# Presentation: 268049

## Wising Up About NIHL

**Public Education Efforts To Prevent NIHL in Children**
- National Institute on Deafness and Other Communication Disorders

- October 20, 2006
- National Institutes of Health
- U.S. Department of Health and Human Services

**Notes:**
Thank you for the opportunity to talk about NIHL public education efforts at 
N-I-D-C-D. 

## Objectives

**Objectives**

-  Learn about
- NIDCD’s support of hearing research.
- NIDCD’s public education efforts in NIHL.
- Evaluation of WISE EARS! national campaign.
- Findings and recommendations for future 	direction.
- Next steps: Campaign and partnership development.

**Notes:**
Today, I’ll give you a glimpse of 
--who we are 
--our efforts to educate the public about NIHL 
--and the results of an evaluation we conducted this summer of our public education campaign.  
I’ll wrap up by discussing our future campaign plans. 

## FY 2005 Budget, by Program Area ($ in thousands)

**FY 2005 Budget, by ****Program Area ****($ in thousands)**

- Smell
- $44,263
- (11%)

- Taste
- $21,748
- (6%)

- Voice
- $24,311
- (6%)

- Balance
- $24,637
- (6%)

- Language
- $37,175
- (9%)

- Hearing
- $206,215
- (53%)

- Speech
- $24,637
- (9%)

**Notes:**
The NIDCD is part of the National Institutes of Health (NIH).

The mission of NIDCD is to prevent disease and promote health through research, training, and education in the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. 

NIDCD is the primary source for funding for hearing research at NIH.  This chart illustrates funding in 2005 for each of our 7 research areas. 

## NIHL in Children 

**NIHL in Children **

- “Young people live in a loud and noisy world. In this age of the escalating use of personal stereo systems, hands-free cell phones, and portable movie/game systems, youth worldwide are exposed to harmful levels of noise every day.”
- James F. Battey, Jr., M.D., Ph.D.
- Director, NIDCD
- February 2006

**Notes:**
Dr. James Battey, director of NIDCD, has expressed his concerns about the potential for NIHL in our children. 

We have his full support in directing greater public education efforts toward children. As you have heard during other sessions, surveys of children’s hearing suggest that they are being exposed to hazardous levels of noise that can affect hearing.

[Optional note: This issue appears to be long-lived, as more companies are introducing devices with even more features. For example, Microsoft intends to start selling before Christmas a wireless digital music and video player to compete with Apple’s iPod. We can begin to see a parallel between potential NIHL in the “MP3 generation” and the evidence of NIHL from Walkmans and similar devices that first appeared in the 1980s.] 

## Communicating Research Results to the Public

**Communicating Research Results to the Public**

-  Health information based on scientific discovery.
-  Fact sheets, newsletter, conference exhibits, press   	releases.
-  Online health information and resources.
-  Toll-free information service.
-  Participation in HHS federal project: Healthy People 	2010.

**Notes:**
Part of our mission at NIDCD is to communicate research results to the public. NIDCD has taken several steps to help raise public awareness.

We develop disease-specific fact sheets, publish a newsletter online, write press releases to attract media coverage of our topic areas, and attend exhibits to interact with organizations with similar missions and goals.
We also operate an information clearinghouse with a toll-free number. Callers can talk to information specialists, who can provide them with our publications or refer them to other organizations involved in communication disorders.
In 2000, the U.S. Department of Health and Human Services launched Healthy People 2010, a national health promotion and disease prevention initiative from the federal government. Part of that initiative includes Healthy Hearing 2010 to help improve hearing health. 
Two of the eight hearing objectives directly relate to NIHL.
Now I’d like to highlight some of NIDCD’s specific NIHL efforts for different age groups.

## Elementary School Children: Grades 3–6

**Elementary School Children: Grades 3–6**

-  “I Love What I Hear”
- Introduce concept of hearing
- 	protection.
- Describe hearing and sound.
-  Resources:
- Videotape/DVD.
- Teacher curriculum guide.
- Web-based interactive sound ruler.
- “How Loud is Too Loud” bookmark.

**Notes:**

This introductory classroom activity book and video, called “I Love What I Hear” was produced in the early 90s for children in grades 3 through 6, and is still popular today. 
Some additional pieces that spun off from this program are a Web‐based interactive sound ruler and a “How Loud Is Too Loud” bookmark.  

