A multicomponent intervention for noise-induced hearing loss and tinnitus prevention applied in three models of American Indian communities

Background: The prevalence of moderate-to-severe hearing problems in American Indian/Alaska Native (AI/AN) populations is 2-4 times higher than other US subgroups. The purpose of this study is to determine the effectiveness of the Listen for Life (L4L) program, a multi-component, community-based educational intervention in three American Indian communities. L4L is based on the established and effective interventions of the Dangerous Decibels (DD) program (www.dangerousdecibels.org). Methods: Participants were 583 4th and 5th grade students in three settings: a reservation with an on-site elementary school, a reservation where children attend public schools in a nearby town, and an urban youth and family center delivering educational programs. L4L is a whole-community intervention that includes a media campaign (radio spots, newspaper ads and articles, YouTube videos), classroom presentations (a 45-min interactive presentation), a community learning event, and web-based learning activities (a set of 8 online games). Results: Across all categories of knowledge, attitudes, and intentions to protect hearing, we observed an average increase of 18% at four months after the intervention. Evidence of sustainability is the transfer of this health promotion program from the university to trained community volunteers. Our findings suggest that the DD curriculum and online activities are as effective in tribal communities as previously observed in other settings. Conclusions: Hearing loss prevention education is valued by AI communities and DD is culturally accepted and adopted. Involving entire communities may help to support lasting shifts in children's knowledge, attitude and behaviors as compared to delivery of the program in schools alone.