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ARTICLE  
Year : 2013  |  Volume : 15  |  Issue : 66  |  Page : 347-354
Adolescents' reported hearing symptoms and attitudes toward loud music

1 Registered Audiologist, Habilitation and Assistive Technologies, University Hospital of Örebro, Sweden
2 School of Health and Medical Sciences, Student of Master Program of Improvement in Health-care Activities, University of Örebro, Sweden
3 School of Health and Medical Sciences, University of Örebro, Swedish Institute for Disability Research, Örebro, Sweden

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Date of Web Publication17-Aug-2013
 
  Abstract 

The aim of the present study was to compare the adolescents' attitudes toward loud music in relation to a set of self-perceived auditory symptoms and psychological variables such as norms, preparedness to take risks and risk-judgment in noisy situations. A questionnaire on hearing and preventive behavior was distributed to 281 upper secondary school students aged 15-19 years. The questionnaire included youth attitude to noise scale, questions about perceived hearing symptoms such as tinnitus and sound sensitivity and finally statements on perceived behavioral norms regarding hearing protection use, risk-taking and risk-judgment in noisy settings. Self-perceived auditory symptoms such as sound sensitivity and permanent tinnitus had a significant relationship with less tolerant attitudes toward loud music. Permanent tinnitus and sound sensitivity together accounted for 15.9% of the variation in attitudes toward loud music. Together with the psychological variables norms, preparedness to take risks and risk-judgment 48.0% of the variation in attitudes could be explained. Although perceived hearing symptoms (sound sensitivity and permanent tinnitus) was associated with less tolerant attitudes toward loud music, psychological variables such as norms, preparedness to take risks and risk-judgment were found to be more strongly associated with attitudes toward loud music and should therefore be considered more in future preventive work. Health promotive strategies should focus on changing not merely individual attitudes, but also societal norms and regulations in order to decrease noise induced auditory symptoms among adolescents.

Keywords: Adolescents, attitudes towards loud music, norms, risk-judgment, risk-taking, sound sensitivity, tinnitus

How to cite this article:
Landälv D, Malmström L, Widén SE. Adolescents' reported hearing symptoms and attitudes toward loud music. Noise Health 2013;15:347-54

How to cite this URL:
Landälv D, Malmström L, Widén SE. Adolescents' reported hearing symptoms and attitudes toward loud music. Noise Health [serial online] 2013 [cited 2021 Sep 27];15:347-54. Available from: https://www.noiseandhealth.org/text.asp?2013/15/66/347/116584

  Introduction Top


Research has concluded that peoples' awareness of the risks of being affected by noise-related hearing problems, such as hearing loss, tinnitus and sound sensitivity, is insufficient to make people actually use hearing protection when being exposed to leisure time noise. [1] One possible explanation may be that the individual attitude toward noise is affected by one's own experiences, which may influence how an individual chooses to act in a noisy situation. [2]

The prevalence of tinnitus varies between different studies. These differences may be explained by factors like the context, how the question regarding tinnitus is formulated and the definition of temporary and permanent tinnitus. [3] Bogoch et al., [1] conducted a study in which they asked people in line to a rock concert if they had experienced tinnitus, at any time and 84.7% answered yes. Davis [4] also made a study on the prevalence of tinnitus and found that 45% had at least on one occasion experienced tinnitus. In a study by Rawool and Colligon-Wayne, [5] 66% of 238 college students agreed with the statement "I have had, in the past, ringing in my ears" and 58% of the students agreed with the statement "Although my ears ring after a social activity, the ringing goes away and I feel that I do not have to worry."

The prevalence of permanent tinnitus reported in studies usually varies between 10% and 15%. [6],[7] Most of these people are not experiencing a lot of discomfort caused by the tinnitus. [7] In a Swedish study by Olsen-Widén and Erlandsson [3] of 1285 adolescents 8.7% reported that they had permanent tinnitus. Permanent tinnitus was defined as having buzzing and ringing in the ear all time. Further 22% reported experiencing temporary tinnitus for 24 h or longer after noise exposure. The quite strict definition of tinnitus can partly explain the relatively low prevalence of tinnitus found in that study. Furthermore, the study was conducted on adolescents aging from 13 to 19 years old, which quite likely would give a lower prevalence of tinnitus in comparison to an adult population. [3] In another Swedish study young men who experience tinnitus after loud noise exposure are in fact at a greater risk not just for tinnitus, but also for high frequency hearing impairment as well as sensitivity to noise. [8]

