# Presentation: 206659

## Research Goal 1:Contribute to the Development, Implementation, and Evaluation of Effective Hearing Loss Prevention Programs

- Carol M. Stephenson, Ph.D.
- Education and Information Division

## Why is this necessary?

**Notes:**
Historically, the typical hearing conservation program has functioned to document the progression of occupational hearing loss.

## Objectives

- Providing authoritative, data driven recommendations and guidelines
- Developing and/or evaluating HLPP “best practices”
- Developing, evaluating, and disseminating model training methods, materials, and tools

- Conduct research that facilitates the improvement
- of occupational hearing loss prevention programs by:

## Highlights

- Authoritative Recommendations and Guidelines
- Noise criteria documents;*  *_A Practical Guide_
- Best Practices
- Identifying shortcomings in HLPPs and developing best practices; field-testing model HLPPs for targeted industries: construction, mining
- Model Training Methods, Materials, and Tools
- HearSāf 2000;  Hearing loss simulator;  Survey tool; Program evaluation checklist; Young worker curriculum; Electronic HPD compendium

**Notes:**
Finally, I will discuss model training methods and tools that were developed during the course of our “Best Practice” research efforts, but which have wide-spread applicability to the general HLP community.

## Criteria Documents

- Use NIOSH research to provide authoritative, data driven recommendations for use by regulatory agencies, academia, industry, hearing health professionals, and labor
- Outputs/Intermediate Outcomes:
- _1973 Criteria Document_
- 1st national policy promoting a comprehensive HLPP
- Much of it adopted in OSHA’s Hearing Conservation Amendment (29 CFR 1910.95, 1983)

## Criteria Documents

- _1998 Criteria Document_
- Promoted 3 dB exchange rate, 85 dB REL, subject fit HP testing
- ACOEM “indispensable reference for every physician”
- DOD emulated (DODI 6055.12)
- AAA adopted as standard of practice
- NHCA directs membership to it as “Best Practice”
- DOL & DOT (Fed. RR Admin.) ANPRs; DOI;  FAA; Cal/OSHA

## Practical Guide

- Provides employers, health professionals, and employees with user-friendly guidance
- Outputs/Intermediate Outcomes:

- 25,000+ print copies; 13,000+ web hits
- ACOEM “indispensable” reference
- Stimulated OSHA to include “recordability” of hearing loss on OSHA Log 300
- Repackaged and distributed by the National Safety Council

**Notes:**
Highly requested
Publicized the need for a national surveillance effort

## Validate Best Practices in HLPPs                                       

- Work with industry to identify shortcomings in HLPPs.  Then... develop and validate practical solutions and best practices
- Outputs/Intermediate Outcomes:
- Impulsive noise increases risk: add 5 dB to TWA, double protect, prioritize controls, etc.
- Validated with stamping plant workers and carpenters (92 vs. 97 dB TWA)

**Notes:**
The ramifications of this for the manager of a HLPP is that if their workforce is exposed to impulsive noise, they may underestimate the risk of HL.

## Best Practices Conferences

- Hearing Loss Prevention for the Construction Industry- OSHA ANPR
- Impulsive Noise- support  for 5 dB correction, recommendations for research, better metrics to quantify risk, and call for instrumentation

## HLPPs in Targeted Sectors: Solutions and Best Practices 

- To develop and evaluate practical, theory-driven approaches for model HLPPs that incorporate best practices
- Outputs/Intermediate Outcomes:
- Validated importance of clearly understanding workers and managers perceptions of self-efficacy, barriers, and site safety culture

## Applying Health Communication Theory to Develop a

- Model Intervention is an Iterative Process

**Theory-driven, data**
**validated approach**

## Intermediate Outcomes

- Validated need to target the audience; focus the message

## And...

- Demonstrated that while *skills *may best be taught one-on-one, worksite *behavior *may best be encouraged through small peer group training.

## Intermediate Outcomes

- NIOSH and others have applied these findings to HLPPs for young workers, aging workers, agricultural workers, construction workers, miners, band teachers, etc.

**Notes:**
R2P

## Model Training Methods, Materials, and Tools

## Information Management System:HearSāf 2000

- To create a system that integrates and manages the data streams relevant to a HLPP
- Outputs/Intermediate Outcomes:
- Demonstrated feasibility of integrating medical, noise survey, audiometry, training, and HPD usage
- Two commercial versions available
- Used as evidence of “feasibility” for OSHA  ruling- each ear baseline

## NIOSH Hearing Loss Simulator

- To create a motivational tool  that raises awareness regarding how hearing loss degrades one’s quality of life
- Outputs/Intermediate Outcomes:
- Windows-based application –                        users can customize
- Over 300 requests, including key officials in NHCA, CAOHC, Universities, State & Federal agencies

