NORA Manufacturing Sector Strategic Goals
927Z1LB - Hearing Loss Intervention for Shipyard WorkersStart Date: 10/1/2005
End Date: 9/30/2010
Principal Investigator (PI)Name: Carol Stephenson
Funded By: NIOSH
Primary Goal Addressed4.0
Secondary Goal AddressedNone
Attributed to Manufacturing100%
The overall goal of this study is to eliminate the extremely high prevalence of hearing loss currently occurring among workers engaged in the shipbuilding and repair industry. This is an intervention effectiveness study within which a program evaluation of existing hearing conservation programs will be conducted. NIOSH will use previously validated methods to perform a systematic and extensive evaluation of the hearing loss prevention programs currently serving these workers. Recommendations for program improvement will be made, new interventions monitored, and program changes will be evaluated for efficacy in eliminating new hearing losses.
This project is a cross-divisional effort focusing on existing hearing loss prevention programs at U.S. Navy shipyards. Specifically, the U.S. Navy has entered into a partnership with NIOSH to reduce occupational hearing loss at the Puget Sound Naval Shipyard (PSHS). At face value, the naval hearing conservation program targeted for this study were designed and implemented according to OSHA guidelines and theoretically should have protected workers' hearing. The Navy has invested heavily in new engineering noise controls, has managed a comprehensive program of audiometric testing, and has offered increasing varieties of hearing protectors to their workforce in an effort to minimize hearing losses. Surprisingly, audiometric monitoring data suggest that workers in these programs are still losing hearing at alarming rates, despite regulatory oversight and good faith efforts to implement a complete, industry focused program. This study is needed in order to understand why these efforts have not been successful. Results from this study may have widespread implications for other industries attempting to follow current hearing conservation regulations, yet still suffering unacceptable levels of hearing loss. During the initial phase of this study, an audit of the PSNS hearing loss prevention program was done by the Navy in consultation with NIOSH. This audit gathered data that may identify reasons for the apparent failure of the existing program. In particular, this project will focus on the correct use of personal protective equipment (hearing protectors). This will involve formative, surveillance-like research collecting qualitative and quantitative data and will include observational assessments of hearing conservation culture and training practices at the shipyard. An existing NIOSH audit method validated in manufacturing and construction will be used by the Navy IH team which has its theoretical underpinnings in the Health Belief Model, the Transtheoretical Model (stages of change), and the P-Process Model for participatory program change. The audit employs a checklist to assist the evaluator in a comprehensive examination of program elements. In the implementation phase of this effort, NIOSH, technical experts and the Navy hearing conservation leadership are evaluating the audit data and then will design, implement, and conduct an initial evaluation of tailored changes at the shipyard. The evaluation study will assess implementation barriers and facilitators, process elements, and personnel factors in a pre/post paradigm examining multiple quantitative and qualitative data sources. Data will come from tests and skill demonstrations documenting improvements in knowledge and skill, interviews with key individuals, focus groups with affected workers and supervisors, and worksite observations. The observations will be conducted using a previously validated checklist tool that permits quantification of specific hearing health behaviors and provides an indication of general site safety culture. A cross-divisional protocol has been developed through DART; HSRB, clearances secured, and baseline site visits began. In FY08, audits were be completed and partners will meet late in 2008 to discuss, develop, and implement an intervention plan that will be field-tested in 2008 and 2009. Findings and recommendations will be prepared for journal publication and dissemination in FY 2010.
The ultimate longitudinal goal of this study and the resulting intervention is to demonstrate a consistent and significant decrease in annual STS rates at this shipyard, and eventually throughout the industry as the lessons learned are disseminated and widely implemented. This has the potential to significantly improve hearing health for more than 150,000 workers in the United States alone. The first opportunity to note a decrease in new STS rates will occur following the first annual audiometry, post-intervention. Consistently decreasing annual STS rates will indicate that the programs are truly improving to protect and conserve workers' hearing. STS rates are calculated from yearly audiometric data that will continue to be collected independent of this study. These data will permit ongoing longitudinal assessment of the effectiveness of the intervention beyond the time frame allotted to this study, and will provide an indication of whether the changes to the program are being maintained long-term. The methods, tools, and interventions employed in this study are expected to be transferable, with appropriate modification of specific elements, to any industry suffering similar problems with hearing loss prevention program failures.
Since 1995, NIOSH has been engaged in a comprehensive program of research addressing methods to improve hearing conservation program efforts across industries. The maritime shipbuilding and repair industry is a target industry for both NIOSH and OSHA based on injury and fatality data. As of April, 2004, more than 155,000 workers are engaged in manufacture of ships and repair (BLS). Maritime workers are covered by the OSHA hearing conservation standard (29CFR 1910.95), which applies to general industry. However, they perform tasks and use tools similar to that of construction workers but unlike construction workers, these maritime workers are not transient and are typically enrolled in a site-specific hearing loss prevention program for many years. Yet, despite participation in these on-site and well monitored programs, recent data (2003) provided by the military shipyards demonstrate incidence rates for standard threshold shifts in hearing (STS) ranging from 18% to 40%. These may be the highest rates among any work sector covered by OSHA 1910.95. These data indicate a serious failure of the existing programs. Reasonable goals for annual STS rates in a successful program would be less than 1% per year, keeping in mind that over a 20 year working lifetime, this rate would indicate that one worker in five would still acquire a significant, noise-induced hearing loss. This project will investigate a best practices approach appropriate for this industry.