People who are sensitive to sound often put more attention to sounds and focus more energy to think about how different sounds are perceived. They often feel insecure in noisy environments. [9] Sound sensitivity is often used as a synonym with the term hyperacusis. [10],[11] It has been proven difficult to measure hyperacusis since there is no uniform definition on where to draw the line for abnormal levels of sound sensitivity. [7] Roeser et al., [10] defines the term hyperacusis as an extreme sensitivity to everyday sounds of low intensity. According to Roeser et al., [10] an audiologist will only on very few occasions meet patients with extreme sound sensitivity/hyperacusis.

Sound sensitivity can be explained in different ways. Firstly, there may be an annoyance for some sounds in the environment. It may also be due to a fear of getting or exacerbating a hearing loss or tinnitus. [7] How a person reacts to sound depends on various factors, such as the time of the day and the environment in which the sound occurs. [6] The same sound can also be experienced differently by different people depending on their individual preferences and attitudes. [6],[9] In a study by Widén and Erlandsson [3] 17.1% of the adolescents reported experience of sound sensitivity. In a Polish study of 10 349 individuals, the prevalence was found to be 15.2%. [12] Participants in a study by Muhr and Rosenhall [8] reported experiencing noise sensitivity "sometimes" of 13.6% and "often or always' of 1.9%.

Adolescents and young adults may expose their hearing to a lot of risks during their leisure time activities such as attending concerts, dances or parties without wearing hearing protection. [3] According to Folmer et al., [13] a lot of people are not aware of the risks associated with exposing oneself to loud noise. In a web based survey on the website of TV-channel Music Television (MTV.com), conducted by Chung et al., [14] 43% reported having experienced tinnitus after attending a discotheque and as many as 61% after attending a concert. Nevertheless, only 14% reported using hearing protection. However, 66% reported that they could consider wearing hearing protection if they got more information about the risks associated with noise exposure and 59% if they got professional advice. Rawool and Colligon-Wayne [5] found a significant association between any history of tinnitus and the use of hearing protection.

Bogoch et al., [1] conducted a study on the risk awareness of listening to loud music, in which 204 individuals responded. The result indicated that 34.3% thought it was fairly likely and 39.8% thought it was very likely that the sound pressure level in concerts could harm their hearing. Nevertheless, the result of the study showed that 80.2% never used hearing protection when attending concerts and in addition that 48.5% responded that they preferred to stand/sit in the loudest location at the concert. Folmer et al., [13] showed that even if a person is aware of the risks associated with loud noise, they don't necessarily choose to wear hearing protection. Proportionally more people are aware of the risks and have experienced auditory symptoms after exposure to loud noise/music, than the amount of people who actually use hearing protection. [1],[6],[14] It seems that more than just information about the harmful effects of loud sounds is necessary to change people's behavior to use hearing protection. [13],[15],[16]

Empirical research suggests that the individual decision about using hearing protection in noisy situations may be governed by variables such as social norms, attitudes and risk perception. [17],[18] In addition, previous studies have found that self-reported permanent tinnitus and sound sensitivity are associated with attitudes toward noise and the decision to wear hearing protection. [19] Although, there is a growing body of research aiming at the risk-taking behavior in noisy settings, there is also a growing need to identify new potentially important variables to be included in work on hearing preventive behavior. The focus of this article is to investigate a larger set of self-perceived noise induced hearing symptoms, together with variables like social norms, preparedness to take risks and risk-judgment in order to analyze possible new associations with attitudes toward loud music.


  Aim Top


The aim of the present study was to compare adolescents' attitudes toward loud music in relation to a set of self-perceived noise induced auditory symptoms combined with psychological variables such as norms, preparedness to take risks and risk-judgment.


  Methods Top


Participants

The sample consisted of 281 upper secondary school students aged 15-19 years (mean age 17). A total of 39 adolescents choose not to participate in the present study, leaving an overall dropout rate of 13.9% The gender distribution was found to be 108 women (44.6%) and 132 men (54.5%). Two participants did not state their gender. To the question "Do you have permanent tinnitus continuously 24 h a day?" 13 (5.4%) individuals answered "Yes" and 229 (94.6%) answered "No".

