D628 Task 1 Capstone Education Program Example

Turn It Down Before It Turns You Down: A Capstone Education Program on Noise-Induced Hearing Loss for Ninth Graders in a Composite City, From the Research to the Classroom Script

Student Name

Leavitt School of Health, Western Governors University

D628: Public Health Graduate Capstone, Task 1

Course Instructor

Month Day, Year

Turn It Down Before It Turns You Down: A Capstone Education Program on Noise-Induced Hearing Loss for Ninth Graders in a Composite City, From the Research to the Classroom Script

The Community Issue

An audiologist at the children's hospital in Millbrook, a composite city of about 300,000, raised the issue with the health department: she was seeing more teenagers referred for ringing in the ears and for hearing tests showing a notch at high frequencies, the pattern typical of noise damage, and most of them used earbuds for several hours a day and attended concerts or loud sports events. Local data are limited. Millbrook's schools screen hearing in kindergarten and grades 1, 3, 5 and 7 but not in high school, and their screening tones stop at 4,000 Hz, which can miss the early high-frequency changes that noise causes. A student survey the department added to the city's youth risk behavior survey found that 61% of ninth graders used earbuds or headphones for more than two hours a day, 38% usually listened at more than half volume, and 44% had experienced ringing in the ears after a concert, game or party in the past year. Only 9% had ever worn earplugs at a loud event.

Analyzing the Research

National studies show that noise damage to hearing begins early. Using audiometric data from the Third National Health and Nutrition Examination Survey, Niskar et al. (2001) estimated that 12.5% of U.S. children aged 6 to 19, about 5.2 million, had noise-induced threshold shifts in one or both ears, usually in one ear and at one frequency. Early changes of this kind are often unnoticed but can progress with continued exposure.

Whether hearing loss in teenagers is increasing is less clear. Comparing survey cycles from 1988-1994 and 2005-2006, Shargorodsky et al. (2010) found that the prevalence of any hearing loss among 12- to 19-year-olds rose from 14.9% to 19.5%, a finding that received wide attention. A later analysis that added the 2007-2008 and 2009-2010 cycles found that prevalence rose to 22.5% and then fell to 15.2%, with no significant overall trend, and that reported noise exposure was not consistently associated with hearing loss across surveys (Su & Chan, 2017). Those studies used the same national survey but different time windows, which shows how much a trend conclusion can depend on the years chosen. What the research supports is not a clear epidemic but a meaningful share of teens with early noise damage and widespread exposure.

The exposure evidence is strong. A systematic review and meta-analysis of 33 studies with 19,046 participants aged 12 to 34 found that 23.8% had unsafe listening practices with personal listening devices, and a model based on intensity and duration estimated that 48.2% were exposed to unsafe levels at loud entertainment venues; worldwide, between 0.67 and 1.35 billion young people could be at risk (Dillard et al., 2022). The studies varied in how they measured exposure, and most relied on self-report, so estimates are uncertain, but even the lower bound describes a large problem.

Evidence on education programs is encouraging but limited. In an evaluation of Dangerous Decibels, a 35-minute interactive classroom program, fourth graders showed gains in knowledge and attitudes that lasted three months. Seventh graders kept their knowledge gains three months later, but their attitudes and intended behaviors returned to baseline (Griest et al., 2007). The authors recommended adding content on peer pressure and using repeated interventions in several formats to change adolescent behavior.

Program Design

The research shaped four design choices. First, because a single session changed adolescents' knowledge but not their behavior, the program has three contacts rather than one. Second, because peer pressure matters, it uses trained 11th-grade peer educators alongside a health educator. Third, because behavior change is easier when the protective action is simple and immediate, it gives every student foam earplugs in a keychain case and walks them through setting a volume limit on their own phone during class. Fourth, because the research cannot show that the program prevents hearing loss directly, it measures behaviors that are closer to the program's reach.

The program, called Turn It Down, runs in all six Millbrook high schools for ninth graders through health classes. Session one, 45 minutes, is the classroom presentation below, with a sound level meter app demonstration. Session two, four weeks later, is a 20-minute peer-led discussion about concerts, games and parties, including how to wear earplugs without being teased. Session three, in the spring, is a short reminder before prom and summer concerts with a second earplug distribution. The health department, the children's hospital audiology clinic and the school district are partners, and a local music venue has agreed to offer free earplugs at its entrance.

