A large portion of the general population is exposed to noise levels that could result in long-term adverse effects on hearing. Gender and occupation were most strongly related to exposure, though most participants in this study had occupations that are not conventionally considered noisy.

The mission of the National Institute for Occupational Safety and Health (NIOSH) is to generate new knowledge in the field of occupational safety and health and to transfer that knowledge into practice for the betterment of workers. Since its establishment in 1970, NIOSH has provided national and world leadership in efforts to prevent occupational hearing loss. In 1996, NIOSH established the National Occupational Research Agenda (NORA). Because occupational hearing loss is one of the most common occupational illnesses among American workers, it was identified as a priority research area, and a NORA Hearing Loss Team was established. The NORA Hearing Loss Team was composed of representatives from industry, academia, labor, professional organizations, and other governmental agencies. The team was tasked with developing a national research agenda for the prevention of occupational hearing loss. Each team member contributed to the original draft, which continued to evolve over time. The current document represents the culmination of several years of deliberation and revision with the goal of identifying needed research to prevent occupational hearing loss. This is Part 1 of the document, outlining research needs on the mechanisms and consequences of occupational exposure to noise and other ototoxicants.

This experiment investigated the effect of small-group versus individual hearing loss prevention (HLP) training on the attenuation performance of passive insert-type hearing protection devices (HPDs). A subject-fit (SF) methodology, which gave naive listeners access only to the instructions printed on the HPD product label, was used to determine real-ear attenuation at threshold (REAT) at third-octave noise bands between 125-8000 Hz. REAT measurements were augmented by use of the Hearing Loss Prevention Attitude-Belief (HLPAB) survey, a field-tested self-assessment tool developed by the National Institute for Occupational Safety and Health (NIOSH). Participants were randomly assigned to one of four experimental groups, consisting of 25 listeners each, in a controlled behavioral-intervention trial. There were two types of HPDs (formable and premolded) and two training formats (individual and small group). A short multimedia program, including a practice session, was presented to all 100 listeners. Results showed training to have a significant effect, for both HPDs on real-ear attenuation and attitude, but, importantly, there was no difference between small-group and individual training.

The effect of training instruction, whether presented as the manufacturer's printed instructions, a short video training session specific to the product, or as a one-on-one training session was evaluated using four hearing protection devices with eight groups of subjects. Naïve subjects were recruited and tested using three different forms of training: written, video, and individual training. The group averages for A-weighted attenuation were not statistically significant when compared between the video or the written instruction conditions, regardless of presentation order. The experimenter-trained A-weighted attenuations were significantly greater than the written and video instruction for most of the protectors and groups. For each earplug, the noise reduction statistic for A-weighting (NRS A ) and the associated confidence intervals were calculated for the 80 th and 20 th percentiles of protection. Across subject groups for each protector, the differences between NRS A ratings were found to be not statistically significant. Several comparisons evaluating the order of testing, the type of testing, and statistical tests of the performance across the groups are presented.

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