Measurements

The main focus of the questionnaire was on loud music from discotheques and concerts. The questionnaire began with two demographical questions about gender and age. They were followed by 22 statements measured on a five-point scale with the response alternatives: Totally disagree, disagree, uncertain, agree and totally agree where the code five indicates total agreement with the statement, whereas one indicates total disagreement. The first 11 statements were a modified version of Youth Attitude to Noise Scale- Revised R (YANS-R). [18] Cronbach's alpha for the YANS-R was α = 0.83, indicating an acceptable reliability of the measurement. Items number 3, 4, 6, 9 and 11 were however reversed scored due to the wording of the items. All 11 items were then summarized and divided by 11 in order to get a mean value for each individual score. This index variable was then used as a variable in further analysis. A high score on the index variable indicates a tolerant attitude towards loud music (e.g. "Music is at its best when it is played really loud."), whereas a low score indicates a less tolerant attitude toward loud music. The rest of the statements included, e.g. norms, preparedness to take risks and risk-judgment. Norms or social norms deals with the individual's thought of how one should act in a certain situation and is regarded as an important regulation of behavior in some research. [19] The statement about norms were worded "You should use hearing protection at concerts and discotheques." Preparedness to take risks, "You have to take some risks, if you want to experience something" and risk-judgment "It's my judgment that loud music at concerts and discotheques are so loud that they may cause hearing impairments." In addition, the participant were asked to give information on how often they went to discos/clubs and concerts and whether they used hearing protection or not.

The questionnaire also included a question about permanent tinnitus formulated as; "Do you have permanent tinnitus continuously 24 h a day?" Finally nine questions regarding other self-perceived auditory symptoms were included. The participants could mark one of the following response alternatives: Never, 0% of the times; Seldom, <25% of the times; relatively often, about 50% of the times; Often, more than 50% of the times and Always, 100% of the times. The question about temporary tinnitus were worded "How often have you had peeps or buzzing sounds in the ears for 24 h or longer after attending concerts, discotheques etc?" The question about sound sensitivity was worded "Do you experience yourself being overly sensitive to sound?"

Procedure and ethics

Data was collected from two upper secondary schools in Sweden. The principles were contacted by telephone and then received additional information by E-mail. The questionnaires were distributed to the students by the authors at one of the schools and by the teachers at the other school. The time needed to answer the questionnaire was approximately 15 min. Information about the purpose of the present study was given to the students along with information regarding voluntary participation and confidentiality. To participate in the study the students had to give their informed consent, write their name and grade. In Sweden, persons aged 15 or older are allowed to make decisions by themselves on whether they should participate or not in a questionnaire study, without having their parent's involvement.

Statistical analysis

Data were analyzed with the IBM SPSS Statistics (19.0.0) for Windows. The answers to the 22 statements were processed as 1, 2, 3, 4 and 5, where 1 corresponded to "Totally disagree from," and 5 corresponded to "Strongly agree" Because the response alternatives is a Likert scale, 4 and 5 indicates a more tolerant attitude to the statements, 1 and 2 indicates a less tolerant attitude and 3 corresponds to a neutral answer. The answers from the 11 statements about YANS-R were compiled to a mean value for every individual. The mean value could vary between 1.0 and 5.0 where 3.0 indicate neither a tolerant nor intolerant attitude toward loud music. A mean value above 3.0 indicate a more tolerant attitude and a mean value below 3.0 a less tolerant attitude. The answers from YANS-R were approximately normally distributed which is a condition for the use of parametric statistics. The answers to the question about permanent tinnitus were coded as 1 for "Yes'' and 2 for "No.'' The questions about the other nine self-perceived auditory symptoms were coded 1, 2, 3, 4 and 5, were 1 corresponded to "Never, 0% of the times," and 5 corresponded to "Always, 100% of the times."

A multiple regression analysis was used in order to analyze if self-perceived auditory symptoms was associated with attitudes toward loud music.

Another multiple regression analysis were performed in order to analyze if the addition of the variables norms, preparedness to take risks and risk-judgment together with self-perceived auditory symptoms were associated with attitudes toward loud music.


