The purposes of the study were to investigate children's knowledge about hearing conservation, the types of protective behaviors they would adopt in noise, the agreement between children's knowledge and intended behaviors in hearing protection, and reasons why they would not take any protective action in noise. A questionnaire was administered to 479 fourth and fifth graders in their school classrooms. Results indicated that children scored low (62.0%) on this hearing conservation questionnaire. They scored the highest in strategies of hearing protection (69.9%), followed by their knowledge in general hearing health (62.6%) and noise hazards (49.6%). Only 55% of children knew that hearing protective devices could protect them against noise. Approximately 28% of children did not intend to adopt any protective behavior in noise and the major reason for this was lack of knowledge. Children's knowledge and their noise protective behavior were correlated ( P < .05). However, possessing knowledge did not guarantee that children would adopt such behaviors when they were exposed to loud sounds. It is important to increase children's knowledge about hearing protection and hazardous noise as well as to encourage actual protective actions.
Keywords: Behavior, elementary school children, hearing conservation, knowledge, questionnaire survey
|How to cite this article:|
Chen H, Huang M, Wei J. Elementary school children's knowledge and intended behavior toward hearing conservation. Noise Health 2009;11:54-8
| Introduction|| |
If adults are exposed to excessive sound levels for certain amounts of time at work, their employers are regulated by the U.S. Occupational Safety and Health Administration (OSHA) to provide a hearing conservation program to protect them against noise. , Even though children are often exposed to high intensity sounds , that might result in their hearing thresholds being elevated , and causing negative effects on their physiology, psychology, and learning, , there are no federal regulations to protect children against noise. , Children's exposure to noise requires more attention, not only because of the above mentioned reasons, but also because textbooks and classroom curricula do not cover sufficient information about hearing protection in noise.  Many teachers lack knowledge on this topic, and are therefore unlikely to provide hearing conservation information to their students.  Educational hearing conservation programs are powerful tools that have demonstrated effectiveness. ,,,, However, unless these programs are specially requested, they are seldom implemented by schools and teachers. In many situations, noise-related threshold changes are avoidable. It is likely that children are susceptible to noise-induced threshold shift (NITS) and noise-induced hearing loss (NIHL) if they do not have adequate knowledge of hearing conservation practices. How well informed are children about noise hazards? Are they informed about hearing protection? The purposes of the study were to investigate children's knowledge about hearing protection, noise hazards, general hearing health, the types of protective actions they intended to adopt in noise, the correlation between children's knowledge of and intended behaviors regarding hearing protection, how many of them intended to take action to protect their hearing in noise, and reasons why they would not take any protective action in noise.
| Materials and Methods|| |
Four hundred and seventy nine fourth and fifth graders from 11 elementary schools participated in the study. Participants were 254 boys (53.03%) and 225 girls (46.97%). The average age was 10.51 years (SD = .60) for boys and 10.48 years (SD = .58) for girls. Eleven children (2.3%) reported having had ear diseases in the past. Only 95 children (19.8%) had previous hearing tests and four of them had significant hearing loss. Forty nine children (10.2%) reported difficulty in discriminating fricative and affricative sounds.
A Hearing Conservation Questionnaire (HCQ) was developed for the study and consisted of four sections: (I) basic information, (II) knowledge about hearing, noise hazards, and hearing protection, (III) intended behaviors in noise, and (IV) reasons why children would not take protective actions in noise (Appendix).
For the basic information section, section I, children filled in their age, gender, history of ear diseases, history of hearing testing, and two questions regarding whether they being aware of any hearing difficulty.
The knowledge section, section II, included 21 items and could be scored in three different subtests: general hearing health (6 items), noise hazards (6 items), and hearing protection (9 items). Children answered "yes", "no", or "do not know" on each item. "Do not know" was considered as an incorrect answer.
Intended behavior in noise, section III, involved only one item: "What kind of behaviors you intend to adopt in noise" with six possible answers. Children could choose more than one of these responses: "use earplugs", "walk away", "block ears with fingers", "shorten staying duration", "move to quieter places", and "do nothing". The previous 5 answers correspond with items 3, 6, 12, 1, and 19 in the knowledge section (section II). The consistency in each set of answers was used for analyses of agreement between intended behavior and knowledge of hearing protection.
In the last section of the questionnaire, section IV, children were asked "Have you ever taken any protective actions in noise?" For those who answered "no", five answers were listed and children could choose more than one of the following responses: (1) did not know how to protect one's hearing, (2) did not know the danger of noise, (3) hearing protective devices (HPDs) are uncomfortable, (4) too much trouble to use HPDs, and (5) too lazy to take any precautions in noise.
| Procedures|| |
The questionnaire was administered by author Minju Huang in the schools, one class at a time. Subjects were told that there would be no punishment for the incorrectness of answers. A small gift was given to each subject at the end of the test as a token to thank them for their participation.
| Results and Discussion|| |
The finding that forty nine children (10.2%) seemed to have some sort of difficulty discriminating fricative and affricative sounds indicates that their hearing acuity needs to be evaluated. In addition to giving these children a hearing evaluation, it is important to know what might contribute to the high incidence of this problem. Excessive noise exposure might be a contributing factor.  That is why the importance of an educational hearing conservation program (HCP) is overemphasized. It is also imperative to provide these children with some type of hearing enhancing device or strategy to compensate for incomplete auditory processing in the classroom and daily life.