## NIOSH Hearing Loss Simulator

***Normal***

***Impaired***25 years of 95dB(A) exposure, 55-year old worker – noise “notch” at 4,000Hz

*Click on picture for sound*

- Simulates effects of exposure, age, sex based on ANSI S3.44 method

*Click to stop sound*

***Severely Impaired***25 years of 105dB(A) exposure, 55-year old worker – noise “notch” at 4,000Hz

## Survey Tool:Application of health communication theory

- A tool to predict behavior on worksites and help target training
- Outputs/Intermediate Outcomes:
- Validated 28 item survey addressing attitudes, beliefs, intentions, barriers, self-efficacy, site safety culture
- Versions of survey piloted in various sectors- shipbuilding will be next
- Used survey results to create sector specific NIOSH training materials

## Sector Specific Training Tools and Materials  to Enhance HP Use and Performance

- Demonstrate that theory-driven training tools positively influence proper fit and use of hearing protectors.
- Outputs/Intermediate Outcomes:
- Multimedia training program that            addresses barriers, self-efficacy, and tinnitus
- Dramatic improvement in HPD attenuation
- Adopted by apprentice training centers
- Adopted by U.S. Navy for field test at shipyard

## Program Evaluation Checklist

- To create a tool that aids in hearing loss prevention program evaluation
- Outputs/Intermediate Outcomes:
- 1st published as part of the “Practical Guide”
- Utilized in HLPP evaluations
- Included in training manual for CAOHC courses for Occupational Hearing Conservationist Certification (25,000)
- Anecdotal evidence of use by industry

## Young Worker Curriculum

- To raise awareness and build                                        basic OSH skills in youth
- Outputs/Intermediate Outcomes:
- Developed the curriculum
- Pilot tested in 10+ states
- Partnering with a diverse network of stakeholders (Dangerous Decibels)
- Planning a widespread dissemination in multiple venues (e.g. State Depts. of Ed., Job Corps, ASSE, NASDCTE, AIHA, OSHA, et al. )

**Notes:**
Teacher’s guide and student activities

## Hearing Protector Compendium

- To provide guidance regarding selection and use of appropriate hearing protection
- Outputs/Intermediate Outcomes:
- 3 text versions: 1976, 1984, 1995
- Current web version
- - searchable
-      - easily modified and updated
- Used by workers, safety professionals, manufacturers

- _[http://](http://www.cdc.gov/niosh/topics/noise/hpcomp.html)__[www.cdc.gov/niosh/topics/noise/hpcomp.html](http://www.cdc.gov/niosh/topics/noise/hpcomp.html)_

**Notes:**
(since 2003)
Version planned for mining

## What’s Ahead?

- Demonstrate the feasibility of centralized, web-based access to audiometric data for HLPPs with highly mobile workers
- Refining audiometric protocols: which test frequencies, protocol for age correction
- Incorporating hearing protector fit-testing into existing HLPPs
- Expand use and validity of the HLPP evaluation checklist– correlate with STS

## Summary

- Federal hearing conservation standards
- New methods for tracking hearing loss
- Clinical standards of practice
- Best practices for managing HLPPs
- Recommendations for development     of targeted training
- An array of model tools, methods, and materials

- NIOSH research has led to data driven recommendations and outputs resulting in:

**Notes:**
Summary – Resulting HLR Program Accomplishments
New methods for tracking hearing loss [among American workers]

## Acknowledgements

- Mark R. Stephenson, Ph.D.
- Senior Research Audiologist
- Christa Themann, M.A.
- Audiologist
- Robert Randolph, M.S.
- Psychologist

## Any Questions?

**This is your ear.**

**This is your ear on noise.**

## NIOSH Hearing Loss Simulator

***Normal***

***Impaired***25 years of 95dB(A) exposure, 55-year old worker – noise “notch” at 4,000Hz

*Click on picture for sound*

*Click on picture for sound*

- Simulates effects of exposure, age, sex based on ANSI S3.44 method

*Click to stop sound*

## I believe exposure to loud noise can hurt my hearing.

**Strongly**
**Agree**

**Agree**

**Strongly**
**Disagree**

**Disagree**

**Neither**

**I believe exposure to loud noise can hurt my hearing.**

**Notes:**
Susceptibility:   Carpenters know noise causes hearing loss

## I think my hearing is being hurt by exposure 

- Strongly
- Agree

- Agree

- Strongly
- Disagree

- Disagree

- Neither

**I think my hearing is being hurt by exposure **
**to loud noise.**

**Notes:**

So.. What stage were most of these carpenters in?  In fact, many are actively concerned about NIHL-- it is on their radar screen!  They are at least in the contemplation stage, if not further along. 

Other questions and focus groups revealed that many carpenters know friends and family members suffering the physical and social effects of NIHL.  

## Effect of Training on Ear Plug Attenuation