What we do BTA supported research Young people's attitudes to loud music January 2017 update by Dr Abby Hunter Exposure to loud noise can cause damage to the ear leading to a greater risk of tinnitus and hearing problems. Concern is growing over the potentially hazardous effects on the hearing health of young adults of attendance at concerts and nightclubs, particularly as the majority of young adults do not take preventative action such as wearing earplugs. In recent years there has been an increase among the younger generation of noise-induced hearing problems. We investigated attitudes and behaviours towards leisure noise and hearing protection among young adults with and without hearing problems. Twenty-eight adults aged between 18 and 35 years took part in a focus group, and 12 young adults with tinnitus and/or hearing loss took part in an interview. Young adults with and without hearing problems expressed positive and negative attitudes towards noise which were often interchangeable depending on the situation. Many participants enjoyed loud music and considered themselves music lovers. The benefits and barriers to earplug use were also similar, however those who had experienced personal injury from noise, either permanent or temporary hearing loss or tinnitus were more likely to report using earplugs. However not all those who had hearing problems did wear earplugs. There is still a stigma attached to wearing earplugs; young adults are concerned about what their friends will think; and there is an (incorrect) perception that earplugs make the music sound ‘muffled’ and limit the ability to engage in conversation. We also went further with our analysis to develop four typologies of people with hearing problems to describe the variation in attitudes and behaviours towards leisure noise and hearing protection. Typology 1: Concerned about communication difficulties only Two participants had hearing loss and one also had tinnitus. Neither of these participants felt their hearing problems were caused by loud music and neither of them were concerned about future noise damage in loud venues, possibly as a result of their hearing problems not being caused by loud music. However, a consequence is that they do avoid loud venues because of the communication difficulties they face, rather than a concern for noise damage. For the last few years my hearing loss has deteriorated quite a bit…I've found it does impact on things quite significantly more than I thought it would…If I go in a crowded environment I struggle to hear people speaking to me, even if it's in close proximity. Things like going to bars and pubs now, I tend to avoid, just because it's so difficult. I prefer quieter environments if I know I'm going to be speaking to people (35 year old female, hearing loss and tinnitus). Typology 2: No change in behaviour and no concern Two participants had tinnitus which was caused by loud music; and two participants had hearing loss due to a medical condition. All of them were able to cope well with their hearing problems and did not indicate any concern about further damage from leisure noise. Consequently they did not report any change in behaviour or lifestyle. When your music is quiet obviously you can still hear it, but you can’t feel it. Once it’s quite loud you can actually feel it in your body as well as hearing it, which I think adds to the experience… I know full well that it is doing nothing good to my ears and so on but I’m really into music…I’ve got various instruments to play…Usually I crank those quite loud. (18 year old male, tinnitus). Typology 3: Poor coping and negative change Two participants had tinnitus and one also had hearing loss. One person felt her hearing problems were caused by loud music and the other person was not sure. Both reported difficulty in accepting and coping with their hearing problems, with one participant particularly distressed by her tinnitus. As a result they were both concerned about leisure noise exposure and the potential for further hearing damage so they both avoided loud music venues: When they [GP] said there wasn’t a cure I absolutely broke down. I said, ‘I cannot live the rest of my life like this’…to find out there wasn’t a cure was one of the most upsetting things I’d ever heard… At first it made me really depressed….It’s awful… I try to avoid being anywhere which is really loud… Sometimes when I get back it’s unbearable to deal with so I’d rather just take myself out of the situation and avoid going. (23 year old female, hearing loss and tinnitus) Typology 4: Cautious and positive change Four participants had tinnitus and one also had hearing loss. They coped well with their hearing problems. They all felt their hearing problems were caused by loud music and as a result they were all concerned about further hearing damage when exposed to loud music. Consequently they used earplugs when in loud venues to continue enjoying music: Because it's irreversible, it can just ruin your life if it gets to the point where it is really loud, the ringing. There are cases where people have been suicidal over it, so I think it's not worth letting it get to that stage…Even if I'm not going to a concert, bars these days, will play things extremely loud. Some people say, "Don't you feel a bit weird or think you look a bit weird?" But I think it's not worth the hearing loss. I do go to gigs quite regularly, but I will make sure that I have got ear protection….I won't risk going in somewhere unless I've got them. (19 year old male, tinnitus). It is interesting that participants with tinnitus behaved differently regarding their attendance at loud venues despite recognising that loud music may have caused the hearing problems in the first place. Tinnitus distress is thought to be linked to personality traits. This could explain the differences in behaviour. Some people were distressed by their tinnitus, had difficulty coping and feared going to loud venues in case the tinnitus got worse. A personality characteristic associated with tinnitus distress is withdrawal which may explain why these individuals tended to avoid loud venues. Others accepted their condition, coped well, but their hearing problems had been a ‘wake-up call’ and they were cautious in their behaviour and used earplugs because they did not want to make the tinnitus worse. Finally, some people carried on as normal, had no change in lifestyle or behaviour and were not concerned enough about hearing damage to prompt them to protect their ears. Conclusion This is a small qualitative study and although key attitudes and behaviours towards leisure noise and hearing protection have emerged from the data, generalisations cannot be made. Nevertheless, these findings have important implications for hearing education programmes. In principle, health promotion and education campaigns have the potential to raise awareness of the association between noise exposure and hearing damage, and to motivate young adults to act accordingly. Few educational hearing programs exist in the UK, and noise induced hearing problems are becoming the ‘silent epidemic’ among young people. In terms of prevention, there is still a long way to go to increase awareness and knowledge about the damaging effects of leisure noise.