DEPARTMENT OF DEFENSE HEARING LOSS PREVENTION EDUCATION

DEPARTMENT OF DEFENSE HEARING LOSS PREVENTION EDUCATION A Comprehensive Hearing Health Program (CHHP) Pilot Study LTC John Andy Merkley, AuD, Army Audiology Liaison Tanisha Hammill, PhD, MPH, Senior Research Administrator February 17, 2018

Disclaimer The views expressed in this presentation are those of the author(s) and do not reflect the official policy or position of the Department of Veterans Affairs, Department of Defense, or the U. S. Government. 3

Agenda Comprehensive Hearing Health Program (CHHP) Overview Pilot Study Educational Materials Results Next Steps 4

Hearing in the Military The ability to hear and communicate is Critical to the safety of each warrior and unit Central to effective command and communications A vital component for lethality and survivability A key consideration in Force Management Attrition, retrain, replace Service members play hard off duty, too! Good hearing enables participation in family life, team sports, and general appreciation of the sounds of nature and music 5

The Hearing Health Triad CHHP EDUCATE Develop hearing health education tools Integrate hearing health education into formal training & leadership schools Individual hearing health education Global Outreach PROTECT Standardize evaluation procedures for hearing protection devices (HPDs) Hazardous noise reduction & advocating for best practices HPD fitting & training MONITOR Assess and support the needs of the Services hearing health surveillance programs Prevent hearing loss through early identification and intervention 6

Educate Increase awareness and understanding of hearing and hearing loss prevention from exposure to hazardous noise levels Promote individual behavior and organizational changes Education opportunities consist of the following: Individual health education during occupational and/or clinical audiology encounter Organizational health events Worksite hearing health class HCE materials available to help promote hearing health education (www.hearing.health.mil) Informational brochures, slick sheets, flip charts, posters No cost 7

CHHP PILOT STUDY

CHHP Pilot Study Objective: To deliver educational sessions using CHHP educational materials as part of every clinical and occupational hearing health encounter to Service Members who are seen at these clinics within participating military locations 9

Study Design Target population: Active duty individuals who are at risk for hearing loss Three groups at each site: Clinical (BHDA) Occupational (FBNA) Control (common area recruitment) Recruitment sites: Air Force JBSA Lackland Clinical: Wilford Hall Audiology Occupational: Public Health Clinic Army Brooke Army Medical Center Clinical: Audiology Occupational: McWethy Troop Medical Clinic Navy/Marines Naval Medical Center San Diego Clinical: Audiology/ENT Occupational: Marine Corps Recruit Depot 10

Study Design Subjects 432 subjects (48 in each group; 9 groups) Inclusion criteria English speaking, U.S. active duty military personnel scheduled to see an audiology provider/ent U.S. active duty military stationed at one of the participating study bases will be eligible for enrollment in the control arm of this study Age 18 and over Exclusion criteria Non active duty, Reservist, National Guard Visually apparent pain, dizziness, or other infirmity that might prevent the patient from providing informed consent, or from comfortably reading and responding to simple instructions on an Android tablet or using a touch screen to make responses 11

Study Design Intervention Educational session administered by an audiologist or hearing technician using CHHP educational materials (5 15 minutes) Material selection is up to the provider Scripts are suggested but not mandatory Questionnaire Designed to assess Knowledge, Attitudes, Beliefs, and Behaviors Timeline Baseline survey Intervention Postappointment survey 6 month follow up survey Clinical X X X X Occupational X X X X Control X X 12

EDUCATIONAL MATERIALS

CHHP Materials for Hearing Health Promotion 14

CHHP Materials for Hearing Health Promotion 15

CHHP Materials for Hearing Health Promotion 16

RESULTS

Results We are still collecting data. This analysis is based on data from 134 subjects (n = 134/432) These results may change as the sample grows and data collection and analysis are completed and should be interpreted as trends and not statistically significant results (yet!) 18

Sample Characteristics

Knowledge: Signs of Hazardous Noise Exposure

Knowledge: Effective Forms of Hearing Protection

Knowledge: Good Ways to Protect Hearing

Attitudes & Beliefs

Perceived Susceptibility

Perceived Barriers

Self Efficacy

Interpersonal

Hearing Protection During Recreation

NEXT STEPS

Next Steps Revising materials Based on the feedback from providers and patients, we will improve and revise educational materials Scaling up program Overall goal to have hearing health education be standardized and consistent throughout the DoD Disseminate CHHP materials and track outcomes on a larger scale Disseminate to VA clinics Precision Medicine Initiative Ongoing study funded by Congressionally Directed Medical Research Programs (CDMRP) to create a risk matrix based on noise exposure, knowledge/attitudes/beliefs/behaviors, genetic predisposition, and current hearing profile This matrix will be used to develop corresponding educational materials targeting personal risk profiles 40

Thank You To Our Team LTC John Andy Merkley, Principal Investigator Tanisha Hammill, PhD, Project Director Natasha Gorrell, MSPH, Project Manager Elsa Granato, MPH, SATX Research Coordinator Sara Murphy, MPH, SoCal Research Coordinator Erin Cesario, Research Coordinator Genevieve Krackau, Research Coordinator Nicole Larionova, Research Coordinator Rina Harman, Research Coordinator Julieta Scalo, PhD, Biostatistician Martin Slade, MPH, Biostatistician Kathy Gates, AuD, Subject Matter Expert Vickie Tuten, AuD, Subject Matter Expert Deanna Meinke, PhD, Consultant David Welch, PhD, Consultant Ravi Reddy, PhD, Consultant 41

QUESTIONS?