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   Methods
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  Table of Contents    
ARTICLE  
Year : 2011  |  Volume : 13  |  Issue : 51  |  Page : 142-146
Noise-induced hearing loss in agriculture: Creating partnerships to overcome barriers and educate the community on prevention

1 Surveillance Branch, Division of Surveillance, Health Effects and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA
2 Hearing Loss Prevention Team, Engineering and Physical Hazards Branch, Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA

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Date of Web Publication1-Mar-2011
 
  Abstract 

Noise-induced hearing loss (NIHL) is a common and preventable injury for farmers. Farmers are frequently exposed to excessive noise, ranking among the top three occupations and industries with the highest risk for hearing loss. Use of hearing protection among farmers is not common. Although the age when NIHL begins among farmers is unknown, its prevalence is higher among male adolescents who live and work on farms. The purpose of this paper is to describe how NIOSH created partnerships to promote hearing conservation for this hard-to-reach population. Partnerships included organizations and individuals who were trusted sources of information for the target population, young farmers 14-35 years of age and their families, and those who had linkages in rural communities. NIOSH engaged partners through exhibits and train-the-trainer workshops at state or national conventions. NIOSH workshops included basic information on NIHL as well as information on free or low-lost resources that participants could use in training others at schools and community events. People with hearing conservation expertise have an important role and many opportunities to improve the knowledge and implementation of hearing conservation among those in agriculture.

Keywords: Hearing loss, agriculture, partnerships

How to cite this article:
Ehlers JJ, Graydon PS. Noise-induced hearing loss in agriculture: Creating partnerships to overcome barriers and educate the community on prevention. Noise Health 2011;13:142-6

How to cite this URL:
Ehlers JJ, Graydon PS. Noise-induced hearing loss in agriculture: Creating partnerships to overcome barriers and educate the community on prevention. Noise Health [serial online] 2011 [cited 2014 Apr 24];13:142-6. Available from: http://www.noiseandhealth.org/text.asp?2011/13/51/142/77218

  Introduction Top


Noise-induced hearing loss (NIHL) is a common and preventable injury for farmers. Although many farmers acknowledge that their work environment is noisy, most do not use hearing protection devices (HPDs) [1] and typical hearing conservation programs used in general industry may have limited application in agriculture, especially on small family farms. This paper describes how NIOSH created partnerships to promote hearing conservation in this hard-to-reach population. The partnerships included organizations and individuals who were trusted sources of information for the target population: young farmers aged 14-35 years and their families.

According to the American Academy of Audiology, [2] "The average, otherwise healthy, person will have essentially normal hearing up to age 60 if his or her ears are not exposed to high noise levels." However, hearing damage often starts at a young age when children and adolescents, who live and work on farms, are exposed to hazardous noise such as squealing pigs, tractors, combines, grain dryers, chain saws and other equipment and tools. Although the age when NIHL begins is unknown, the prevalence of NIHL is higher among male adolescents who live and work on farms. [3] Karlovich [4] estimated that 25% of the male farmers incur hearing handicaps by age 30 and 50% by age 50. Intervention research has shown that education of adolescents about NIHL can increase their usage of HPDs. The parents of students in an intervention group reported that they themselves also increased their use of HPDs. [5],[6],[7]

Exposure to noise is recognized increasingly by public health professionals and researchers as a public health problem with serious consequences. In the Farm Family Health and Hazard Survey, 36% of the New York adult farmers and farm residents reported some difficulty in hearing. [8] In a literature review, McCullagh [9] consistently found that those who live and work on farms have a significantly higher prevalence of hearing loss consistent with NIHL than the general population. In a study of rural residents aged 8 through 92, the National Health Interview survey (1997-2003) found significant increases in reported hearing loss among farmers. Compared with health care service workers, farm operators were twice as likely to report hearing difficulty. [10]


  Methods Top


We used a participatory, community or regionally based public health approach to introduce the concept of NIHL to the farming community. Participatory research involves collaboration among the stakeholders and helps assure that the final campaign elements will, in large part, be responsive to the needs of the target audience. This project involved partnerships between NIOSH and key organizations with access to agricultural workers. The primary goal was for members of these key influential organizations to promote hearing conservation among farmers.