## Middle School Children: Grades 7–8

**Middle School Children: ****Grades 7****–****8**

-  “How Your Brain Understands
- 	What Your Ear Hears”
-  Develop healthy hearing habits.
-  Avoid excessive exposure to 	loud noises.
-  Resources:
- Interactive, Web-based teaching units about science/human health through which students:
- Learn about, explore, and investigate sound, communication, and the brain.
- Apply concepts to solve problems and reduce the risk of hearing loss.
- Free to science teachers and school administrators.

**Notes:**
For students in grades 7 and 8, NIDCD worked with NIH’s Office of Science Education to develop a middle school curriculum supplement called, “How Your Brain Understands What Your Ear Hears.”  
These interactive teaching units combine cutting-edge science research discoveries from NIH with state-of-the-art instructional materials. Each supplement has a teacher’s guide for two weeks’ of lessons on science and human health.  
These materials are free to science teachers and school administrators and are aligned to state standards.  [Online curriculums are available without charge on our Web site, too. ]

## WISE EARS! All Ages

**WISE EARS! ****All Ages**

-  1999: WISE EARS!—NIDCD partners with NIOSH to 	promote a national campaign to prevent NIHL in children and 	workers.
- Raise awareness about NIHL among all audiences.
- Motivate all audiences to take action.
- Resources:
- Promotional materials: Bookmarks, door hangers, magnets, stickers.
- Coalition newsletter.
- Web-based materials.
- Fact sheets for different audiences.
- Media outreach.
-  2004: WISE EARS! coalition grows to a network of nearly 90 	organizations to promote awareness in media, communities.

**Notes:**
NIDCD’s broader effort to prevent NIHL among all age groups is reflected in our WE! campaign. 
In late 1999, NIDCD and the National Institute for Occupational Safety and Health (NIOSH) launched WE!, a national education campaign aimed at a very broad audience:  the public and workers of all ages. 
The credit for the planning, creation and development of WE! goes to Dr. Marin Allen, the former director of communications at NIDCD, and Dr. Max Lum, associate director for health communications at NIOSH.  They and their staff spearheaded the campaign during the early years of the program to promote awareness messages and work with coalition members to spread the word about NIHL.
WE! campaign materials are one of the most popular items that we distribute through our clearinghouse. These include promotional materials, fact sheets from both NIDCD and NIOSH, and outreach materials for the WE! coalition members to encourage them to use materials and promote awareness of NIHL.  
By 2004, we had engaged nearly 90 organizations in our campaign efforts.

## Measuring WISE EARS! 

**Measuring WISE EARS! **

-  2006: Evaluation of the campaign
- Part I. Identify NIHL information available to the public through:
- Literature searches.
- Media coverage.
- WISE EARS! and other national public education campaigns about NIHL.
- Part II. Interview WISE EARS! coalition members about:
- Outreach to target audiences.
- Appeal/effectiveness of WISE EARS! materials.
- Future direction of the campaign.

**Notes:**
During this past summer, we conducted a two-part study to evaluate how well we were achieving our objectives and to explore ideas how we could improve campaign efforts. 
Part I was an environmental scan of current literature, media coverage, and national public education campaigns about NIHL.
We wanted to identify what information is available to the public and who is bringing this information to the public’s attention.
And Part II, which I will discuss in a few minutes, was to get feedback from our coalition members.

##  Public awareness of NIHL is growing.
Mainstream media coverage is high.
Broad-based organizations (e.g., MTV) contribute resources to raising public awareness about NIHL. 
NIHL prevention campaigns target youth.

- Mainstream media coverage is high.
- Broad-based organizations (e.g., MTV) contribute resources to raising public awareness about NIHL.
- NIHL prevention campaigns target youth.

| Listen to Your Buds
(www.asha.org/listentoyourbuds) |  |
| --- | --- |
| 
Dangerous Decibels
(www.dangerousdecibels.org)

 |  |
| It’s How You Listen That Counts (www.earbud.org) |  |

**Findings From the Environmental Scan**

**Notes:**
We found that NIHL is being covered in the mainstream media at unprecedented levels. 	
Between June 2005 and June 2006, 85 percent of articles related to noise-induced hearing loss appeared in daily newspapers and consumer magazines. By contrast, only 55 percent of NIHL articles appeared in mainstream media during the previous year. 

We also found that broad-based organizations (e.g., MTV) are involved in raising public awareness about NIHL causes and prevention, particularly among youth and young adults.Most notable are these ongoing campaigns:
--Listen to Your Buds, conducted by the American Speech-Language-Hearing Association, is aimed at children ages 5 to 10.
--Dangerous Decibels, based at the Oregon Hearing Research Center, targets children ages 5 to 14.
--Earbuds, or It’s How You Listen That Counts, is sponsored by the House Ear Institute. This program targets the music-listening habits of teens and young adults ages 12 to 22.

