title: Randomized trial of a hearing conservation intervention for rural students: long-term outcomes.
abstract: OBJECTIVE
  We had the rare opportunity to conduct a cluster-randomized controlled trial to observe the long-term (16-year) effects of a well-designed hearing conservation intervention for rural high school students. This trial assessed whether the intervention resulted in (1) reduced prevalence of noise-induced hearing loss (NIHL) assessed clinically and/or (2) sustained use of hearing protection devices.
  
  
  METHODS
  In 1992-1996, 34 rural Wisconsin schools were recruited and 17 were assigned randomly to receive a comprehensive, 3-year, hearing conservation intervention. In 2009-2010, extensive efforts were made to find and contact all students who completed the original trial. Participants in the 16-year follow-up study completed an exposure history questionnaire and a clinical audiometric examination. Rates of NIHL and use of hearing protection were compared.
  
  
  RESULTS
  We recruited 392 participants from the original trial, 200 (53%) from the intervention group and 192 (51%) from the control group. Among participants with exposure to agricultural noise, the intervention group reported significantly greater use of hearing protection compared with the control group (25.9% vs 19.6%; P = .015). The intervention group also reported significantly greater use of hearing protection for shooting guns (56.2% vs 41.6%; P = .029), but the groups reported similar uses of protection in other contexts. There was no significant difference between groups with respect to objective measures of NIHL.
  
  
  CONCLUSIONS
  This novel trial provides objective evidence that a comprehensive educational intervention by itself may be of limited effectiveness in preventing NIHL in a young rural population.
authors: National Farm Medicine Center, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA. marlenga.barbara@mcrf.mfldclin.edu
authors: Barbara
authors: B
authors: Marlenga
authors: James G
authors: JG
authors: Linneman
authors: William
authors: W
authors: Pickett
authors: Douglas J
authors: DJ
authors: Wood
authors: Steven R
authors: SR
authors: Kirkhorn
authors: Steven K
authors: SK
authors: Broste
authors: Mary Jo
authors: MJ
authors: Knobloch
authors: Richard L
authors: RL
authors: Berg
mesh_terms: D000293:Adolescent; D001299:Audiometry / Q000379:methods; D016001:Confidence Intervals; D004430:Ear Protective Devices / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006317:Hearing Loss, Noise-Induced / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D016014:Linear Models; D008297:Male; D020380:Needs Assessment; D009623:Noise, Occupational / Q000517:prevention & control / Q000706:statistics & numerical data; D016017:Odds Ratio; D011322:Primary Prevention / Q000379:methods*; D012016:Reference Values; D012424:Rural Population; D013997:Time Factors; D014922:Wisconsin; D055815:Young Adult