1. Do negative attitudes towards loud music prevent music- induced hearing loss? Stephen Widén University West, Sweden Soly ErlandssonUniversity West, Sweden Margareta BohlinUniversity West, Sweden Alice HolmesGainsville, University of Florida Ted JohnsonElmira, College, Elmira, New York

2. Some empirical work… Widén, Holmes, A.E., Johnson, T., Bohlin, M., & Erlandsson, S.I. (2009). Hearing, use of hearing protection, and attitudes towards noise among young American adults. International Journal of Audiology; 48: 537-545 Widén, Holmes, A.E., Johnson, T., Bohlin, M., & Erlandsson, S.I. (2009). Hearing, use of hearing protection, and attitudes towards noise among young American adults. International Journal of Audiology; 48: 537-545 Erlandsson, S.I., Holmes, A.E., Widén, S.E., Bohlin, M. (2008). Cultural and social perspectives on attitudes, noise and risk behaviour in children and young adults. Seminars in Hearing, 29: 29-41. Erlandsson, S.I., Holmes, A.E., Widén, S.E., Bohlin, M. (2008). Cultural and social perspectives on attitudes, noise and risk behaviour in children and young adults. Seminars in Hearing, 29: 29-41. Holmes A.E., Widén, S.E., Erlandsson, S.E., Carver, C.L.,White, L.L. (2007). Perceived hearing status and attitudes towards noise in young adults. American Journal of Audiology, 16: 182-189. Holmes A.E., Widén, S.E., Erlandsson, S.E., Carver, C.L.,White, L.L. (2007). Perceived hearing status and attitudes towards noise in young adults. American Journal of Audiology, 16: 182-189. Widén, S.E., & Erlandsson, S.I. (2007). Risk perception in musical settings –a qualitative study. International Journal of Qualitative Studies on Health and Well- being 2:1, 33-44. Widén, S.E., & Erlandsson, S.I. (2007). Risk perception in musical settings –a qualitative study. International Journal of Qualitative Studies on Health and Well- being 2:1, 33-44. Widén, S.E., Holmes, A.E., Erlandsson, S.I. (2006). Reported Hearing Protection Use in Young Adults from Sweden and the USA: Effects of Attitude and Gender. International Journal of Audiology 45: 273-280. Widén, S.E., Holmes, A.E., Erlandsson, S.I. (2006). Reported Hearing Protection Use in Young Adults from Sweden and the USA: Effects of Attitude and Gender. International Journal of Audiology 45: 273-280. Olsen Widén, S.E., & Erlandsson, S.I. (2004). The Influence of Socio-Economic Status on Adolescent Attitude to Social Noise and Hearing Protection. Noise & Health 7: 25, 59-70. Olsen Widén, S.E., & Erlandsson, S.I. (2004). The Influence of Socio-Economic Status on Adolescent Attitude to Social Noise and Hearing Protection. Noise & Health 7: 25, 59-70.

3. Noise or music? ”It´s a matter of perception and attitudes” ”It´s a matter of perception and attitudes” What is music for the adolescent is most likely noise to the parent… What is music for the adolescent is most likely noise to the parent… Loud decibels may be harmful to the hearing independently of it´s origin. Loud decibels may be harmful to the hearing independently of it´s origin.

4. General purposes with the research To get an understanding for adolescents’ health risktaking behaviour regarding noise exposure e.g. why do some use hearing protection and other’s not? To get an understanding for adolescents’ health risktaking behaviour regarding noise exposure e.g. why do some use hearing protection and other’s not? To provide a theoretical framework to be able to describe and understand adolescents’ risk taking behaviour regarding music exposure. To provide a theoretical framework to be able to describe and understand adolescents’ risk taking behaviour regarding music exposure.

5. Definitions of Risk and Risk Perception Risk can be defined as an objective reality, which means that risks exists independently of individuals’ awareness of them. Risk can be defined as an objective reality, which means that risks exists independently of individuals’ awareness of them. Risk perception can be defined as a social construction, the risk will be created as an construction in our mind, when we notice something being dangerous. Risk perception can be defined as a social construction, the risk will be created as an construction in our mind, when we notice something being dangerous. Discourse in society makes us become aware of the risks. Discourse in society makes us become aware of the risks. Experiences (own as well as other’s) makes become aware of risks. Experiences (own as well as other’s) makes become aware of risks.

