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|Year : 2004 | Volume
| Issue : 25 | Page : 59--70
The influence of socio-economic status on adolescent attitude to social noise and hearing protection
SE Olsen Widen1, SI Erlandsson2,
1 University of Trollhättan/Uddevalla; Department of psychology, Göteborg University, Sweden
2 University of Trollhättan/Uddevalla, Sweden
S E Olsen Widen
University of Trollhättan-Uddevalla, Box 1236, S-462 28 Vänersborg
The focus of the present study, of 1285 adolescents, was young people's attitudes towards noise and their use of hearing protection at discos and pop concerts. Comparisons were made between adolescents from different age groups, and with different socio-economic status. Logistic regressions indicated that «DQ»worry before attending noisy activities«DQ» and «DQ»hearing symptoms«DQ» such as tinnitus and noise sensitivity could, to some degree, explain the use of hearing protection in noisy environments. Another conclusion to be drawn from this study was that adolescents' attitudes and behaviors regarding hearing protection use differed between levels of socio-economic status. Individuals with high SES expressed more negative attitudes and used ear protection to a greater extent than those with lower SES. This result might indicate differences in the development of future auditory problems among individuals with different levels of socio-economic status. The cause of hearing impairment and tinnitus may not be restricted merely to noise exposure. Psychological aspects, such as attitudes towards noisy environments and the individual's behavior regarding the use of hearing protection may be considered as important factors in the understanding of why the prevalence of hearing related problems has increased among adolescents.
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Olsen Widen S E, Erlandsson S I. The influence of socio-economic status on adolescent attitude to social noise and hearing protection.Noise Health 2004;7:59-70
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Olsen Widen S E, Erlandsson S I. The influence of socio-economic status on adolescent attitude to social noise and hearing protection. Noise Health [serial online] 2004 [cited 2020 Jul 14 ];7:59-70
Available from: http://www.noiseandhealth.org/text.asp?2004/7/25/59/31646
Exposure to noise seems to increase with age during adolescence since older adolescents attend pop concerts and discotheques more frequently than their younger peers do. Beyond adolescence, social noise exposure usually decreases with age. Leisure time noise can be one of the reasons behind young peoples' hearing impairments, but the effects of systematic and repeated habits involving noise exposure are only noticed much later in life (Jokitulppo et al., 1992). A difference between girls and boys regarding their choice of leisure time activities was reported by Jokitulppo et al. (1992). Activities with the greatest exposure to high decibel levels, such as playing in a band, attending motor sports or shooting, were activities preferred by boys. Girls were exposed to loud sounds, most frequently in connection with activities involving music, such as concerts and discotheques. Temporary buzzing in relation to noisy leisure time activities like discotheques and pop concerts was found to be unexpectedly high among 309 children, aged between 10 to 16 years old (Erlandsson and Olsen, 2001). More than half of the group (52%) had noted sounds in their ears or head after attending a noisy activity like a pop concert. Olsen and Erlandsson (2004a) found that approximately 8.7% of 1285 adolescents between 13-19 years of age reported permanent tinnitus, whilst temporary tinnitus was reported by 21.6% of the respondents. Noise sensitivity was mentioned by approximately 17% of the sample and significantly more girls than boys were sensitive to noise.
A large population study in the USA, including 5249 children and young adults aged between 6 and 19 years showed that 12.5 % of the sample had Noise Induced Threshold Shifts (NITS; Niskar, et al., 2001). One important finding in this study was that children and young adults of parents with a low Poverty Income Ratio (PIR), a measure of economic conditions, had the highest prevalence of NITS. Research indicates the presence of an association between socioeconomic status (SES), health and health related behavior (Haan, et al., 1989; Backlund, et al., 1996). Usually research concerning SES and health is focused on middle-aged individuals (Chen, et al., 2002). Most studies confirm the hypothesis that individuals from groups with lower SES generally have more health problems than their higher SES counterparts (Backlund, et al., 1996; Frank and Mustard, 1994). When SES increases, risk factors and the prevalence of e.g. asthma, visual- and audiological problems, injuries, and other diseases like ear infections, appear to decrease (Chen, et al., 2002). Olsen and Erlandsson (2004a) however, did not find any significant differences between SES levels with regard to self-reported tinnitus and noise sensitivity among Swedish adolescents.
