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Hearing Loss, Noise Exposures, and Hearing Protection Use in Midwestern Farmers: A Preliminary analysis Josie J. Ehlers, MPH Environmental, Agricultural, and Occupational Health Dept. College of Public Health, University of Nebraska Medical Center June 27, 2016 Hazardous noise in agriculture • High prevalence of hearing loss – Second highest rate out of 25 different industries (Tak & Calvert, 2008) – Estimated 25% young farmers and 50% older farmers have hearing loss (Rein, 1992) Image Source: Indiana Grain LLC, 2008 – Most will have some evidence of hearing loss by age 30 (Rein, 1992) Objectives • Evaluate two-years of data from a 4-year randomized control study − A point-sourced intervention designed to increase hearing protection use. • Assess the typical noise exposures on the farm • Evaluate the characteristics of hearing loss among farmers • Evaluate the attitudes and beliefs regarding hearing loss and hearing protection • Evaluate changes over time Methods • Study Design – Visits at baseline (year one) and at year two • The following measurements were collected: Personal noise dosimetry Audiometric testing Hearing protection device perception (HPDP) questionnaire • Study Population – Fifty-two farms were recruited and randomized • Control farms (n=26) 36 farmers • Intervention farms (n=26) 51 farmers Methods • Personal Noise Dosimetry Measurements −Larson Davis dosimeter, Model 706 • Automatically computed into OSHA and NIOSH standards Image Source: The Modal Shop, Inc., 2015 Methods • Audiometric Testing – Conducted annually on each farm – Administered by occupational hearing conservationist − Stratified into categories of hearing loss at each frequency per recommendations by NIOSH Methods • Hearing Protection Device Perception (HPDP) Questionnaire – Gauged farmers’ attitudes and beliefs about hearing loss and hearing protection – Evaluated • • • • • Perceived barriers to preventive actions Self-efficacy Social norms Perceived susceptibility to hearing loss Perceived severity of consequences of hearing loss • Behavioral intentions Results • Personal Noise Dosimetry Figure 1 – Percentage of farmers that exceeded exposure standards Results • Substantial amount of variability − NIOSH’s REL • More Conservative + More Accurate = More Protective • Researchers suggests that protective measures should be taken under all circumstances (Rabinowitz, et. al, 2013) − Even moderate noise exposures over an extended period of time could cause permanent hearing loss Results • Audiometric Testing Figure 2 – Frequency distribution of hearing loss in the left ear for all farmers at year one. Figure 3 – Frequency distribution of hearing loss in the right ear for all farmers at year one. 25 Number of Farmers Number of Farmers 25 20 15 10 20 15 10 5 5 0 0 0.5 kHz 1 kHz 2 kHz 3 kHz 4 kHz 6 kHz 8 kHz Frequency Mild Moderate/Severe Moderate Severe 0.5 kHz 1 kHz 2 kHz 3 kHz 4 kHz Frequency Mild Moderate/Severe Moderate Severe 6 kHz 8 kHz Results • Audiometric Testing − Most considerable hearing loss was observed between 4000 Hz and 6000 Hz • Typically associated with high frequency noise exposures and often considered noise-induced hearing loss (Depczynski, Challinor, & Fragar, 2011) • Other factors could predict individual susceptibility − Left ears tended to have more hearing loss than right ears • Individual behaviors may cause hearing loss to be more pronounced in one ear over the other (Duarte, 2015) − No significant change in hearing observed between year one and year two • Noise-induced hearing loss is a gradual process Results • HPDP Questionnaire 3.00 2.50 2.00 1.50 1.00 Control Farmers Year 1 Intervention Farmers Year 1 Past Behavior Perceived Barriers Muffled Noise Percieved Severity of Consequences Behavioral Intention Percieved Benefits to Preventative Action Perceived Susceptibility Social Norms Behavioral Intention Future Self-Efficacy 0.00 