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Year : 2008  |  Volume : 10  |  Issue : 41  |  Page : 105-109
Elementary school children's knowledge and intended behavior towards hearing conservation

1 National Kaohsiung Normal University, Taiwan
2 Dahu Elementary School, Taiwan
3 National Taitung University, Taiwan

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  Abstract 

The purposes of the study were to investigate children's knowledge about hearing conservation, the types of protective behaviors they would adopt towards noise, the agreement between children's knowledge and intended behaviors in hearing protection, and reasons why they would not take any protective action against noise. A questionnaire was administered to 479 4 th and 5 th graders in their school classrooms. Results indicated that children scored low (62.01%) on this hearing conservation questionnaire. They scored the highest in strategies of hearing protection (69.89%), followed by their knowledge in general hearing health (62.56%) and noise hazards (49.65%). Only 55% of the children knew that hearing protective devices could protect them against noise. Approximately 28% of the children did not intend to adopt any protective behavior towards noise and the major reason for this was a lack of knowledge. Children's knowledge and their noise-protective behavior were correlated ( P < 0.05). However, possessing knowledge did not guarantee that children would adopt such behaviors when they were exposed to loud sounds. Hence, 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 towards hearing conservation. Noise Health 2008;10:105-9

How to cite this URL:
Chen H, Huang M, Wei J. Elementary school children's knowledge and intended behavior towards hearing conservation. Noise Health [serial online] 2008 [cited 2020 Aug 11];10:105-9. Available from: http://www.noiseandhealth.org/text.asp?2008/10/41/105/44349

  Introduction Top


If adults are exposed to excessive sound levels for certain amounts of time at work, the U.S. Occupational Safety and Health Administration requires that their employers provide a hearing conservation program to protect them against noise. [1],[2] Even though children are often exposed to high intensity sound [3],[4] that might result in their hearing thresholds being elevated [5],[6] and consequent negative effects on their physiology, psychology, and learning, [7],[8] there are no federal regulations to protect children against noise. [1],[2] Children's exposure to noise requires more attention, not only because of some of the reasons listed above, but also because textbooks and classroom curricula do not cover enough information about hearing protection against noise. [9] Many teachers lack knowledge on this topic, and are therefore, unlikely to provide hearing conservation information to their students. [10] Educational hearing conservation programs are powerful tools that have demonstrated effectiveness. [2],[3],[11],[12],[13] 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 shifts (NITSs) 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 this 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 from noise, and reasons why they would not take any protective action against noise.


  Materials and Methods Top


Subjects

Four hundred and seventy-nine 4 th and 5 th graders in 11 elementary schools participated in this study. The participants included 254 boys (53.03%) and 225 girls (46.97%). The average age was 10.51 ± 0.60 years for boys and 10.48 ± 0.58 years for girls. Eleven children (2.3%) reported having had ear diseases in the past. Only 95 children (19.8%) had the experience of a hearing test and four of them had hearing problems. Forty-nine children (10.2%) reported to have some sort of hearing difficulty in discriminating fricative and affricative sounds.

Questionnaire

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 towards noise, and IV. reasons why children would not take protective actions against noise (Please see the appendix).

For the basic information section (section I), children filled in their age, gender, history of ear diseases, experience of a hearing test, and answered two questions as to whether they were aware of any hearing difficulty.

[Table 1] shows the knowledge section (section II) of HCQ. It included 21 items and could be scored in three different subtests: general hearing health (six items), noise hazards (six items), and hearing protection (nine items). Children answered "yes," "no", or "do not know" on each item. "Do not know" was considered as an incorrect answer. The percentage of correct items was recorded for each subtest.

Intended behavior towards noise (section III) involved only one item: "What kind of behaviors you intend to adopt towards noise" with six possible answers. Children could choose more than one of these responses: "use earplugs", "walk away", "block ears with fingers", "shorten stay duration", "move to quieter places", and "do nothing". The previous five answers correspond with items 3, 6, 12, 1, and 19 of the knowledge section (section II), respectively. The consistency in each set of answers was used for the analyses of agreement between behavior and knowledge about hearing protection.

In the last section of the questionnaire (section IV), children were asked "Have you ever taken any protective actions against 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 are uncomfortable, (4) too much trouble to use hearing protective devices, and (5) too lazy to take any precautions against noise.

Procedures

The questionnaire was administered by author MH in children's schools, one class at a time. Subjects were told that there would be no punishment for incorrect answers. A small gift was given to each subject at the end of the test as a token of thanks for their participation.


  Results and Discussion Top


It is surprising to find out that 49 children (10.2%) seemed to have some sort of hearing difficulty in discriminating fricative and affricative sounds in this study. It indicates that these children's hearing acuity needs to be evaluated. Besides a hearing check, it is important to know what might have caused the high incidence of this problem; noise might be one reason. [6] The importance of an educational hearing conservation program cannot be overemphasized. It is also imperative to provide these children with some type of hearing-enhancing device or strategy to compensate for the loss of incomplete hearing in the classroom and daily life.