Studies of socio-economic factors in adulthood indicate the presence of a pattern in which individuals with lower SES have a greater propensity to engage in risk-taking behaviors regarding their health (Graham, 1994; Stronks, et al., 1996). Individuals with low SES often engage in health risk behaviors such as smoking, poor dietary habits and physical inactivity more frequently than individuals with higher SES. Interestingly enough, the relationship between SES and health does not seem to be the same throughout the human life span. Research indicates that the relationship may change due to increased age, as SES seems to have a stronger effect in certain parts of life, as opposed to others (Chen, et al., 2002). The relationship between SES and health during childhood and adulthood seems to be well established, where, in general, low SES is associated with poorer health. However, in contrast to research studies including both children and adults, studies that have focused on adolescents have found less support for the link between SES and health during this period of life (West, et al., 1990; Macintyre and West, 1991; Rahkonen, et al., 1995). This absence of an association between SES and health during adolescence might involve different risk factors or behaviors that could be related to poor health (Chen, et al., 2002).
In spite of the growing interest in studying the association between SES and health, relatively little is known about possible factors that are involved and how they interact. Even though SES itself is not a causal factor of poor health, it is still very important to investigate the relationship between SES and health, since it might provide clues to the possible factors involved (Kaplan and Lynch, 1997). The findings regarding socio-economic status and health risk behaviors among adolescents are not consistent. Some studies support the idea that health risk behaviors e.g. smoking, drug use, alcohol consumption and physical inactivity are more common among adolescents from families with low SES (Piatila, et al., 1995, Greenland, et al., 1995). Other studies indicate that SES have little or no connection with health risk behaviors (Glendinning, et al., 1994; Donato, et al., 1995). Even if there is no simple correlation between SES and health outcomes in adolescents, SES differences may be linked to health risk behaviors, and can cause poor health later on in life (Pietila, et al., 1995). Socioeconomic differences in adolescence can, from this perspective, be regarded as an important predictor to SES-related health outcomes in adulthood. Noise induced hearing loss can be avoided by reducing damaging noise exposure by the use of hearing protection (Rabinowitz, 2000). Therefore, participating in noisy activities without using hearing protection can be seen as a health-risk behavior, since it may cause future hearing problems.
Aim of the study
The aim of the present study was to discover whether adolescents' attitudes towards noise differed due to age and socio-economic status (SES). Additionally, the study investigated the influence of factors like permanent tinnitus, noise sensitivity, socio-economic status and attitude towards noise, on the use of hearing protection at discotheques and pop concerts.
The sample included 1547 pupils (13 to 19 years of age) at different schools in Goteborg and Vanersborg, Sweden. The response rate was 1324 (85.6%). Out of these questionnaires, 39 (2.5%) were incorrectly filled in regarding YANS (see measurements), and were therefore excluded. The total number of missing cases (internal and external) was 262 questionnaires (16.9%). Out of the remaining 1285 questionnaires, 593 (46.1%) were completed by secondary school students (aged 13-15), and 692 (53.9%) by upper secondary school students (aged, 16-19). The distribution of girls and boys was 665 (51.8%) and 620 (48.2%) respectively. Certain information was lacking due to incorrectly completed questions regarding the SES variable. The total number of missing cases was 107 (8.3%). The majority of these cases were secondary school students (seventh or eight grades, some 14.5% of the secondary school group). Ten adolescents from vocational programs (3.2%) and 11 from theoretical programs (2.9%) did nor correctly complete the part of the questionnaire that asked about their parents' SES. These questionnaires were, however, correctly completed with regard to all of the other questions, and were therefore included. The distribution of SES in the sample was satisfactory and is presented in [Table 1].
The measurements included in the questionnaire were the following:
1) Demographic questions (nine items),
2) Holling head Four Factor Index of Social Status (four items),
3) Youth Attitude to Noise Scale (YANS, eighteen items),
4) Hearing Symptom Description (HSD, nine items),
5) Adolescents' Habits and use of Hearing protection (AHH, fifteen items).
The demographic part (1) included questions about the participants' age, gender, and choice of educational program. Other questions included dealt with parental education and employment (2). This latter information was used to determine the SES of the family and thus used to classify the SES of the child (Hollinghead, 1975; Swedish version, Broberg, 1992). The purpose of YANS (3) was to measure adolescents' attitudes towards noise (Olsen and Erlandsson, 2004b). YANS consisted of 18 items divided into four dimensions. The items were formulated as statements, with a five-degree Likert scale from "totally disagree" to "totally agree". A positive attitude referred to an attitude towards noise, where noise was seen as something "unproblematic", whereas a negative attitude referred to the individual's perception of noise as something "bad" and something to "keep away from".