To determine those who farmers trust for new useful information and those who had linkages for accessing farmers, we needed to understand the social networks of farmers. Chapman conducted a study in Wisconsin dairy farmers and found that farmers trust and/or interact with other farmers (83%), producer newsletters and magazines (81%), dealers and suppliers (57%) and farm shows and field days (54%). [11] Examples of organizations with linkages into agricultural communities include the National Association of Agricultural Educators (NAAE), which has 13,000 teachers reaching 783,000 students in 2009; Progressive Agriculture Foundation (PAF) reaching 90,000 people in the US and Canada annually; Farm Safety 4-Just Kids (FS4JK) that has approximately 135 community-based groups across the US; Farm Bureau (FB) that is the largest farm organization in the US and is dedicated to the interests of US farmers and ranchers; and state cooperative extension education programs, such as 4-H, that are part of the US Department of Agriculture. The extension service is associated with individual counties and state Land Grant Universities. These organizations often use communication resources identified by Chapman. In rural communities, individuals may be members of several organizations, making it easier for multiple organizations to collaborate on common concerns. For example, community-based safety days sponsored by the PAF are locally assisted by one or more community-based organizations, e.g. FB, 4-H, FS4JK, the Cooperative Extension Service and/or FFA (formerly known as the Future Farmers of America), a school-based organization sponsored by the Department of Education.

We identified potential key agricultural organizations that were trusted by and influenced agricultural workers through existing networks among members of the National Institute for Farm Safety (NIFS) and other networks related to agricultural safety and health. In June 2007, NIOSH initiated a short meeting of NIFS attendees from the NIOSH-funded Agricultural Centers and others interested in the prevention of hearing loss among farmers. Most who attended were members of one or more organizations listed in [Table 1]. They shared related activities that they had performed and other potential opportunities. They reviewed the drafts of two brochures that NIOSH was developing in collaboration with partners, and how the brochures could be used by both those who were already involved in NIHL prevention and those who could be encouraged to initiate NIHL prevention. Over the course of the project, these persons volunteered to serve as informal key informants or otherwise provided support and guidance for work with their organizations and others. Their names and e-mail addresses were added to an e-mail list of persons interested in promoting the prevention of NIHL in agriculture that is managed by the NIOSH project leader. The e-mail list was used, for example, to inform people about NIOSH and other resources.
Table 1: Examples of hearing loss prevention activities with partners

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Specific details of the campaign were developed in collaboration with partners based on their resources and interests. The role of NIOSH was to identify potential partners, partner with these key organizations, initiate meetings with these partners to share ideas for promotion of hearing conservation, conduct train-the-trainer events (for partners), present interactive displays at events and disseminate information via trade publications. At all training events and presentations, NIOSH provided packets of materials that included samples of at least two types of hearing protection, the two brochures completed at the onset of this project, an invitation for bulk orders of brochures for use in their community and sources of additional free or low-cost resources. NIOSH filled requests for the brochures at no cost. The role of the partners was to promote hearing conservation among those they influenced in a way most suitable to their organization and audience. Examples of efforts by partners include use of one-on-one contacts by the influencers while conducting other business, use of mass media, collaboration with providers of goods using literature racks at point-of-sale and URL links from web-based catalogs to NIOSH resources.

Selected groups from most of the partner organizations have been involved in other types of farm safety promotions, such as promoting roll-bars on tractors and supporting farm safety days for children [Table 1].

We used qualitative methods to evaluate the group activities. The NIOSH project officer was able to track some of the activities, partners and outgrowths of both NIOSH and partner efforts. This information was gained from partners or others who voluntarily reported this information. These efforts included tracking requests for brochures, reports on how brochures were used by others, attendance at workshops, willingness of trade publications to include related articles, requests for presentation materials, URL links to the brochures by organizations on their web sites and both hits and downloads of brochures.


  Results Top


Hearing loss prevention activities were conducted by participating partner organizations in at least 43 states, as evidenced by the fact that NIOSH received requests for bulk orders of both brochures by persons in at least 43 states who attended their workshops or exhibits.

Two NIOSH companion educational brochures on noise and hearing conservation were completed in collaboration with farmers and those with expertise and networks for health promotion among farmers. They're your ears - Protect them (#2007-175) [12] and Have you Heard? Hearing Loss Caused by Farm Noise is Preventable (#2007-176) [13] are consistent with communication research, in that they provide messages targeted to persons at various stages of change related to hearing protection use.