  Results Top


In [Table 1], means and standard deviations for some of the measurements in the study are presented.
Table 1: Mean and standard deviation for YANS-R, norms, preparedness to take risks and the risk-judgment

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[Table 2] presents reported frequencies regarding hearing symptoms related to noise exposure. From the table, it can be concluded that the experience of noise related symptoms and reactions are quite common among adolescents when visiting environments where loud music is played. For instance, about 26% of the adolescents report that they have experienced being hard of hearing about 50% of times up to 100% of the times when attending clubs, discotheques or concerts.
Table 2: Percentage (%) and frequencies (n) of reported hearing symptoms

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A correlation matrix was used in order to analyze associations between self-perceived auditory symptoms, attitudes toward loud music and worry because of experienced symptoms [Table 3]. Temporary tinnitus did not correlate significantly with attitudes toward loud music. By contrast, sound sensitivity, noise annoyance, discomfort because of sound and being tired of sound had a moderate negative correlation with attitudes. The remaining auditory symptoms, worry because of temporary tinnitus, hard of hearing, worry because of being hard of hearing and pain in ears correlated weakly with attitudes.
Table 3: Correlations (Pearson's) between self-reported hearing symptoms, worry because of hearing symptoms and attitudes towards noise

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In the correlation matrix [Table 4], the correlations between attitudes toward loud music, norms regarding hearing protection use, preparedness to take risks and risk-judgment are presented. The analysis indicates low to moderate correlations between the variables.
Table 4: Presents Pearson's correlation between attitudes, norms, preparedness to take risks and risk-judgment

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A multiple regression analysis [Table 5] was used to investigate how much self-perceived auditory symptoms covaries with attitudes toward loud music. The independent variables that proved to contribute significantly to the model were permanent tinnitus and sound sensitivity. Altogether the variables in the model accounted for 18.2% of the variance.
Table 5: Independent variables association with attitudes toward loud music (YANS-R), indicated by multiple regression analysis

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In order to analyze variables that might correlate with attitudes towards loud music a multiple regression analysis with two blocks of variables was used. In the first block, the self-perceived auditory symptoms, permanent tinnitus and sound sensitivity were included, which was found to be the only significant variables from previous analysis [Table 5]. These two variables accounted for 15.9% [Table 6], Block 1 of the variation in attitudes toward loud music. In the next step [Block 2], we added the variables norms, preparedness to take risks and risk-judgment. Altogether the variables included in Block 2 accounts for 48.0% [Table 6], Block 2 of the variation in attitudes towards loud music. All independent variables were found to be significant.
Table 6: Independent variables association with attitudes toward loud music (YANS-R), indicated by multiple regression analysis

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  Discussion Top


The aim of this study was to compare adolescents' attitudes toward loud music in relation to different self-perceived auditory symptoms and psychological variables such as norms, preparedness to take risks and risk judgment. Adolescents' with permanent tinnitus or sound sensitivity had less tolerant attitudes toward loud music. In an earlier study, Widén et al., [20] found that individuals with self-perceived auditory symptoms such as sound sensitivity and hearing loss generally had less tolerant attitudes toward loud music associated with youth culture, e.g. discotheques, concerts and gyms. Their results are comparable with the result in the present study. Permanent tinnitus and sound sensitivity accounted for 15.9% of the variation in attitudes toward loud music. However, none of the other auditory variables contributed significantly to the model. When adding the variables norms, preparedness to take risks and risk-judgment the amount of explained variance increased to 48.0%. This can be interpreted as the variables "norms," "preparedness to take risks" and "risk-judgment," actually are stronger predictors to attitude than most of the self-perceived auditory symptoms are. The result from the analysis should be interpreted as individuals holding the norms that one should wear hearing protection when being exposed to loud music do have less tolerant attitudes toward loud music. It is reasonable to believe, especially among adolescents that the peer group norms are providing guidance to how the individual should behave in a certain noisy situation. In addition, persons who think that one should take risks in order to experience things are more likely to hold tolerant attitudes toward loud music, which might increase the risk of not wearing hearing protection when being exposed to loud music. It is an interesting finding that tolerant attitudes toward loud music are associated with a general disposition to take risks in order to get new experiences. We can only speculate about the reasons for this, one is that adolescence is a period in life where a certain degree of risk-taking and experimenting with identity to some extent are a natural part of that period in life. Some individuals are more drawn towards risk-taking than others and maybe this can be explained by personality traits such as being sensation seeking. [21] Finally, those who think that there is a risk of getting a hearing impairment in places where loud music is played, also tend to hold less tolerant attitudes toward loud music, which most reasonably would increase the probability of a hearing protective behavior. Arguably, norms, preparedness to risk-taking and risk-judgment plays an important role for the behavioral outcome and therefore may be of interest to investigate further in future research.