##  Gaps exist in youth knowledge of NIHL and 	between awareness and positive action.
Knowledge: 16 percent of adolescents and young adults reported in an MTV survey that they had heard, read, or seen anything related to the issue of hearing loss. 
Behavior: 72 percent of college students, who demonstrated a high degree of knowledge about NIHL prevention, reported that they never wore hearing protection. 

- Knowledge: 16 percent of adolescents and young adults reported in an MTV survey that they had heard, read, or seen anything related to the issue of hearing loss.
- Behavior: 72 percent of college students, who demonstrated a high degree of knowledge about NIHL prevention, reported that they never wore hearing protection.

**Findings From the****Environmental Scan**

**Notes:**
Despite these efforts, our children demonstrate a lack of knowledge about NIHL.
According to a survey conducted through the MTV Web site, only 16 percent of adolescents reported that they had heard, read, or seen anything related to hearing loss. Only 9 percent received this information through their school. [Chung, J.H., Des Roches, C.M., Meunier, J., and Eavey, R.D. (2005). Evaluation of noise-induced hearing loss in young people using a Web-based survey technique. Pediatrics, 115, 861–867.]
There also is an apparent gap between what they do know and positive choices based on that knowledge. 
A study by Crandell et al. found that a majority of college students demonstrate a high degree of knowledge concerning noise exposure and NIHL. However, 72 percent reported that they never wore hearing protection. [Crandell, C., Mills, T.L., and Gauthier, R. (2004). Knowledge, behaviors, and attitudes about hearing loss and hearing protection among racial/ethnically diverse young adults. Journal of the National Medical Association, 96, 176–186.]  
Several other studies have recorded a similar discrepancy between awareness and behavior. 

## Lessons Learned Fromthe Environmental Scan

-  Programmatic
- Give a NIHL campaign a higher priority within NIDCD.
- Conduct a comprehensive campaign evaluation.
-  Strategic
- Focus on a specific target audience.
- Select partners and delivery channels with the highest potential to attract and engage the target audience.
- Reach additional target audiences by supporting programs conducted by other organizations.
-  Tactical
- Conduct a more aggressive and responsive media outreach.
- Make greater use of technology to expand campaign outreach.

**Recommendations From ****the Environmental Scan**

**Notes:**
The key findings of our environmental scan indicate that we could conduct a more effective campaign by making several key changes.  I’ll mention a few. 
Programmatically, we need to give our campaign more visibility within NIDCD. 
We also need to conduct regular campaign evaluations so that we can determine how successfully we are meeting our objectives.

Strategically, we should focus on a specific target audience. Although the ultimate goal is to prevent NIHL among all audiences, it is unrealistic to expect one campaign to achieve that goal. Targeting our message also allows greater potential for active partners and reaching additional target audiences by supporting programs conducted by other organizations, such as NIOSH’s workplace efforts. 

Tactically, we should use media channels and greater use of technology to expand our outreach. According to the results of a GenerationRX.com survey, of teens and young adults who frequently use the Internet, 75 % searched for health information; 72% downloaded music; 50% shopped; and 46% checked sports. 
Thirty-nine percent of respondents reported a change in personal behavior because of health information obtained online. [Chung, J.H., Des Roches, C.M., Meunier, J., and Eavey, R.D. (2005). Evaluation of noise-induced hearing loss in young people using a Web-based survey technique. Pediatrics, 115, 861–867.]

##  Coalition involvement
Coalition members reflect the goal of WISE EARS! 
Majority of coalition members do not promote the campaign aggressively. 
Many respondents value, use, and refer others to the WISE EARS! Web site and materials. 
Respondents indicate a willingness to partner with NIDCD to promote future health messages.

- Coalition members reflect the goal of WISE EARS!
- Majority of coalition members do not promote the campaign aggressively.
- Many respondents value, use, and refer others to the WISE EARS! Web site and materials.
- Respondents indicate a willingness to partner with NIDCD to promote future health messages.

**Key Findings From****the Coalition Interviews**

**Findings From the**
**Coalition Interviews**

**Notes:**
In Part II of the evaluation, our interviews of coalition members revealed that many share NIDCD’s concern about the need to improve and expand our efforts, particularly among children.
  --However, the majority of coalition members do not promote the campaign in their communication efforts.  But many also said they used our materials and referred others to our Web site. 
--Most coalition members indicated that their organizations would like to partner with NIDCD to promote future health messages and would welcome opportunities to be involved.

