfor the actual use of HP. The authors like to point out that,although the results of the current questionnaire werelooked upon through the TPB, several disparities with theTPB construct guidelines were present. First, a TPB as-sessment is usually performed on a 7-point bipolar adjec-tive scale, whereas in the present study, a 5-point Likertscale was applied. Second, the TPB states that 5 to 6 itemsare required for each construct. This criteria was met fortheevaluation ofattitudes (19 itemsof the YANS)andper-

ceived behavioral control (7 items) but not for subjectivenorms(2 items).However,in ouropinion,itis notnecessaryto follow the TPB guidelines strictly to identify influencingfactors for a certain social behavior. Other studies havebeen performed also not completely following the strictguidelines of the TPB (36). Nevertheless, the use of theidea of the TPB is useful for the explanation of the behaviorof young people and the factors influencing HP use.

A limitation of this study was that the sample populationwas limited to university undergraduate students and con-tained (by coincidence) a relatively large proportion offemale students. As only few sex differences were found,chances are small that this caused biasing. In addition, theprevalence of permanent tinnitus must be interpreted

with caution. The role of noise is not clear as the presenceof permanent tinnitus was assessed with a yes-no question,the etiology of the permanent tinnitus was not questioned,and pre-existing conditions were unknown. The prevalenceof permanent tinnitus is therefore a general prevalenceincluding all possible causes. In the future, a larger pop-ulation will be targeted containing also high school stu-dents withdifferent backgrounds and educational programs.

CONCLUSION

In summary, our findings revealed that a large pro-portion of young adults experiences NIT, but this does

not result in the use of HP, possibly because of a lackof knowledge concerning the risks of loud music. Thepresent article underlines the importance of hearing damagein young adults. Its novelty is to increase our knowledgeabout why HP is not used in individuals regularly exposedto loud music. The use of the idea of the TPB provideselucidation of this paradox and helps to identify the factorsassociated with performing a certain behavior and, thus,providing suggestions toward improvement of preventivecampaigns. In the future, campaigns must provide suffi-cient information concerning the risks of loud music and





6/8

focus on tinnitus as a sign of overexposure. Young adultsshould consider tinnitus as alarming instead of a naturalconsequence of loud music. This is a first step to chan-ging the attitudes toward noise to achieve an increaseof HP use in this population.

Acknowledgments:The authors thank the Stavros NiarchosFoundation for financial support for tinnitus research in ado-lescents and young adults. The authors also thank Jasna Peetersand Berina Ihtijarevic, two master students of Medicine, forcooperation in the distribution of the questionnaires. Finally,the authors also thank the 2 reviewers for their useful commentsand advice.

REFERENCES

1. Centers for Disease and Prevention/NIOSH. Criteria for a Re-commended Standard: Occupational Noise Exposure Revised Cri-teria. Cincinnati, OH:US Department of Healthand Human Services;1998.

2. Vogel I, Brug J, Van der Ploeg CP, et al. Prevention of adolescents

music-induced hearing loss due to discotheque attendance: a Delphistudy.Health Educ Res 2009;24:1043Y50.

3. Mercier V, Hohmann BW. Is electronically amplified music tooloud? What do young people think? Noise Health 2002;4:47Y55.

4. Serra MR, Biassoni EC, Richter U, et al. Recreational noise expo-sure and its effects on the hearing of adolescents. Part I: an inter-disciplinary long-term study. Int J Audiol 2005;44:65Y73.

5. Babisch W, Ising H. Music listening habits of adolescents. Withspecial reference to discotheque exposure. HNO 1994;42:466Y9.

6. Kageyama T. Loudness in listening to music with portable head-phone stereos. Percept Mot Skills 1999;88:423.

7. Meyer-Bisch C. Epidemiological evaluation of hearing damagerelated to strongly amplified music (personal cassette players, dis-cotheques, rock concerts)Yhigh-definition audiometric survey on1364 subjects.Audiology 1996;35:121Y42.

8. Widen SE, Erlandsson SI. Self-reported tinnitus and noise sensi-tivity among adolescents in Sweden. Noise Health2004;7:29Y40.