Since the variables included in our study accounted for 48.0% of the variation in attitudes toward loud music, it certainly leaves room for other variables to be associated with attitudes. One suggestion would be socio-economic status (SES). Olsen-Widén and Erlandsson [22] found that SES was connected to individuals' attitudes toward noise associated with loud music played in discotheques and concerts. Individuals with low SES generally seemed to have more tolerant attitudes compared with those with high SES. At the same time, SES seemed to have the largest impact on the attitude during the early adolescence and that its impact declined with rising age. Individuals with low SES also were less likely to wear hearing protection, in comparison to those with high SES. It is reasonable to conclude that since SES previously has been found to be associated with both attitudes and behavior, it would be an important variable to include in a model for hearing preventive behavior.

When looking at the associations between self-reported auditory symptoms [Table 3], "Hard of hearing" and "Worry because of being hard of hearing" had a weak negative correlation with attitudes toward loud music. "Temporary tinnitus" and "Worry because of temporary tinnitus" showed no significant correlation. Both "Worry because of temporary tinnitus" and "Worry because of being hard of hearing" concerned 'worry' related to self-perceived auditory symptoms, something that Widén and Erlandsson [3] and Bogoch et al., [1] previously found had strong connections to the use of hearing protection. Widén et al., [23] showed that attitudes affected the individuals' readiness to use hearing protection. Since both worry and attitudes have a connection to use of hearing protection and attitudes itself have a connection to self-perceived auditory symptoms, it would be expected that worry combined with self-perceived auditory symptoms should have had a stronger connection with attitudes than we actually found. A suggested explanation to this finding could be that the participants were young and most likely relatively inexperienced with attending clubs and discotheques. Therefore, it is possible that if we had investigated an older population worry might have contributed to the model. From the correlation matrix [Table 3], it can also be interpreted that having experienced "Temporary tinnitus," "Worry because of temporary tinnitus," "Hard of hearing" and "Worry because of being hard of hearing" are strongly associated with the experience of pain in ears. It may therefore be concluded that there are a group of adolescents who report having several loud music-related temporary hearing symptoms after attending clubs, discotheques, concerts etc. This finding indicates that the sound levels in some activities that young people participate in, may put adolescents hearing at risk. The result also indicates that some individuals have behavior, which can lead to, e.g. noise-induced hearing loss in the long run.

In our study, 5.4% reported that they had permanent tinnitus. In total, 39.7% reported having experienced temporary tinnitus and 39.2% reported experiencing sound sensitivity. The question about sound sensitivity were worded "Do you experience yourself being overly sensitive to sound?" The use of overly is a way to get the participants to assess whether their symptoms are exceeding what they considered to be normal. An extreme sensitivity to everyday sounds is what Roeser et al., [10] would define as hyperacusis. It is likely that some of the participants, who claim to be overly sensitive to sound 100% of the times, could fit under this definition of hyperacusis. However, it is not possible to deduce from the present survey with certainty since the question only measures the frequency of the symptom and not the degree of severity. In addition, a previous study have found a significant association between noise sensitivity and the use of medications, which has not been investigated in the present study. [8]

A noteworthy result is that about 14% of the sample reported that they have experienced sound sensitivity 50% of the times or more (up to 100% of the times) when they attended noisy situations. This implies that sound sensitivity is a quite common problem among adolescents which could mean that the sound levels at concerts or dances usually is perceived as too loud. As can be seen in [Table 2], all hearing symptoms are reported quite commonly, which strengthens the impression that adolescents hearing might be put at risk during leisure time activities. About 30% report that they quite often (50-100% of times) are tired of sounds after a normal day. This result indicates that the sound environment in today's society for some individuals is considered to be a problem.