Percentages of correct responses in the knowledge section of the HCQ are shown in [Table 2]. 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 . [12]

Statistical analysis (two-way ANOVA) indicated that there was no significant difference between boys' and girls' scores ( P > 0.05). 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. More emphasis should be devoted to these concepts if an educational hearing conservation program is developed for children. Although the scores in other two subtests were better than scores in the noise hazard subtest, the 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 HCQ were drawn for further analysis and these items were related to knowledge about taking protective actions against noise. The column on the left in [Table 3] shows that among the five possible protective actions to be taken against noise, children knew the best in walking away (84.3%). It was followed by shortening stay duration (72.7%), moving to quieter places (72%), blocking ears with fingers (66.9%), and using earplugs (55.3%). The data gathered from section III of HCQ, "What kind of behaviors you intend to adopt towards noise", was analyzed and recorded in the column on the right in [Table 3]. It shows that the type of action children intended to take against noise, from high to low, was walking away (80.3%), blocking ears with fingers (54.1%), moving to quieter places (52.2%), shortening stay duration (41.9%), and using earplugs (30.4%). The percentage of intended use of earplugs in this study (30.4%) was higher than that reported by other researchers. [2],[11],[14] One reason for this disagreement among studies was that some of these studies asked about subjects' actual experience of using earplugs in noise, [11],[14] 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 in the HCQ. The data in [Table 3] 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 against noise. This discrepancy indicates that a link between knowledge and intended behavior does not necessarily exist. For example, 55.3% of the 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.

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 shown in [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5]. The results indicated that children's protective strategies towards noise were not independent of their knowledge ( P < 0.05). Children who possessed the knowledge of walking away, blocking their ears with their fingers, and moving to quieter places had a greater likelihood of showing the correlated behaviors towards noise. It is probable that the provision of an educational hearing conservation program would increase the percentage of children taking protective actions against noise. However, there were some children who knew that using earplugs and shortening the time spent in noisy environments 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 hearing conservation program, 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 against noise and why not", revealed that 343 children (71.6%) had tried to take some kind of protective action against noise. In other words, 136 children (28.4%) did not report any behavior towards protecting their hearing from noise. Several reasons were found among these children that might explain this observation. 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 against noise" ( N = 26, 19.12%). It seems that lack of knowledge is the major reason.


  Conclusions and Implications Top


Children in this study had low average scores (62%) in a hearing conservation questionnaire. A hearing conservation program 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 from 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 towards noise. Only 55% of the children knew that hearing protective devices could protect their hearing from noise. Approximately 28% of the children did not intend to adopt any protective behaviors towards noise, with the major reason for this being a lack of knowledge (48.5% of them did not know how to protect themselves from noise). Children's knowledge of and their intentions to utilize protective strategies against noise were highly correlated. However, possessing knowledge did not guarantee that 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.

 
  References Top

1.Folmer RL. Why aren't hearing conservation practices taught in schools? Healthy Hearing 2004. Available from: http://www.healthyhearing.com/hearing_library/article_content.asp?article_id=151.  Back to cited text no. 1    
2.Griest SE, Folmer RL, Martin WH. Effectiveness of "Dangerous decibels": A school-based hearing loss prevention program. Am J Audiol 2007;16:S165-81.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Chermak GD, Peters-McCarthy E. The effectiveness of an educational hearing conservation program for elementary school children. Lang Speech Hear Serv Sch 1991;22:308-12.  Back to cited text no. 3    
4.Blair JC, Hardegree D, Benson PV. Necessity and effectiveness of a hearing conservation program for elementary students. J Educ Audiol 1996;4:12-6.  Back to cited text no. 4    
5.Brookhouser, PE, Worthington, DW, Kelly WJ. The effectiveness of an educational hearing conservation program for elementary school children. Laryngoscope 1992;102:645-55.  Back to cited text no. 5    
6.Niskar AS, Kieszak SM, Holmes AE, Esteban E, Rubin C, Brody DJ. Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: The third national health and nutrition examination survey, 1988-1994, United Sates. Pediatrics 2001; 08:40-3.  Back to cited text no. 6    
7.Cohen S, Weinstein N. Nonauditory effects of noise on behavior and health. J Soc Issues 1981;37:36-70.  Back to cited text no. 7    
8.Haines MM, Stansfeld SA. The effects of environmental noise on child health and learning: A review of international research. Acoust Aust 2003;31:17-22.  Back to cited text no. 8    
9.Frager AM, Kahn A. How useful are elementary school health textbooks for teaching about hearing health and protection? Lang Speech Hear Serv Sch 1988;19:175-81.  Back to cited text no. 9    
10.Lass NJ, Carlin MF, Woodford CM, Campanelli-Humphreys AL, Judy JM, Hushion-Stemple EA. A survey of classroom teachers' and special educators' knowledge of and exposure to hearing loss. Lang Speech Hear Serv Sch 1985;16:211-22.  Back to cited text no. 10    
11.Lewis D. A hearing conservation program for a junior high school. Hearing J 1989;42(3):19-24.  Back to cited text no. 11    
12.Chermak GD, Curtis L, Seikel JA. The effectiveness of an interactive hearing conservation program for elementary school children. Lang Speech Hear Serv Sch 1996; 27:29-39.  Back to cited text no. 12    
13.Lerman Y, Feldman Y, Shnaps R, Kushnir T, and Ribak, J. Evaluation of an occupational Health education program among 11 th grade students. Am J of Indust Med 1998; 34:607-613.  Back to cited text no. 13    
14.Lass NJ, Woodford CM, Lundeen C, Lundeen DJ, Everly-Myers D. A survey of high school students' knowledge and awareness of hearing, hearing loss, and hearing health. The Hearing J 1987;40:15-9.  Back to cited text no. 14    

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Correspondence Address:
Hsiaochuan Chen
National Kaohsiung Normal University, Kaohsiung
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1463-1741.44349

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]

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