Between December 2007 and November 2009, NIOSH conducted a total of 11 exhibits and 18 train-the-trainer workshops at 11 state or national conferences. These workshops provided information on why people needed to use HPD, where to buy them and examples of simple means to reduce noise exposure in farming. All but three workshops were by invitation and outgrowths of prior workshops. In addition, NIOSH conducted one workshop via webinar and two for FB members. The workshops for FB members required annual training for those purchasing FB insurance. This allowed NIOSH to conduct training with our target audience of mostly small farm owner-operators who would otherwise not likely have access to this information. The 50 available connections for the webinar were filled, with multiple persons participating at some sites. The workshops conducted at the NAAE conventions reached educators in other fields of career and technical education (e.g., welding, construction, mechanics) because, nationally, NAAE meets in conjunction with the Association of Career and Technical Education (ACTE). About 500 NAAE members, ACTE members and others participated in these workshops. Every workshop and exhibit generated requests for:

  • additional workshops,
  • copies of the PowerPoint presentations,
  • inclusion on an e-mail list for those interested in hearing conservation,
  • directions for building a mannequin like the one used by us,
  • brochures and
  • other resources for training others.
Overall, NIOSH provided samples of the brochures to approximately 4500 members of various organizations and filled over 500 requests for a total of over 330,000 copies of each brochure. Among 75 participants at eight workshops at NAAE/ACTE national conventions (2008 and 2009), 74% requested at total of about 3400 brochures. Some partners sent quantities to their contacts who then subsequently requested bulk orders from NIOSH.

Over 250 people have requested to receive periodic e-mails, with more information and resources on the prevention of NIHL, new ideas and resources and upcoming training events, e.g. webinars. Additionally, NIOSH partnered with media popular with this audience, to promote hearing conservation with the audience. Through this partnership, NIOSH published eight articles in trade journals by working in collaboration with an agricultural journalist. These publications have an estimated total circulation of over 800,000 readers.


  Discussion Top


This project has demonstrated that multiple key agricultural organizations show interest and will partner with public health practitioners who can provide them with expertise in hearing conservation. These collaborations then facilitate dissemination of the information through social and professional networks. These efforts are consistent with their organization's missions, objectives, activities and, in some situations, available resources. For example, local FFA Chapters could promote hearing conservation as a Community Service-Learning Projects. Service-Learning is a key activity in FFA. Local Chapters can apply to the National FFA Organization for $2000 "Live to Serve" grants to assist with such projects.

Early in conversations with teachers and others, NIOSH discovered that they were also concerned about the potential for NIHL related to music players as well as from farm-related noise. Therefore, we included this issue in all workshops and exhibits. To accomplish this, we obtained a mannequin that we named "Nick," which was designed to teach people how loud they were listening to their music players. This concept was developed by Genna Martin and can be built for about $100. A sound-level meter wired to one ear of a mannequin registers the amount of sound from the earphone of personal music players. We also provided participants with a website address where they could acquire free instructions on how to build a mannequin like our "Nick." At least 10 such mannequins were built and used by others as a result of our events. See http://www.dangerousdecibels.org .

The partners in this effort recognize that, with very few exceptions, farmers of all ages fail to receive hearing conservation training like the programs required by OSHA for general industry. In a similar fashion to general industry, where supervisors can promote hearing conservation and reinforce the need to use HPDs, family members, agricultural organizations and those with expertise in hearing conservation can partner effectively to assume that role in agriculture.

Hearing conservation specialists have important responsibilities and opportunities

Professionals with hearing conservation expertise as well as those who distribute HPDs have an important role and many opportunities to improve the availability of hearing conservation among those in agriculture. Such professionals include occupational health nurses, industrial hygienists, safety persons and others who are certified hearing conservationists. At both the national and the community-based levels, these professionals need to work together with those who have linkages with the agricultural communities to develop, pilot and evaluate sustainable programs. Because of the existing availabilities in rural communities, it may be possible that speech pathologists in schools and audiologists in local hospitals could become part of local partnerships.

What can hearing conservationists do in collaboration with agricultural organizations?