Perceived Barriers Comfort 0.50 Control Farmers Year 2 Intervention Farmers Year 2 Figure 3 –– Attitudes Attitudesand andbeliefs beliefsofofthe thecontrol controland and intervention farmers by year Figure 4 intervention farmers by year Note Responserefers referstotothetheaverage averageresponse responseshared sharedbyby group each Note –– Average Average response thethe group for for each yearyear, 1 = Strongly 2 =3 Agree; 3 = Disagree; and 4 =Disagree Strongly Disagree where where 1 = Strongly Agree; 2Agree; = Agree; = Disagree; and 4 = Strongly Results • HPDP Questionnaire − General observations • ~ 20% of farmers were uncertain about when to use hearing protection • Nearly half of farmers reported that they always used hearing protection • All farmers tended to agree that important noises would be muffled • Consistent with findings by Svensson et al. (2004) − Differences between intervention and control farmers • Year one Control farmers felt more confident about their ability to properly use hearing protection than intervention farmers (p=0.030) Intervention farmers agreed more strongly that the consequences of hearing loss were severe (p=0.019) • Year two Intervention farmers disagreed more strongly that comfort was a barrier to wearing hearing protection (p = 0.010) Control farmers agreed more strongly that they used earing protection more while on the job (p = 0.016) Conclusion • Farmers are exposed to hazardous noise and have significant hearing loss • Only about 50% of farmers actually reported using hearing protection • None of the farmers who participated were exposed to noise in excess of OSHA’s PEL • More than half were exposed to noise in excess of NIOSH’s REL • A statistically significant change in hearing was not observed • Subtle changes in attitudes and beliefs • Provision of personal protective equipment (PPE) and PPE training appears to be an innovative approach to reduce hearing loss among farmers • Merits further analysis Acknowledgements • Dr. Chandran Achutan, PhD, CIH • Mr. Sean Navarrette, MPH • This study was supported by a grant from the National Institute for Occupational Safety and Health (U54 OH010162). References Depczynski, J., Challinor, K., & Fragar, L. (2011). Changes in the hearing status and noise injury prevention practices of australian farmers from 1994 to 2008. Journal of Agromedicine, 16(2), 127-142. doi:10.1080/1059924X.2011.554770 Duarte, A. S. M., Guimarães, A. C., de Carvalho, G. M., Pinheiro, L. A. M., Ng, R. T. Y., Sampaio, M. H., . . . Gusmão, R. J. (2015). Audiogram comparison of workers from five professional categories. Biomed Research International, 2015, 201494-201494. doi:10.1155/2015/201494 Indiana Grain LLC. (2008). The American Farmer’s Dirty Little Secret. Retrieved from http://www.indianagrain.com/blog/the-american-farmer-s-dirty-little-secret Rabinowitz, P., M., Galusha, D., Dixon-Ernst, C., Clougherty, J., E., & Neitzel, R., L. (2013). The dose-response relationship between in-ear occupational noise exposure and hearing loss. Occupational & Environmental Medicine, 70(10), 716-721. doi:10.1136/oemed-2011-100455 Rein, B. K. (1992). Health hazards in agriculture - an emerging issue. Retrieved from http://nasdonline.org/1246/d001050/health-hazards-in-agriculture-an-emerging-issue.html Svensson, E. B., Morata, T. C., Nylén, P., Krieg, E. F., & Johnson, A. (2004). Beliefs and attitudes among Swedish workers regarding the risk of hearing loss. International Journal of Audiology, 43(10), 585-593 9p. Tak, S., & Calvert, G. M. (2008). Hearing difficulty attributable to employment by industry and occupation: An analysis of the national health interview survey--united states, 1997 to 2003. Journal of Occupational and Environmental Medicine, 50(1), 46-56. doi:10.1097/JOM.0b013e3181579316 The Modal Shop, Inc. (2015). Larson Davis Noise Dosimeters. Retrieved from http://www.modalshop.com/rental/Spark-Series-Noise-Dosimeters?ID=290 Questions?