6. Possible risks associated with loud music Stronger and better digital technique, improves the quality of the sound, makes it more comfortable to listen to. Stronger and better digital technique, improves the quality of the sound, makes it more comfortable to listen to. Frequence and duration of exposure are important for the development of a hearing impairement. Frequence and duration of exposure are important for the development of a hearing impairement. Hearing impairements are also a social handicap that affects our ability to communicate, (secondary effect). Hearing impairements are also a social handicap that affects our ability to communicate, (secondary effect). Adolescence is a relatively short period of life, but established habits during this time may have consequences to the health later in life, and the consequences may be difficult to perceive. Adolescence is a relatively short period of life, but established habits during this time may have consequences to the health later in life, and the consequences may be difficult to perceive.

7. Theoretical perspectives on why adolescents expose themselves to loud decibels in musical settings Music is an important ingredient in many adolescents’ creation of an identity. Self image Judgement of risks Norms and ideals

8. Social Norm Perceived susceptib- ility Norm. Ideals Risk considera tion Attitudes Behaviour Experience

9. Study: Hearing, use of hearing protection, and attitudes toward noise among young American Adults Participants: Sample 258 undergraduate students (age 17-21) Sample 258 undergraduate students (age 17-21) Gender distribution was 28% male, and 72% female. Gender distribution was 28% male, and 72% female. Socio-economic background was homogenious (high or medium high education level of the parents). Socio-economic background was homogenious (high or medium high education level of the parents).

10. Audiological measurements Otoscopy, individuals with impacted cerumen were excluded Otoscopy, individuals with impacted cerumen were excluded Tympanometry, excluding people with middle ear problems Tympanometry, excluding people with middle ear problems Hearing screening (pure-tone audiometry) in a sound-attenuated audiology booth, 20 dB was the screening criterion. Hearing screening (pure-tone audiometry) in a sound-attenuated audiology booth, 20 dB was the screening criterion. Screening 500, 1000, 2000, 4000 and 6000Hz. Screening 500, 1000, 2000, 4000 and 6000Hz.

11. Questionnaires Hearing symptom description scale (Erlandsson & Olsen 2004). Hearing symptom description scale (Erlandsson & Olsen 2004). Adolescents Habits and Use of Hearing Protection (Erlandsson & Olsen, 2004). Adolescents Habits and Use of Hearing Protection (Erlandsson & Olsen, 2004). Youth Attitude Towards Noise scale (Widén & Erlandsson 2006). Youth Attitude Towards Noise scale (Widén & Erlandsson 2006).

12. Results Out of 258, 67 (26%) failed the pure tone audiometry Out of 258, 67 (26%) failed the pure tone audiometry 26% of those who reported they had normal (n=247) hearing actually failed the screening test. 26% of those who reported they had normal (n=247) hearing actually failed the screening test. 11 persons reported in the questionnaire that they had a hearing loss, but only 3 of these failed the screening test. 11 persons reported in the questionnaire that they had a hearing loss, but only 3 of these failed the screening test. Noise sensitivity was reported by 81 persons (31%). Out of them 25% failed the screening test. Noise sensitivity was reported by 81 persons (31%). Out of them 25% failed the screening test.

13. Results Temporary self-reported hearing symptoms were reported mostly in music related activities (discos, concerts, clubs). Temporary self-reported hearing symptoms were reported mostly in music related activities (discos, concerts, clubs). Temporary tinnitus (lasting 24h or more after noise exposure) were reported by 15%. Temporary tinnitus (lasting 24h or more after noise exposure) were reported by 15%. Nearly 50% reported that they on occation had experienced pain in relation to loud volumes (discos 10%, concerts 38%). Nearly 50% reported that they on occation had experienced pain in relation to loud volumes (discos 10%, concerts 38%).