##  Future direction
Develop NIHL-prevention materials for a more targeted audience.
Focus the campaign on youth. 
Conduct a more aggressive campaign, with more emphasis on distributing materials through the Web, mass media, and partnering organizations.

- Develop NIHL-prevention materials for a more targeted audience.
- Focus the campaign on youth.
- Conduct a more aggressive campaign, with more emphasis on distributing materials through the Web, mass media, and partnering organizations.

**Recommendations From **
**the Coalition Interviews**

**Notes:**
The majority of respondents we interviewed suggested that future campaign efforts should focus on youth.
They suggested that we make greater use of technology and mass media to raise awareness and take stronger steps to disseminate materials through the schools as well as through coalition partners. 

I also should point out that a number of respondents suggested that we replace the owl as our logo. 

[As a result, several coalition members who serve a specific audience (e.g., musicians or the military) are developing and distributing their own targeted materials in lieu of using broader WISE EARS! materials.] 

##  Focus on children ages nine to 14 supported by:
Studies suggesting exposure to hazardous levels of noise.
Opportunity to influence attitudes and behaviors before or as tweens develop listening, leisure, and working habits. 
Opportunity to complement existing education programs aimed at youth.  

- Studies suggesting exposure to hazardous levels of noise.
- Opportunity to influence attitudes and behaviors before or as tweens develop listening, leisure, and working habits.
- Opportunity to complement existing education programs aimed at youth.

**Recommended Target Audience: Tweens**** **

**Notes:**
Based on these recommendations, we are looking to develop a new prevention campaign focused on tweens, children between the ages nine to 14 years old. 

As I mentioned earlier, commendable programs aimed at educating young people about NIHL exist.  Our new program will fill a target audience gap by addressing the specific interests and behaviors of the children between and at either end of the Listen to Your Buds and Earbuds campaigns.  In this manner, we can reinforce our messages as children interests and behaviors change. 

##  Developing a new NIHL prevention campaign will involve:
Tailoring materials to appeal to the specific target audience.
Pretesting concepts, messages, and materials with the intended audience.
Developing collaborative partnerships.

-  Developing a new NIHL prevention campaign will involve:
- Tailoring materials to appeal to the specific target audience.
- Pretesting concepts, messages, and materials with the intended audience.
- Developing collaborative partnerships.

**Next Steps: Retarget, Rename,** **and Redesign**

**Notes:**
This brings us to the next step: applying what we’ve learned to Retarget, Rename, and Redesign.
We need to reinvigorate the program with a more focused agenda. 
Because the WE! name recognition is low, the advantages of a name change outweigh the loss. In addition, the current trend is for campaign names to be action steps, such as “Listen Up,” which actually represents a call to action.
We also must concentrate on engaging active, committed partners. We are looking to complement, rather than duplicate, existing efforts.  
For example, we have an existing curriculum and have helped to fund parts of  the Dangerous Decibels campaign. The “walk-through” ear of the Dangerous Decibels project seems like a natural for this age group and the type of interactive, multi-media format and product we’re interested in. 
As part of the NIH communications community, we also have access to media  channels, such as the NIH radio and the National Library of Medicine’s health magazine, to reach larger audiences.  

##  Partner opportunities and responsibilities:
Extend outreach and campaign communication channels. 
Raise national awareness of their own organization. 
Receive campaign materials to use in support of their own outreach efforts.
Receive recognition in media materials. 
Annual evaluation of their involvement and commitment.

-  Partner opportunities and responsibilities:
- Extend outreach and campaign communication channels.
- Raise national awareness of their own organization.
- Receive campaign materials to use in support of their own outreach efforts.
- Receive recognition in media materials.
- Annual evaluation of their involvement and commitment.

**Next Steps: Rebuild and **
**Reinvigorate Partnerships**

**Notes:**
In closing, NIDCD needs the involvement of other organizations and to rebuild  campaign partnerships. 
But, as with all good partnerships, those involved should be able to anticipate benefits as well as responsibilities.
NIDCD must be active in providing coalition members with their role and expectations.
To maintain continuous campaign improvement, we will conduct regular reviews and ask all coalition partners to participate in annual evaluations of their involvement and public education efforts.
To quote Yogi Berra, “If you don’t know where you’re going, you may end up someplace else.”  
Our ultimate destination is a generation of youth who will have sound hearing now and for a lifetime.  