An exploratory factor analysis with an oblique rotation based on a sample of 1285 adolescents, was conducted in order to investigate the dimensionality of the instrument. The factor analysis indicated a four factor solution with 18 items ((x = 0.80, see below). 1. Attitudes towards noise that can be associated with certain elements of youth culture, e.g. music at discotheques, α = 0.78 (six items). 2. Attitudes towards common daily noises, e.g. sounds from traffic, computers, fans, refrigerators etc, α = 0.72 (five items). 3. The individual's intention to influence his or her sound environment, α = 0.63 (four items). 4. Attitudes towards the ability to concentrate in noisy environments a = 0.53 (three items).
Analysis concerning adolescents' attitudes towards noise was based on the entire instrument. The means and the standard deviations of the four factors and the entire YANS is presented in [Table 2].
Bivariate correlations were conducted between the four factors and the entire YANS. These correlations and the explained variance of each factor and the entire YANS is presented in [Table 3].
The HSD (4) included questions about hearing symptoms (Erlandsson and Olsen, 2004a), such as permanent tinnitus (buzzing or ringing in the ears), pain in the ears, noise sensitivity, temporary tinnitus and hearing impairments (reported in Olsen and Erlandsson, 2004a). Questions regarding the types of activities where these symptoms first occurred were also asked. The questions that focused on permanent tinnitus and noise sensitivity were formulated in the following way: "Do you have permanent tinnitus (buzzing or ringing) in your ears all the time?" "Do you consider yourself to be oversensitive to noise?" The sample was divided into four symptom groups based on questions regarding the prevalence of permanent tinnitus and noise sensitivity. Group 1; No hearing problems (NHP). Group 2; Tinnitus (T). Group 3; Noise sensitivity (NS). Group 4; Tinnitus and noise sensitivity (TNS). Individuals who had indicated hearing impairments in the questionnaire were excluded from the NHP group. A question concerning worry before attending noisy activities due to previous experience of auditory problems (yes, no) was included, since one hypothesis was that worry could affect the decision to use hearing protection.
The AHH (5) consisted of fifteen questions about the adolescent's involvement in noisy activities (Erlandsson and Olsen, 2004b) measured on a four-degree scale and ranged from the alternative "never" to "several times a week or daily". For each question the participant could indicate whether or not ear plugs was used (yes or no).
The questionnaire was distributed to students enrolled at eight different schools in Vanersborg and Goteborg. Five upper secondary schools and one secondary school were selected in Goteborg and one secondary school and one upper secondary school in Vanersborg. The educational programs (theoretical and vocational) did not differ between the upper secondary schools in Vanersborg and Goteborg. Goteborg has approximately 800,000 inhabitants, including its surrounding municipalities, and Vanersborg has about 30,000 inhabitants. The two locations were chosen in order to be able to identify any potential differences regarding, for example, the use of hearing protection and attitudes. Another reason for choosing a small town and a large city, was that it made it more possible to generalise the results, such as the prevalence of tinnitus, to a Swedish population.
The school principals were informed about the study and gave their permission for the investigation to be conducted. A short letter containing information about the study and its purpose was sent to the class teachers involved, who distributed the questionnaire to the pupils. The completed questionnaires were put into an envelope, which was picked up by one of the researchers at a prearranged time. This procedure was carried out in all of the schools included. In the case of secondary school students (under 15 years of age), a letter to their parents in which they were asked to give their permission for their child to take part in the study, was sent to each child's home. The time needed to complete the questionnaire was approximately 20 minutes.
A 2 x 3 factorial ANOVA was used to analyze the relationship between age and SES, with regard to attitudes towards noise. Furthermore, two multiple logistic regression analyses (enter) were conducted in order to analyze adolescents' use of hearing protection at 1) discotheques, and 2) pop concerts. Each multiple logistic regression analysis consisted of two models. In the first model, the use of hearing protection was the dichotomous dependent variable, while the independent variables were symptom groups, YANS, and SES. To be able to use attitude towards noise as an independent variable in the multiple logistic regression analysis, we divided the scale into three categories based on the quartiles of the entire scale (YANS). The 25% of the sample in the lower quartile (1.33-2.61) were individuals who could be characterised as having a more negative attitude. The 50% of the sample in the two middle quartiles (2.62-3.89) were characterised by having a neutral attitude, whereas the remaining 25% in the upper quartile (3.90-4.89) had positive attitudes towards noise. In the second model the same set of variables were tested (symptom groups, YANS and SES), but this time, four new independent variables were included. These were gender, age group (secondary school/upper secondary school), worry (whether the person was worried about his/her hearing prior to participating in noisy activities) and, finally musical activity (whether the person was involved in any kind of musical activity in his/her spare time, e.g. playing in a band or orchestra). The analyses were conducted using SPSS 11.0.
