Sexo, drogas e cadê o rock’n’roll? O programa dangerous decibels® Brasil como estratégia de promoção da saúde auditiva no programa saúde na escola

Abstract

Introduction: In the past decades, increasing concern on noise has been observed, which ranks second in the world ranking of environmental pollution. In modern society, apart from the environmental noise, the use of gadgets and earphones, along with the attendance to noisy entertainment settings have grown in a progressive and alarming pace. Children and adolescents are the most exposed to entertainment noise, and a trend to increasing hearing disorders has been described in this age group. As there is still no cure or reversion for noise induced hearing loss (NIHL), although it is preventable, hearing education would be one of the approaches to the problem. In 2007, the School Health Program (SHP), an intersectoral Health and Education policy, was set up in Brazil in order to meet part of that demand for health education. The SHP aims to contribute to the full education of students from state schools by means of health promotion, prevention and care actions. In 2017, the SHP expanded actions and included hearing health promotion as a priority in educational interventions. Currently, among the most acknowledged hearing health promotion and educational programs worldwide, targeting children and adolescents with qualified educators in Brazil, the Dangerous Decibels® (DD) Program stands out. The evidence-based Program with structured strategies was even recommended by the World Health Organization in its latest world hearing report in 2021. Objectives: the main objective of the study was to propose the implementation of the DD Program as a strategy for Hearing Health Promotion within the SHP in the municipality of Itajaí, Santa Catarina State/Brazil; the specific objectives were to conduct a systematic review on the effectiveness of hearing health education programs; to profile the study sample in terms of knowledge, habits, attitudes and behaviors in face of noise, and define the prevalence of tinnitus complaint, relating the obtained data to gender, age range and social risk; additionally, to assess the effectiveness of the educational intervention by means of the DD Program among that population. Methodology: apart from the research field records, a systematic review was held, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocol; in addition, three studies were also conducted: two quantitative, analytical, crosssectional, observational studies, and one non-randomized, clinical (quasiexperimental), before-and-after type of study. They were further described following the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. The convenience sample comprised the population of 2,160 students, enrolled in the 6th grade of 32 Municipal Schools from Itajaí, Santa Catarina State, in its eight Educational Hubs. The minimum samples calculated were 715 students (CI=95%), considering the 2,160 students mentioned and 1,068 students, based on an infinite population. The final study sample comprised 1,835 students, among them, 838 (45.7%) were females and 997 (54.3%), males, mean age of 11.53 ± 0,8 years. As an educational intervention, the Dangerous Decibels® classroom strategy, following its 9 steps, 45 minutes each session, administered by the researcher to all classes. Data collection was conducted by means of three specific questionnaires, previously validated and translated to Portuguese, applied by the researcher and teachers in three different research times: before the educational intervention (A), immediately after the educational intervention (B), and three months after the educational intervention (C). The questionnaires entailed identification data, age, gender, habits and hearing symptoms, and thematic questions divided in 3 scales: knowledge attitudes and behaviors towards the noise. For the 12 statistical analysis of the individual results for questionnaires A, B and C, descriptive methods were used (absolute and relative frequency tables in percentages - %), and for the comparative analyses, paired T-test (for the parametric data), paired samples Wilcoxon test (for non-parametric tests). For the comparative analyses between questionnaires A, B and C, whenever it was possible, McNemar Test (paired data), significance level of 0.05, was used. Statistica 13.3 software was used to perform the analyses. For the analysis and comparison of the hit scores in questionnaires A, B, and C, in each of the three mentioned scales (knowledge, attitudes and behaviors), ANOVA repeated measures model was used, significance level of 0.05. For the association between the independent variables (gender, age range, social risk and hazardous hearing habits) and the impact on the presence/absence of tinnitus, the univariate analysis was used by means of the Chi-square test. The variables that show statistical significance by the univariate analysis (α = 10%), were included in a multinomial logistic regression model, estimating the adjusted odds ratio (OR) to a multivariate model, with the respective confidence intervals of 95%. All analyses were held using JAMOVI software, significance level of 5%. Results: The thesis, delineated by its objectives, was developed and grounded the elaboration of four studies, in addition to the researcher’s perceptions by means of the records in the field diary, which will permeate its different sessions. Thus, the study results will be shown as follows: Article 1: systematic review (on the effectiveness of hearing health education programs), which evidenced that the 36 studies included were effective, disregarding the educational strategies used; Article 2: a general profile of the student population participating in the study (comprising knowledge, habits, attitudes and behaviors towards noise). The article verified that most children and adolescents have potentially hazardous habits for the development of hearing disorders, with a high rate of hearing complaints, scarce knowledge on the theme, and on the proper attitudes towards noise, besides the intentions to change risk behaviors. By relating those data to gender, age and social risk, it was observed that males have more hazardous habits and tinnitus complaints, while females have more knowledge and intention to wear hearing protection, regarding age range, younger students protect themselves more, while the older ones are more exposed to noise, with more tinnitus complaints, but no difference perceived for the knowledge item; Article 3: epidemiological study (the prevalence of tinnitus and correlated variables in the assessed sample): tinnitus prevalence was 72.15% by means of multivariate analysis, showing significant correlation between tinnitus complaint and gender (males present 1.47 times more chances than females), age and number of habits with noise exposure/risk habits. Associations between tinnitus complaint and social risk factor or previous knowledge on the theme were not observed; Article 4: assessment study on the effectiveness of the Dangerous Decibels® educational program in the SHP from Itajaí municipality, Santa Catarina State/Brazil. It showed that the DD Program activities were effective for the changes in the students’ knowledge, habits, behaviors and attitudes towards noise and the use of hearing protection; in the variance analyses, only the behavior dimension did not keep the results in the assessed group after three months from the intervention. Conclusions: scientific publications assessing the effectiveness of hearing health education programs, selected for the systematic review, showed their effectiveness, disregarding the strategy used, being an important tool to contribute to the self-care and the promotion of healthy hearing behaviors; regarding the field work, it can be concluded that most children and adolescents from the assessed sample have hazardous habits for developing NIHL, scarce knowledge on the theme or on proper attitudes to face the noise problem. Thus, males and those in older groups 13 showed the worst attitudes and behaviors towards the potential hearing risk related to noise exposure, also showing high prevalence of tinnitus complaints. Such complaints are related to older groups, to males and greater number of hazardous habits (noise exposure), regardless of the social risk and/or previous knowledge on the theme; and the DD Program was an effective strategy for hearing- health promotion among the participants in the intervention, and its insertion is proposed in the SHP activities. Final considerations: The data evidenced the problem dimensions, beyond the lack of knowledge in the area, opening perspectives and themes for reflections to be considered in designs, updates and directions for proposals and future hearing health education programs and strategies, aiming at children and adolescents in public Health and Education policies.