9. Niskar AS, Kieszak SM, Holmes AE, et al. Estimated prevalence ofnoise-induced hearing threshold shifts among children 6 to 19 yearsof age: the Third National Health and Nutrition Examination Sur-vey, 1988-1994, United States. Pediatrics2001;108:40Y3.

10. Berg AL, Serpanos YC. High frequency hearing sensitivity inadolescent females of a lower socioeconomic status over a period of24 years (1985-2008). J Adolesc Health 2011;48:203Y8.

11. Holgers KM, Juul J. The suffering of tinnitus in childhood andadolescence.Int J Audiol2006;45:267Y72.

12. Harrison RV. Noise-induced hearing loss in children: a less thansilent environmental danger.Paediatr Child Health 2008;13:377Y82.

13. Henderson E, Testa MA, Hartnick C. Prevalence of noise-inducedhearing-threshold shifts and hearing loss among US youths.

Pediatrics 2011;127:e39Y46.14. Quintanilla-Dieck ML, Artunduaga MA, Eavey RD. Intentional

exposure to loud music: the second MTV.com survey reveals anopportunity to educate. J Pediatr 2009;155:550Y5.

15. Chung JH, Des Roches CM, Meunier J, et al. Evaluation of noise-induced hearing loss in young people using a web-based surveytechnique.Pediatrics 2005;115:861Y7.

16. Bogoch II, House RA, Kudla I. Perceptions about hearing protec-tion and noise-induced hearing loss of attendees of rock concerts.Can J Public Health 2005;96:69Y72.

17. Zocoli AM, Morata TC, Marques JM, et al. Brazilian young adultsand noise: attitudes, habits, and audiological characteristics. Int J

Audiol2009;48:692Y9.

18. Maassen M, Babisch W, Bachmann KD, et al. Ear damage causedby leisure noise.Noise Health2001;4:1Y16.

19. Jokitulppo JS, Bjork EA, kaan-Penttila E. Estimated leisure noiseexposure and hearing symptoms in Finnish teenagers.Scand Audiol1997;26:257Y62.

20. Weisz N, Hartmann T, Dohrmann K, et al. High-frequency tinnituswithout hearing loss does not mean absence of deafferentation.

Hear Res 2006;222:108Y14.

21. Kujawa SG, Liberman MC. Acceleration of age-related hearing lossby early noise exposure: evidence of a misspent youth. J Neurosci2006;26:2115Y23.

22. Kujawa SG, Liberman MC. Adding insult to injury: cochlear nervedegeneration after WtemporaryW noise-induced hearing loss. J Neu-rosci 2009;29:14077Y85.

23. Crandell C, Mills TL, Gauthier R. Knowledge, behaviors, andattitudes about hearing loss and hearing protection among racial/ethnically diverse young adults.J Natl Med Assoc 2004;96:176Y86.

24. Daniel E. Noise and hearing loss: a review. J Sch Health 2007;77:225Y31.

25. Widen SE, Holmes AE, Erlandsson SI. Reported hearing protectionuse in young adults from Sweden and the USA: effects of attitudeand gender.Int J Audiol 2006;45:273Y80.

26. Weichbold V, Zorowka P. Effects of a hearing protection campaignon the discotheque attendance habits of high-school students. Int

J Audiol2003;42:489Y93.

27. Weichbold V, Zorowka P. Can a hearing education campaignfor adolescents change their music listening behavior?Int J Audiol2007;46:128Y33.

28. Olsen SE. Psychological aspects of adolescents perceptions andhabits in noisy environments. 2004. Licenciate dissertation (unpub-lished). Department of Psychology, University of Goteborg, Sweden.

29. Widen SE, Holmes AE, Johnson T, et al. Hearing, use of hearingprotection, and attitudes towards noise among young Americanadults.Int J Audiol2009;48:537Y45.

30. Keppler H.Optimization of the diagnosis of noise-induced hearing

loss with otoacoustic emissions. Thesis/Dissertation, 2010. Uni-versity Ghent.

31. Bohlin MC, Erlandsson SI. Risk behaviour and noise exposureamong adolescents.Noise Health 2007;9:55Y63.

32. Davis AC, Lovell EA, Smith PA, et al. The contribution of socialnoise to tinnitus in young people - a preliminary report.Noise Health1998;1:40Y6.