14. Results symptoms and attitudes In general, those experiencing temporary symptoms (ear pain, temporary tinnitus) held significantly more anti-nose attitudes. In general, those experiencing temporary symptoms (ear pain, temporary tinnitus) held significantly more anti-nose attitudes. Anti-noise attitudes in turn are significantly related to more frequent use of hearing protection. Anti-noise attitudes in turn are significantly related to more frequent use of hearing protection.

15. 4 ”symptom groups” No hearing problem at all (n = 127) No hearing problem at all (n = 127) Failed hearing screening (n = 47) Failed hearing screening (n = 47) Noise sensitivity (n = 57) Noise sensitivity (n = 57) Failed hearing screening + noise sensitivity (n = 20) Failed hearing screening + noise sensitivity (n = 20)

16. 4 symptom groups and attitudes Significant differences between the 4 groups Significant differences between the 4 groups Those with no self experienced symptoms or those who failed the hearing screening held the most pro-noise attitudes, whereas those reporting noise sensitivity (or a combination of noise sensitivity and failing hearing screening) held the most anti-noise attitudes. Those with no self experienced symptoms or those who failed the hearing screening held the most pro-noise attitudes, whereas those reporting noise sensitivity (or a combination of noise sensitivity and failing hearing screening) held the most anti-noise attitudes.

17. Conclusion Self experienced symptoms are more positively related to stronger anti noise attitudes than hearing loss on its own. Self experienced symptoms are more positively related to stronger anti noise attitudes than hearing loss on its own. Self experienced symptoms may serve as a ”feed back” that noise may be a problem, whereas threshold shifts pass unnoticed to the individual. Therefore, it is not possible to take action regarding the behaviour, when you are not aware of that you have a problem. Self experienced symptoms may serve as a ”feed back” that noise may be a problem, whereas threshold shifts pass unnoticed to the individual. Therefore, it is not possible to take action regarding the behaviour, when you are not aware of that you have a problem.

18. Previous studies confirms that: Self experienced symptoms such as noise sensitivity, temporary or permanent tinnitus, and ear pain are associated with more anti-noise attitudes and a higher degree of hearing protection use, whereas no experience of hearing ”problems” are associated with more pro-noise attitudes and less hearing protection use at concerts and discos. Self experienced symptoms such as noise sensitivity, temporary or permanent tinnitus, and ear pain are associated with more anti-noise attitudes and a higher degree of hearing protection use, whereas no experience of hearing ”problems” are associated with more pro-noise attitudes and less hearing protection use at concerts and discos.

19. Reflections It’s our awareness of a health problem (from feed back) and the interpretation we make of this, that may serve as a trigger for changing our attitudes and behaviour. It’s our awareness of a health problem (from feed back) and the interpretation we make of this, that may serve as a trigger for changing our attitudes and behaviour. Discourse are important for how we interpret the feed back, that is, the perception of noise/music as a risk. Discourse are important for how we interpret the feed back, that is, the perception of noise/music as a risk.

20. Preventive work Attitude and behavioural change are important aspects in preventive work. Attitude and behavioural change are important aspects in preventive work. By providing ”good” knowledge about noise and hearing, it may affect adolescents attitudes and behaviour in a health preventive way. By providing ”good” knowledge about noise and hearing, it may affect adolescents attitudes and behaviour in a health preventive way.

21. Hearing screening versus self reports… In total 67 persons failed the hearing screening test, only 3 of them (4%) had reported in the questionnaire that they had a hearing loss. In total 67 persons failed the hearing screening test, only 3 of them (4%) had reported in the questionnaire that they had a hearing loss. 8 out of 11 (73%) self reported hearing loss could not be verified in the hearing screening test. 8 out of 11 (73%) self reported hearing loss could not be verified in the hearing screening test.

22. We have a measurement problem! The reliability of self reports (questionnaires) within health research should be called in question. The reliability of self reports (questionnaires) within health research should be called in question. What reliability problems are there with screening tests? What reliability problems are there with screening tests? Does these two measurements measure the same thing? Does these two measurements measure the same thing?

23. Contacts stephen.widen@hv.se stephen.widen@hv.se stephen.widen@hv.se