## Patricia Blessing
Chief, Office of Health Communication 
and Public Liaison
National Institute on Deafness and
Other Communication Disorders
301-496-7243
blessinp@mail.nih.gov 
www.nidcd.nih.gov 

- Chief, Office of Health Communication
- and Public Liaison
- National Institute on Deafness and
- Other Communication Disorders
- 301-496-7243
- blessinp@mail.nih.gov
- www.nidcd.nih.gov

**Contact Information**

**Notes:**
I welcome your comments and suggestions. My contact information is shown here. 
I would also like to acknowledge my colleague Charlotte Ball who worked on the evaluation this past summer and is here today.  
Thank you.
I’d be happy to answer questions. 

## Environmental Scan Bibliography

**Environmental Scan Bibliography**

- Biassoni, E.C., Serra, M.R., Richter, U., Joekes, S., Yacci, M.R., Carignani, J.A., Abraham, S., Minoldo, G., and Franco, G. (2005). Recreational noise exposure and its effects on the hearing of adolescents. Part II: Development of hearing disorders. *International Journal of Audiology*, 44, 74–86.Bogoch, I.I., House, R.A., and Kudla, I. (2005). Perceptions about hearing protection and noise-induced hearing loss of attendees of rock concerts. *Canadian Journal of Public Health*, 96, 69–72.Borchgrevink, H.M. (2003). Does health promotion work in relation to noise?  *Noise & Health*, 5 25–30.
- Chung, J.H., Des Roches, C.M., Meunier, J., and Eavey, R.D. (2005). Evaluation of noise-induced hearing loss in young people using a Web-based survey technique. *Pediatrics*, 115, 861–867.Crandell, C., Mills, T.L., and Gauthier, R. (2004). Knowledge, behaviors, and attitudes about hearing loss and hearing protection among racial/ethnically diverse young adults. *Journal of the National Medical Association* 96, 176–186.Daniell, W.E., Swan, S.S., McDaniel, M.M., Camp, J.E., Cohen, M.A., and Stebbins, J.G. (2006). Noise exposure and hearing loss prevention programmes after 20 years of regulations in the United States. *Occupational and Environmental Medicine*, 63, 343–351.Fausti, S.A., Wilmington, D.J., Helt, P.V., Helt, W.J., and Konrad-Martin, D. (2005). Hearing health and care: The need for improved hearing loss prevention and hearing conservation practices. *Journal of Rehabilitation Research & Development*, 42, 45–62.

**Notes:**
Selected bibliography of current literature focused on children’s hearing and listening habits, from the WISE EARS! environmental scan. 

## Environmental Scan Bibliography

**Environmental Scan Bibliography**

- Folmer, R.L., Griest, S.E., and Martin, W.H. (2002). Hearing conservation education programs for children: A review. *Journal of School Health*, 72, 51–57.Kujawa, S.G. and Liberman, M.C. (2006). Acceleration of age-related hearing loss by early noise exposure: Evidence of a misspent youth. *Journal of Neuroscience*, 26(7), 2115–2123.Niskar, A.S., Kieszak, S.M., Holmes, A.E., Esteban, E., Rubin, C., Brody, D.J. (2001). Estimated prevalence of hearing loss among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey. 1988–1994. United States. *Pediatrics*, 108(1), 40–43.Sadhra, S., Jackson, C.A., Ryder, T., and Brown, M.J. (2002). Noise exposure and hearing loss among student employees working in university entertainment venues. *The Annals of Occupational Hygiene*, 46, 455–463.Serra, M.R., Biassoni, E.C., Richter, U., Minoldo, G., Franco, G., Abraham, S., Carignani, J.A., Joekes, S., and Yacci, M.R. (2005). Recreational noise exposure and its effects on the hearing of adolescents. Part I: An interdisciplinary long-term study. *International Journal of Audiology*, 44, 65–73.Weichbold, V., and Zorowka, P. (2003). Effects of a hearing protection campaign on the discotheque attendance habits of high-school students. *International Journal of Audiology*, 42, 489–493.Widen, S.E.O., and Erlandsson, W.I. (2004). The influence of socio-economic status on adolescent attitude to social noise and hearing protection. *Noise & Health*, 7, 59–70.

**Notes:**
Selected bibliography of current literature focused on children’s hearing and listening habits, from the WISE EARS! environmental scan.