33. Ajzen I, Fishbein M.Understanding Atittudes and Predicting SocialBehavior. Englewood Cliffs, NJ: Prentice Hall; 1980.

34. Ajzen I. The theory of planned behaviour: reactions and reflections.Psychol Health 2011;26:1113Y27.

35. Ajzen I. The theory of planned behavior.Organ Behav Hum DecisionProc1991;50:179Y211.

36. Dumitrescu AL, Wagle M, Dogaru BC, et al. Modeling the theory ofplanned behavior for intention to improve oral health behaviors: theimpact of attitudes, knowledge, and current behavior. J Oral Sci2011;53:369Y77.

37. Ajzen I, Joyce N, Sheikh S, et al. Knowledge and the prediction ofbehavior: the role of information accuracy in the theory of plannedbehavior.Basic Appl Soc Psychol 2011;33:101Y17.

6 A. GILLES ET AL.




7/8

APPENDIX: TRANSLATED QUESTIONNAIRE

Youth Attitude Toward Noise Scale (YANS)

Totallyagree

Partlyagree Neutral

Partlydisagree

Totallydisagree

1. I think that the sound level at discos, dances, rock concerts and sporting events, ingeneral, is too loud.

2. Listening to music while doing homework helps me concentrate.3. I am prepared to do something to make the school environment quieter.4. I consider leaving a disco, rock concert, dance or sporting event if the sound level is

too loud.5. I can concentrate even if there are many different sounds around me.6. I think it is unnecessary to use earplugs when I am at a disco, rock concert, dance or

sporting event.7. It is important for me to make my sound environment more comfortable.8. I dont like when it is quiet around me.9. The sound level at discos, dances, rock concerts or sporting events is not a problem.10. Noise and loud sounds are natural parts of our society.11. Traffic noise is not disturbing to me.12. The sound level should be lowered at discos, rock concerts, dances or sporting

events.13. I think it should be quiet and calm in the classroom.

14. Sounds from fans, refrigerators, computers, etc., do not disturb me.15. I am prepared to give up activities where the sound level is too loud.16. The sound level at my school is comfortable.17. It is easy for me to ignore traffic noise.18. There should be more rules or regulations for the sound levels in society. (F1-)19. When I cannot get rid of sounds that bother me, I feel helpless.

Olsen-Widen S.E. & Erlandsson S.I. (2004). Youth Attitude Toward Noise Scale (YANS). In: Olsen S.E (2004). Psychological aspects ofadolescents perceptions and habits in noisy environments. Licentiate dissertation. Department of Psychology, University of Goteborg, Sweden.

Questions concerning hearing protection

Totally agree Partly agree Neutral Partly disagree Totally disagree

Intentions to wear HP in the future- I will use hearing protection in the future

Influence of peers- My friends never wear hearing protection- My friends think it is a good idea to wear hearing protection

Behavior toward HP- Hearing protection puts too much pressure on my ears- I know how to use hearing protection- Wearing hearing protection is uncomfortable- I am not sure when hearing protection needs to be replaced- I know in which situations I should use hearing protection- Hearing protection reduces my ability to communicate with others- Wearing hearing protection is annoying

Knowledge about the consequences of loud music- Exposure to loud music can damage my hearing

Questions concerning tinnitus

Yes No

I always experience tinnitus

After having spent 30 minutes in loud music I I Never Sometimes Often Always

think my hearing decreasedam afraid the tinnitus will not disappear





8/8

Point out below how loud the tinnitus is after at least 30 minutes of loud music exposure (0 = no tinnitus; 10 = unbearable)

Right ear

g g g g g g g g g g g

0 1 2 3 4 5 6 7 8 9 10

Left ear

g g g g g g g g g g g

0 1 2 3 4 5 6 7 8 9 10

How long does the tinnitus persist after loud music exposure?

gLess than 30 minutesgbetween 30 minutes and 2 hoursgbetween 2 hours and 6 hoursgbetween 6 hours and one daygmore than one daygnot applicable

How often do you visit a discotheque/ night club?

gdailygweekly

gmonthlygyearlygnot applicable

8 A. GILLES ET AL.


Gilles_etal_2012_UniversityStudents.pdf

Documents

Transcript of Gilles_etal_2012_UniversityStudents.pdf