Adolescents and attitudes towards noise
A 2 x 3 factorial ANOVA was conducted to ascertain whether the effect of SES regarding adolescents' attitudes towards noise differed due to age. The analysis indicated that both main effects were significant. A significant difference was found between SES groups [F(2,1178) = 28.53; p SD = 0.53). Accordingly, the most positive attitudes were found, for both age groups, among those students with a low SES, the most positive of these being secondary school students (m= 3.26, SD = 0.58). The variance explained by the analysis was 8.5%. [Figure 1] illustrates the result. In [Table 4], the number of persons who report the use of hearing protection at discotheques and pop concerts is presented.
Adolescents' use of hearing protection at discotheques
[Table 5] present two models of multiple logistic regression analysis (enter) of adolescents' use of hearing protection at discotheques. The first model, explaining 21.6% of the variance, accounts for variables such as symptom groups [permanent tinnitus and noise sensitivity (TNS), experience of tinnitus only (T), experience of noise sensitivity only (NS), no hearing problems (NHP)], attitudes towards noise and finally, SES.
The analysis of the first model revealed that subjects holding more negative attitudes towards noise were significantly more likely to use hearing protection (odds ratios: 7,44) as opposed to those with more positive attitudes. Participants reporting a neutral attitude were 3,75 times more likely to report the use of hearing protection, as opposed to those reporting a positive attitude. The increase in odds ratios of reported use of hearing protection among adolescents coming from families with high SES as compared to adolescents having a low SES level, was significant. Model 1 also indicated that adolescents only reporting permanent tinnitus (T) were 2.20 times more likely to report the use of hearing protection at discotheques than the NHP group. The increase in odds ratios made a significant contribution to the model. Subjects who belonged to the TNS group were reported significantly more use of hearing protection compared to the NHP group (odds ratios: 8.37).
The second model included variables such as symptom groups, attitudes towards noise, SES, gender, age group, worry, and performing musical activities. This model explained 32.2% of the variance. The improvement of the chi-square value between the first and the second model indicated that the new added variables, strengthened the model. However, one difference between the first and the second model was that the odds ratios for the group reporting permanent tinnitus only (T) decreased and was no longer significant. The same tendency was observed as regards the use of hearing protection in the TNS group (odds ratios: 8.37 versus 3.96). However, it still made a significant contribution to the variance explained by the model.
The analysis indicated that gender did not have an effect on the use of hearing protection in this study, although age does. Older adolescents were more likely to report the use of hearing protection than was the case amongst younger adolescents. We also found that subjects who reported being worried prior to noise exposure were more likely to use hearing protection than those adolescents who did not report worry. Playing in a band or orchestra also indicated a greater likelihood of using hearing protection (odds ratios: 4,39).
Adolescents' use of hearing protection at pop concerts
[Table 6] present two models of multiple logistic regression analysis regarding adolescents' use of hearing protection at pop concerts.
According to model 1 attitudes contributed significantly to the explanation of adolescents' use of hearing protection at pop concerts. Subjects with neutral or negative attitudes were significantly more likely to report the use of hearing protection compared to subjects holding a positive attitude towards noise. Of the SES groups, adolescents from homes with high SES were significantly more likely to report the use of hearing protection. The NS group and the TNS group were significantly more likely to report use of hearing protection at pop concerts, in comparison to subjects with no hearing related symptoms. Symptom groups, attitude and SES explained 16.8 % of the variance in the first model.
In model 2, subjects having a negative attitude towards noise were more likely to report the use of hearing protection, compared to those having a positive attitude. Odds ratios decreased in comparison to model 1, but were still significant. The odds ratios were not significant for the group with a neutral attitude when compared to subjects with a positive attitude, which was the case in model 1. In the case of reported use of hearing protection, the odds ratios (2.58) were in favor of adolescents with high SES, compared to those with low SES, and contributed significantly. Subjects who belonged to the TNS group were more likely to use hearing protection at pop concerts compared to the NHP group. The odds ratios decreased in model 2, in comparison to model 1, but contributed significantly to the variance explained. The variables in model 2, together, accounted for 25.7% of the variance. Furthermore, the increase in the chi square value when the last variables were included significantly improved the model.
Gender was not found to contribute significantly to any of the regression models, although age did. Worry did not contribute significantly to the explanation of hearing protection use at pop concerts as it did at discotheques. However, being involved with music in leisure time correlated with an increased use of hearing protection at pop concerts.