Percentages of correct responses in the knowledge section of the HCQ are shown in [Table 1]. The total average score in this section was 62.01%. It is obvious that children's knowledge about hearing, noise hazards, and hearing protection needs to be improved. Children's scores in this study were similar to data reported by Chermak et al . 
Statistical analysis (two-way ANOVA) indicated that there was no significant difference between boys' and girls' scores ( P > .05). However, significant differences were shown among scores of the three subtests. Post-hoc analysis indicated that children scored the best in knowledge about hearing protection, followed by their knowledge about general hearing health, and they scored lowest in knowledge about noise hazards. Items in the noise hazard section included statements like "hearing will not be harmed by listening to an iPod with intense sound for extensive amount of time", "intense sound would elevate our hearing sensitivity temporarily", and "once hearing loss becomes permanent, it will not go back to normal even with a lot of rest." On average, children in this study identified the correct answers in this section less than 50% of the time. If an educational HCP is developed for children, more emphasis should be devoted to these concepts. Although the scores in other two subtests were better than scores in the noise hazard subtest, average scores on each subtest were lower than 70%. Therefore, efforts are needed to increase children's knowledge in each of these areas.
Children's answers to five items in section II of the HCQ were drawn for further analysis and these items were compared to their knowledge about taking protective actions in noise. The left column in [Table 2] shows that among the five possible protective actions to be taken in noise, children knew the best in walking away (84.3%). It was followed by shortening staying duration (72.7%), moving to quieter places (72%), blocking ears with fingers (66.9%), and using earplugs (55.3%). Responses to "What kind of behaviors you intend to adopt in noise" were analyzed and recorded in the right column in [Table 2]. The actions children intended to take in noise, ranked from highest to lowest, were walking away (80.3%), blocking ears with fingers (54.1%), moving to quieter places (52.4 %), shortening staying duration (41.9%), and using earplugs (30.4%). The percentage of intended use of earplugs in this study, 30.4%, was higher than that had been reported by other researchers. ,, This discrepancy might have occurred because some of these studies asked about subjects' actual experience of using earplugs in noise, , whereas in this study, we asked about intended behavior.
Walking away from sources of loud sounds might be easier for children to implement than using earplugs. The possibility that many children do not have access to earplugs might be one explanation for their responses on the HCQ. The data [Table 2] also revealed that the percentage of children who possessed knowledge about hearing protection was higher than the percentage of children who intended to take protective actions in noise. This discrepancy indicates that a linkage between knowledge and intended behavior does not necessarily exist. For example, 55.3% of children knew that wearing earplugs was one of the methods that could be used to protect hearing, however, only 30.4% of the children indicated that they would use earplugs in noisy environments. While possessing knowledge is the first step in developing healthy hearing habits, encouraging children to implement hearing protective behaviors is another important goal to be achieved.
In order to investigate the agreement between children's knowledge about hearing protection in noise and their intended behaviors, analyses of Chi-square were performed on the data [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5]. The results indicated that children's protective strategies in noise were not independent of their knowledge ( P < .05). Children who possessed the knowledge of walking away, blocking ears with fingers, and moving to quieter places had a greater likelihood of showing the correlated behaviors in noise. It is probable that the provision of an educational HCP would increase the percentage of children taking protective actions in noise. However, there were some children who knew that using earplugs and shortening the time spent in noise could decrease the harmful effects of noise, yet they stated that they would not take these protective actions. Again, doing is not always a consequence of knowing. Besides providing knowledge through an educational HCP, more activities that might help to elicit desired actions should be included.
The data collected in section IV, "Have you ever taken any protective actions in noise and why not", revealed that 343 children (71.6%) had tried to take some kind of protective actions in noise. In other words, 136 children (28.4%) did not report any behavior to protect their hearing in noise. Among these children, several reasons were found that might explain it. The highest percentage was "did not know how to protect their hearing" ( n = 66, 48.53%). It was followed by did not know the danger of noise ( n = 37, 27.21%), too much trouble to use HPDs ( n = 29, 21.32%), HPDs were uncomfortable ( n = 26, 19.12%), and too lazy to take any protection in noise ( n = 26, 19.12%). It seems that lack of knowledge is the major reason. More efforts are required in this regards.
| Conclusions and Implications|| |
Children in this study had low average scores (62%) on a HCQ. A HCP might help these children to improve their knowledge about hearing, noise hazards, and hearing protection. Various percentages of children, 30.4-80.3%, reported intended behaviors to protect their hearing in noise, but higher percentages of children knew that these actions would protect their hearing in noise. In other words, the percentage of children who possessed knowledge about methods of hearing protection was higher than the percentage of children who reported intentions to implement hearing protective behaviors in noise. Only 55% of children knew that HPD could protect their hearing against noise. Approximately 28% of children did not intend to adopt any protective behaviors in noise, with the major reason for this being lack of knowledge (48.5% of them did not know how to protect themselves in noise). Children's knowledge of and their intentions to utilize protective strategies against noise were highly correlated. However, possessing knowledge did not guarantee they would adopt the behavior when they walked into a noisy place. It is important to increase children's knowledge about hearing protection as well as to encourage them to implement actual protective actions.
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Graduate Institute of Audiology and Speech Therapy, National Kaohsiung Normal University, 116 Heping 1st Road, Kaohsiung
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]