The question about the auditory symptom "Tired of sound" was the most experienced auditory symptom [Table 2]. Only 28.3% reported that they had never experienced it. Therefore, we believe that it is of great importance that society creates healthier sound environments for young people to grow up in. In a study on hearing loss among adolescents in Mexico City, the prevalence was found to be 21%. The main related risk factor was reported to be leisure time noise exposure, such as attending discotheques and concerts. Four out of five adolescents in Mexico were aware of the risks of noise exposure. However, they continued to place themselves in situations of risky noise exposure. [24]

It seems according to Folmer et al., [13] that even though many are aware of the risks they still choose not to protect their hearing. Weichbold and Zorowka [15] argue that information about the risks of loud music exposure is not sufficient to actually change behavior. They conducted a study on young people's use of hearing protection at discotheques. The participant answered the question if they used hearing protection at discotheques, both before and after they participated in an information campaign about hearing and the risks of loud music exposure. The result showed that the use of hearing protection increased from 0.0% to 3.7% after the campaign.

Widén et al., [20] concludes that having experienced self-perceived auditory symptoms may be more important than just information to change young people's attitudes and behaviors. It is suggested that in addition to information, e.g. one could listen to how tinnitus may sound [5] and listen to manipulated speech simulating a hearing loss. Rawool and Colligon-Wayne [5] and Widén et al., [20] further argues that these experiences could act as triggers to help change attitudes and therefore behaviors for youth at risk of developing auditory symptoms before they do.

However, the results from the present study indicate that the variables norms, preparedness to take risks and risk-judgment are more strongly linked to attitudes toward loud music than the experience of most auditory symptoms are. This may have implications on how to work preventively to change young people's attitudes and reduce the prevalence of auditory symptoms in the future. Both information and the experience of auditory symptoms still play a role in the shaping of attitudes. However in order to actually change attitudes and behaviors, preventive work has to affect young people's norms, preparedness to take risks and the way they perceive and judge health risks. Young people's preparedness to take risks have strong connections to how many risks they actually expose themselves to. [25] It is therefore important to find a way to influence young people's preparedness to take risks in order to influence their actual behavior in a healthier direction. Widén and Erlandsson [16] point out that if the society considers it normal to stay in noisy settings, individuals have a greater tendency to expose themselves to risks in such situations. Hence, preventive work should not only focus on changing the individuals' health risk-behavior by establishing attitudinal change by adding, e.g. knowledge, but also include work on societal norms and regulations.

Rawool [26] points out that for changing peer norms in the youth, several other strategies need to be considered in conjunction with attempts to change attitudes and norms. Rawool reviewed several strategies for reducing noise exposure at music venues including development and implementation of evidence-based guidelines, safety standards for music venues, acoustic treatment of venues and financial incentives for keeping sound levels within safe limits, provision of rooms for regenerative breaks, provision of free earplugs and display of sound levels on a big screen. Hence, future investigations should consider these strategies. Most likely a combination of strategies may be more effective than any single strategy.

Rawool's [26] argumentation is somewhat in line with Widén, [27] that it is not merely enough to change adolescents attitudes and behaviors by adding, e.g. information or knowledge through some health educational program. From systems theoretical point of view, it is not an easy task to change health risk behaviors since it is not just individual attitudes that have to be changed. [28] It is most likely the whole system of interrelated levels such as laws and regulations, peer norms and family values etc., that has to be changed. The conclusion that can be drawn from this argumentation is that if you focus on changing individuals attitudes in a society where, e.g. norms and regulations are promoting health risk behaviors it will most likely not be a successful strategy.


  Conclusions Top


Perceived hearing symptoms (sound sensitivity and permanent tinnitus) were found to be associated with less tolerant attitudes toward loud music in this study. However, psychological variables such as norms, preparedness to take risks and risk-judgment were found to be more strongly associated with attitudes toward loud music. Therefore, these variables need to be considered more in future preventive work along with other health promotive strategies. Health promotive strategies should focus on changing not merely individual attitudes, but also societal norms and regulations in order to decrease noise induced auditory symptoms among adolescents.

 
  References Top

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Correspondence Address:
Stephen E Widén
Department of School of Health and Medical Sciences, Örebro University, Swedish Institute for Disability Research, Örebro University, Örebro
Sweden
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Source of Support: The authors are grateful for the funding provided by the Swedish Institute for disability Studies and Örebro University, Conflict of Interest: None


DOI: 10.4103/1463-1741.116584

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