Socio-economic status (SES) was found to be associated with the individual's attitude in this study. The factorial ANOVA indicated that adolescents from families with low SES were, in general, more positive towards noise, as compared to those with higher SES. The result indicated that attitudes became increasingly negative with age, independent of SES group. This could be interpreted in the sense that belonging to a certain category of SES had a greater influence on the individual's attitude during early adolescence, than it had during later years of adolescence, a finding supported by previous research by Chen et al (2002). Pietila et al. (1995) suggested that there are differences between adolescents from different SES groups as regards health risk behaviors, although there are no actual differences in health during this period of life. Differences in health risk behavior might, however, be a good predictor for poor health later in life. Our study indicated that low SES is associated with positive attitudes towards noise, and the less frequent use of hearing protection. The combination of positive attitudes towards noise and little or no use of hearing protection, can be seen as an example of health risk behavior. To expose oneself to high levels of noise as a result of going to concerts or discotheques without using any hearing protection may, in the long run, cause damage to the hearing.
Use of hearing protection can, to a certain degree, be explained by variables such as the presence of hearing symptoms. For those who belonged to the TNS group compared to the NHP group, the odds ratios increased strongly. Furthermore, attitudes contributed significantly to explaining the variance of hearing protection use. Adolescents with a positive attitude were less likely to report use of hearing protection. The odds ratios for hearing protection use increased significantly for those having a negative attitude.
The two regression analyses indicated an association between SES and the use of hearing protection. Hearing protection use increased in adolescents with high SES compared to those with low SES. This finding indicates a difference in health orientated behavior among adolescents with different levels of SES, something that might contribute to future differences in actual health. How can the existence of differences between SES groups as regards health orientated behavior and health risk behavior be adequately explained? One possible answer might be that there is a difference in the way individuals with different levels of SES perceive and evaluate risk-taking and the future consequences of such behavior. Attitude and behavioral differences may be of significance for the individual's future health, conclusions that are consistent with previous findings on SES and health risk behavior (Pietila, et. al., 1995).
Variables such as gender, age group, worry and participation in musical activities were included in the second models in both analyses. Some of these variables improved the models significantly. Age had significant effect on the use of hearing protection, where the odds ratios increased for the older group compared to the younger group. The largest effect was found for older adolescents attending concerts. Participation in musical activities in leisure time, e.g. playing in a band, increased the use of hearing protection at discotheques and concerts. Someone who plays an instrument might be more aware of the risks associated with exposure to loud sounds. To be worried prior to noise exposure also seemed to significantly increase the use of hearing protection at discotheques, but not at concerts. Finally, gender did not explain any variance regarding the use of hearing protection at discotheques or concerts.
The use of hearing protection must be considered to be an important step towards the prevention of hearing impairments, although second only to the overall reduction of sound levels in society. In Sweden there has been discussion for a long time regarding noise and the importance of wearing earplugs when exposed to loud decibel levels. It is a relatively common thing that earplugs are offered for free, or at a low price at e.g. pop concerts. Information and knowledge are obviously important steps in the prevention of noise induced hearing impairments and tinnitus, since they may have an affect on individuals' decisions to protect themselves from high decibel levels during noisy activities. In a study to be reported, comparisons have been made between Sweden and the US, pointing to large differences regarding the use of ear plugs between the two countries. The present study indicated, interestingly enough, that age and SES have an effect on behavior as regards the use of hearing protection. The use of hearing protection at noisy events should be considered as behaviors connected to the subject's attitude towards noise. Subjects with low SES were found to have positive attitudes towards noise and were, at the same time, less inclined to use hearing protection, whereas adolescents with high SES reported a greater use of hearing protection and expressed more negative attitudes towards noise.
It seems reasonable to conclude that adolescents with positive attitudes towards noise, without wearing hearing protection when exposed to high levels of sound, may develop hearing impairments later in life. According to Jokitulppo et. al. (1992) adolescents' exposure to noise increases with age leading to an increasing frequency of noise-induced hearing impairments among older adolescents. A drawback of the present study was that the amount of noise exposure and its effects on hearing were not investigated. Our study results point to the presence of behavioral differences related to SES and age as regards exposure to noise. It is uncertain as to whether exposure to noise increases with age since the use of hearing protection also seems to increase with age. To continue investigating the relationships between SES, attitudes and the use of hearing protection is important, since the differences between SES groups, in the long run are likely to, result in SES-related differences in future auditory health. Research on the association between SES and health must take into account latent factors such as the individual's attitudes and behavior, in order to be able to adequately explain and understand the relationship between SES and health. Although, there may be some evidence that using hearing protection increases with age and SES, the majority of the sample in the study did not use hearing protection at concerts and discotheques and were in fact exposed to noise. In order to investigate the impact of noisy environments on young peoples' hearing and use of hearing protection, future research is required.
The authors are grateful for the funding provided by the Stinger foundation and the University of Trollhattan / Uddevalla.
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