Let’s be honest, when most of us attend or take part in noisy recreational activities (e.g., nightclubs, concerts, playing musical instruments, indoor/outdoor sporting activities, motorsports) the last thing we reach for are hearing protection devices (e.g., earplugs and earmuffs). This is despite the fact that these activities can often range in loudness levels over 100 dBA, with the potential to cause hearing symptoms (e.g., dullness in hearing/tinnitus) after 15 minutes of continuous exposure. This is one of the reasons why the World Health Organization estimates that over a billion teenagers and young adults are at risk of hearing symptoms due to recreational noise exposure.

The use of hearing protection devices is recognized as a method of reducing noise exposure. However, the amount of people using these devices within recreational contexts just ‘some of the time’ can be as low as ~5%, and even fewer people ‘always’ using them. Some people do tend to walk away from loud sources of noise, or go and take a break on a night out (e.g., regeneration break), and this is another method of protecting your hearing.

In order to improve hearing protection behaviors (e.g., earplugs, earmuffs, regeneration breaks) through interventions it would be beneficial to know how effective previous interventions have been in recreational contexts, and what were the active ingredients (behavior change techniques (BCTs)) of these interventions trying to bring about the change.  Knowing what BCTs have been applied previously, or perhaps not, can help future designers of hearing protection interventions to potentially improve uptake. We conducted a systematic review of any intervention studies that measured a deliberate attempt to increase hearing protection behaviors during noisy recreational activities.

So what did we find? We found eight studies measuring behavior post-intervention, of which only three were experimental post-test designs (two randomized controlled studies and one quasi). The most common behavior reported was the use of earplugs, seen in all eight studies, with five having a small to medium effect (d ≥ 0·3 ≤ 0·5) at measuring an increase, or difference in earplug use – including all three experimental studies. The overall increase or difference in earplugs being used ‘some of the time’ across all eight studies ranged from 3% -14.6%, but with very few ‘always’ using earplugs people are at risk of acquiring hearing symptoms.

In terms of BCTs, across all studies we found a total of 17 different techniques had been deployed out of a possible 93 available from within the ‘behavior change technique taxonomy version 1’, with the majority serving an intervention category of ‘education’ (e.g., information about health consequences). With so few BCTs coded it leaves a large scope to test previously unused techniques. However, all three experimental studies restructured the environment by providing free earplugs (e.g., adding objects to the environment), and each measured a small to medium effect for at least one recreational context – perhaps indicating that this should be at least considered for future interventions.

Overall the results tell us there are very few hearing protection interventions addressing recreational noise exposure, a global hearing health concern, and those that have tackled the issue have had mixed success. Further intervention studies should be conducted that employ randomized controlled designs, with use of systematic approaches to intervention development (e.g. the behavior change wheel), as this will help target specific behavior change techniques in an effort to increase hearing protection behaviors and raise effect sizes.

Will you be reaching for your earplugs the next time?