The Presentation for Ninth Graders

Slide one: Your ears do not heal. The tiny hair cells in your inner ear turn sound into signals your brain can hear. Loud sound can damage them, and once they are gone, they do not grow back. Ringing after a concert is your ears telling you they were hurt.

Slide two: How loud is too loud? A normal conversation is about 60 decibels. A school hallway at lunch can hit 80. Earbuds at full volume and a concert can pass 100. At 100 decibels, damage can start in about 15 minutes. Every 3 decibels louder cuts the safe time in half.

Slide three: You are not the only one. About one in four young people listens to music at levels that can damage hearing, and nearly half are exposed to unsafe sound at concerts and clubs. Hearing loss from noise usually comes slowly, so most people do not notice until it is too late.

Slide four: The 60/60 idea. Keep your volume at 60% or less for no more than 60 minutes at a time, then give your ears a break. Let's open your phone settings right now and set a volume limit together.

Slide five: Earplugs are not for losers. Musicians and athletes wear them. Foam earplugs cut sound by enough to protect you and you can still hear the music, just not as harsh. Here is yours. Let's practice rolling one and putting it in.

Slide six: What would you do? A friend says earplugs look weird at the game. What could you say? Discuss in pairs, then share.

Slide seven: Know the warning signs. Ringing, muffled sound or trouble understanding people in noisy rooms after loud events are signs of damage. Tell a parent or the school nurse and get your hearing checked.

Evaluation Plan

The evaluation uses a pre-post survey with a comparison group, since two of the six schools will start the program a year later. Short-term outcomes are knowledge and attitudes measured immediately after session one. Intermediate outcomes, measured at three and nine months, are the share of students who report having a phone volume limit set, usually listening at half volume or less, and wearing earplugs at their last loud event. The comparison schools make it possible to separate program effects from changes in the wider culture. Process measures include the number of students reached, earplugs distributed and fidelity to the session plans. The department will also ask the district to add high-frequency testing at 6,000 and 8,000 Hz to its screening and to screen in ninth grade, which would provide better community data over time.

Conclusion

Noise damage to teenagers' hearing is common, preventable and largely silent until it is permanent. The research is mixed on whether hearing loss is rising, but consistent that exposure is widespread and that one-time education changes adolescents' knowledge more than their behavior. Turn It Down responds with repeated contacts, peer educators, earplugs in hand and a volume limit set in class, and it measures the behaviors most likely to protect students' hearing.

References

Dillard, L. K., Arunda, M. O., Lopez-Perez, L., Martinez, R. X., Jiménez, L., & Chadha, S. (2022). Prevalence and global estimates of unsafe listening practices in adolescents and young adults: A systematic review and meta-analysis. BMJ Global Health, 7(11), e010501. https://doi.org/10.1136/bmjgh-2022-010501

Griest, S. E., Folmer, R. L., & Martin, W. H. (2007). Effectiveness of "Dangerous Decibels," a school-based hearing loss prevention program. American Journal of Audiology, 16(2), S165-S181. https://doi.org/10.1044/1059-0889(2007/021)

Niskar, A. S., Kieszak, S. M., Holmes, A. E., Esteban, E., Rubin, C., & Brody, D. J. (2001). Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: The Third National Health and Nutrition Examination Survey, 1988-1994, United States. Pediatrics, 108(1), 40-43. https://doi.org/10.1542/peds.108.1.40

Shargorodsky, J., Curhan, S. G., Curhan, G. C., & Eavey, R. (2010). Change in prevalence of hearing loss in US adolescents. JAMA, 304(7), 772-778. https://doi.org/10.1001/jama.2010.1124

Su, B. M., & Chan, D. K. (2017). Prevalence of hearing loss in US children and adolescents: Findings from NHANES 1988-2010. JAMA Otolaryngology: Head & Neck Surgery, 143(9), 920-927. https://doi.org/10.1001/jamaoto.2017.0953