MP3 Players and Hearing Loss: Adolescents’ Perceptions of Loud Music and Hearing Conservation INEKE VOGEL, MSC,JOHANNES BRUG,PHD, ESTHER J. HOSLI,PHD, CATHARINA P. B. VAN DER PLOEG,PHD, AND HEIN RAAT, MD, PHD Objective To explore adolescents’ behaviors and opinions about exposure to loud music from MP3 players. Study design We conducted a qualitative analysis of focus-group discussions with adolescents aged 12 to 18 years from 2 large secondary schools (1 urban and 1 rural) for pre-vocational and pre-university education. The semi-structured question route was theoretically framed within the protection motivation theory. Results Most adolescents— especially male students and students from pre-vocational schools—indicated that they often played their MP3 players at maximum volume. Although they appeared to be generally aware of the risks of exposure to loud music, they expressed low personal vulnerability to music-induced hearing loss. Most adolescents said that they would not accept any interference with their music-exposure habits. Conclusions Interventions should target students from pre-vocational schools and should focus on increasing adolescents’ knowledge of the risks of loud music and how to protect themselves. Besides hearing education for adolescents and technical modifications of MP3 players, volume-level regulations for MP3 players may be warranted. (J Pediatr 2008;152:400-4) W ith the massive spread in the popularity of portable MP3 players, exposure to high sound levels has increased dramatically, and millions of adolescents and young adults are potentially at risk of permanent hearing loss through listening to their favorite music. 1 Music-induced hearing loss may be evolving into a significant social and public health problem: increasing numbers of adolescents and young adults already show related symptoms, such as distortion, tinnitus, hyperacusis, or threshold shifts. 2-4 Although studies investigating the hazardous effects of headphone-listening have yielded equivocal results, the output levels from the headphones of commercially available portable music players are high enough to cause music-induced hearing loss when the phones are used at high volumes for long periods. 5,6 The rapid development of digital technology has resulted in new kinds of portable music players, such as MP3 players, in which sound quality is no longer distorted at higher volumes. Because they are equipped with improved headphones, sound-leakage is minimal, allowing them to be used at high volume levels in most environments without disturbing others. 7 Especially in noisy environments, listeners often choose high volumes. 8 As a result, they create the conditions for higher sound levels and longer exposure times, both of which are known to increase the risk of hearing damage. MP3 players thus may be the most important risk factor for music-induced hearing loss in young people. To prevent such music-induced hearing loss, adolescents using MP3 players should take precautionary measures or external measures, such as introduction of legal sound limits, 9,10 should be considered. Either way, useful inputs on possible prevention strategies and interventions would be provided if modifiable determinants of behavior related to sound-exposure were explored. 11 Because of the absence of studies on the behavioral determinants of hearing conservation in adolescents, 12 we conducted focus group interviews 13,14 with adolescents to explore their behaviors and opinions about exposure to loud music from MP3 players. METHODS Participants Students from 2 secondary school communities, 1 urban and 1 rural, were invited to participate in 8 focus-group discussions. Because a summary of the literature on correlates PMT Protection motivation theory From the Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (I.V., J.B., H.R.); and Department of Preven- tion and Healthcare, TNO Quality of Life, Leiden, The Netherlands (E.H., C.v.d.P.). Supported by a grant (#2100.0107) from the Netherlands Organization for Health Research and Development (ZonMw) Pre- vention Research Program. The work was done entirely independently of the funder. Submitted for publication Dec 28, 2006; last revision received May 9, 2007; ac- cepted Jul 5, 2007. Reprint requests: I. Vogel, Dept of Public Health, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail: i.vogel@erasmusmc.nl. 0022-3476/$ - see front matter Copyright © 2008 Mosby Inc. All rights reserved. 10.1016/j.jpeds.2007.07.009 400