  • Volunteer their services individually or supported by their employer to offer services to organizations for single events in local communities.
  • Help identify ways to facilitate the availability of low-cost hearing screening.
  • Ensure that one or more persons in the community become certified as hearing conservation technicians.
  • Work with local high schools to raise their awareness of the importance of the need for hearing conservation programs for teachers and students.
  • Work with one or more local, state or national organizations to review the needs and resources for hearing conservation and develop plans for building the needed expertise and assisting with developing a community-based program.
There is a need and opportunity for partnerships to go beyond the scope of this project to identify and disseminate ideas for a range of low-cost engineering controls that will reduce noise exposure on farms and in the labs (shops) of high school and college agricultural classes. Some simple engineering controls are applicable (e.g., keep doors and windows closed in tractor cabs and mufflers in repair) and others could be developed. Agricultural educators have mechanical expertise that could be useful in designing acceptable interventions in collaboration with persons with expertise in noise control. Educators also provide an avenue to dissemination of the intervention.

Involving the partners with access to the population and those with other resources and expertise in planning makes good use of resources and enhances both groups ownership of a problem and intervention. At this time, no one organization, or all the currently involved organizations together, have the resources to fully address this need. Continued collaboration and networking can make best use of scarce resources.


  Acknowledgments Top


The authors express their sincere appreciation for all the organizations and individuals who have become partners and collaborators with NIOSH to promote hearing loss prevention among their members and in their communities. They are too numerous to mention individually. However, many of them are listed in [Table 1]. The authors would also like to thank Ellen Galloway for her editing assistance.

 
  References Top

1.McCullagh MS, Lusk S, Ronis D. Factors affecting use of hearing protection devices among farmers: A test of the health promotion model. Nurs Res 2002;51:33-9.  Back to cited text no. 1
    
2.American Academy of Audiology. Preventing noise-induced occupational hearing loss. Washington, D.C.: American Academy of Audiology; 2003.  Back to cited text no. 2
    
3.Broste SK, Hansen DA, Strand RL, Stueland DT. Hearing loss among high school farm students. Am J Public Health 1989;79:619-22.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Karlovich RS, Wiley TL, Tweed T, Jensen DV. Hearing sensitivity in farmers. Public Health Rep 1988;103:61-71.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Knoblock M, Broste S. A hearing conservation program for Wisconsin youth working in agriculture. J School Health 1998;68:314-8.  Back to cited text no. 5
    
6.Knobloch M. Influencing parental safety behavior: The secondary impact of a youth-directed intervention. J Health Educ 1999;30:115-9.  Back to cited text no. 6
    
7.Reed DB, Westneat SC, Kidd PS. Observation study of students who have completed an agriculture safety education program. J Agric Saf Health 2003;9:275-84.  Back to cited text no. 7
[PUBMED]    
8.Gomez MI, Hwang SA, Sobotova L, Stark AD, May JJ. A comparison of self-reported hearing loss and audiometry in a cohort of New York farmers. J Speech Lang Hear Res 2001;44:1201-8.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.McCullagh M. Preservation of hearing among agricultural workers: A review of literature and recommendations for future research. J Agric Saf Health 2002;8:297-318.  Back to cited text no. 9
[PUBMED]    
10.Tak S, Calvert GM. Hearing difficulty attributable to employment by industry and occupation: An analysis of the National Health Interview Survey-United States, 1997 to 2003. J Occup Environ Med 2008;50:46-56.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Chapman LJ, Newenhouse AC, Karsh BT, Taveira AD. The use and value of information systems as evaluated by dairy and specialty crop farm managers. J Agromedicine 2009;14:324-35.  Back to cited text no. 11
[PUBMED]    
12.NIOSH. They're your ears - Protect them. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2007. DHHS(NIOSH) Publication No. 2007-175.  Back to cited text no. 12
    
13.NIOSH. Have you heard? Hearing protection can prevent hearing loss from farm noise. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2007. DHHS(NIOSH) Publication No. 2007-176.  Back to cited text no. 13
    

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Correspondence Address:
Janet J Ehlers
RN NIOSH, R-17, 5555 Ridge Avenue, Cincinnati, OH 45223
USA
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DOI: 10.4103/1463-1741.77218

PMID: 21368439

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