Behaviour Change

PROPAGANDA FOR CHANGE is a project created by the students of Behaviour Change (ps359) and Professor Thomas Hills @thomhills at the Psychology Department of the University of Warwick. This work was supported by funding from Warwick's Institute for Advanced Teaching and Learning.

Thursday, February 28, 2019

PartyPlugs: Protect your ears while going out

The Problem and its Relevance
More and more young people willingly expose themselves to loud noise, especially in recreational settings (Quintanilla-Dieck, Artunguaga & Eavey, 2009). Yet, any exposure of significant intensity and duration can be harmful, even if the noise is not experienced as too loud (Rabinowitz, 2000). It can cause ear pain, noise sensitivity, tinnitus and even hearing loss (Gilles et al., 2012). Over a longer period, exposure to loud music damages the inner and outer hair cells which can result in permanent hearing loss (Zhao, Manchaiah, French & Price, 2010). Even though many people do know that loud noise can be harmful, many people don’t consider it a problematic health issue (Quintanilla-Dieck et al., 2009).

Concerts, personal listening habits and nightclubs are commonly identified as the main sources of exposure to loud noise in recreational contexts (Rawool & Colligon-Wayne, 2008; Gilles et al., 2012). Attendance to nightclubs has repeatedly been reported as the cause for symptoms such as tinnitus, ear pain and hearing loss (Chung, Des Roche, Meunier & Eavey, 2005). Tinnitus is defined as the ‘perception of sound in absence of an actual external sound’ (Han et al., 2009, 11) and can take different forms. The sounds most often associated with tinnitus are high-pitched sounds like escaping steam (Han et al., 2009). Even though the quantitative relationship between recent loud music exposure and tinnitus is not well understood (Moore, Zobay, Mackinnon Whitmer & Akeroyd, 2017), the relatively long exposure to high sound levels when going out might be responsible for transient tinnitus (Gilles et al. 2012). For comparison: Hearing protection is compulsory for workers that are exposed to noise more than 85 dB(A) for 8 hours a day. Music in nightclubs, however, ranges from 95 to 110 dB(A) with a tendency to increase during the night (Gilles et al., 2012). A weekly exposure of over 1.25 hours to such sounds levels is considered to exceed occupational safety standards (Vogel, Brug, van der Ploeg & Raat, 2010). Given that people might go to clubs several nights per week and/or spend several hours in a club, the exposure is beyond safe levels. However, only a minority of people report using hearing protection or engaging in protective behaviours (Vogel et al., 2010; Chung et al., 2005; Rawool & Colligon-Wayne, 2008)

In one study among Dutch students, 89.5% of students reported having experienced tinnitus after loud music exposure (Gilles et al., 2012). In another study by Rawool & Colligon-Wayne (2008) 66% of respondents in a student population reported that they had experienced tinnitus in the past. However, most of the students (58%) were not concerned about it. This showcases a contradiction in people’s attitude towards loud music: Even though many have suffered from its consequences, it is not deemed an important issue. Rather tinnitus is understood as a natural consequence of clubbing and no action is taken (Gilles et al., 2012).
However, there are certain behavioural changes that can lower the risk of tinnitus and hearing loss. Visitors of nightclubs are recommended to keep at least two meters distance from the music source and take breaks from exposure during the night (Vogel et al., 2010). Additionally, wearing hearing protection can reduce the impact loud music has on the ears. Toivonen and colleagues (2002) show that proper insertion of earplugs can attenuate noise by up to 31 dB. This would reduce sound to safe levels.
The target audience
With our project, we want to raise awareness for the dangers of loud music and promote the use of earplugs among students. However, the target audience of this project are nightclubs around the University of Warwick. We decided not to approach the students directly but to address nightclubs instead. Thereby, we wanted to influence them in a more indirect way (see Psychological Persuasion Techniques used in our project).

Our intervention: PartyPlugs
In order to get an insight into the experiences of students at Warwick, we set up a short questionnaire. We asked where they go out, how often they went on a night out and how they experienced the volume of the music in nightclubs. We were also interested if they had ever worn earplugs and if not why they didn’t wear them. Fifty people filled out the online questionnaire. The results show that the majority of the students goes out more than once a week (62%). They experience the music to be at adequate or slightly too loud levels. When asked if they experienced a beeping noise after going out, more than half of students indicated to have experienced this at least once. Out of these, 36% reported experiencing transient tinnitus sometimes. However, only a small majority of students (8%) occasionally wear earplugs when going out.
We used this information to compose an email that we send afterwards to eight nightclubs around the University of Warwick. In this email, we described the harms of loud music supported by scientific evidence. We also included the results from our own questionnaire to inform the nightclubs on how their guests experience the music volume. Furthermore, we asked if they had any policy in order to protect the clubbers against tinnitus and hearing loss. We proposed to help raise awareness by putting up posters we would provide them with. Another option we suggested was to make earplugs available in their club. 

We didn’t get any response to the emails we send to the nightclubs. As a consequence, we decided to contact them through Facebook. We sent a shortened version of the information we used in the email. This time we got one message back. The club answered that they take ear protection very seriously. They explained that they have a sign at the entrance informing the guests that free earplugs are available at the bar. The other nightclubs opened our message but did not reply. In addition to this, we wrote an email to the well-being officer of the Student Union to ask about their opinion on the problem. However, we have not received an answer to this day.

Psychological and persuasion techniques used
In our project, we used several persuasion techniques to raise awareness for the issues around exposure to loud music. We chose to address nightclubs instead of students for several reasons.
Taken from Ajzen, 1991
According to the theory of planned behaviour (Ajzen, 1991), intentions towards a certain behaviour can be accurately predicted by attitudes, subjective norms and perceived behavioural control. An attitude towards a behaviour refers to the degree to which someone has a (un)favourable evaluation or appraisal of the behaviour. In our case, it refers to how favourable or unfavourable students evaluate the use of hearing protection while going out. From our literature review, it seems that the general attitude of young people towards hearing protection is rather indifferent. To be able to change students’ behaviour so that they use hearing protection, their attitude has to shift to a favourable appraisal of it. One way of changing people’s attitudes towards a behaviour is by making the intended behaviour more familiar. As Cialdini argues, familiarity has a positive effect on liking, which in turns affects persuasion (Cialdini, 2009). Part of this familiarization could be established by seeing posters or earplugs at nightclubs. Monahan, Murphy and Zajonc (2000) showed that unconscious repeated exposure to a stimulus can affect liking. Even if the posters are not consciously seen by the partygoers, they could still increase familiarity and liking. Moreover, if students like the clubs they go to, which we assume to be the case, this positive affect could be diffused towards the messages about earplugs (Monahan et al., 2000).
Secondly, social norm refers to the perceived social pressure to perform or not perform the behaviour. Since the use of earplugs is not common among young people nowadays, social pressure to wear them is low. If we want students to use hearing protection while going out, we would need to create a higher social pressure. We reasoned that one way to achieve this is through the nightclubs themselves. If they advertise the use of earplugs and make them available at the bar, they convey the norm that it is normal in their club to wear earplugs.
Perceived behavioural control, finally, refers to the perceived ease or difficulty of performing the behaviour, reflecting both past experience and anticipated obstacles. Not considering attitudes or social norms, wearing earplugs itself can be considered easy. However, buying earplugs and bringing them on the night out might be considered hard by students. When the clubs provide earplugs, on the other hand, this would remove an important obstacle. Therefore we asked the nightclubs in our email to make earplugs available at the bar.

To make the nightclubs themselves aware of the issue we used both scientific evidence and the results of an exploratory survey, as described above.
By using scientific evidence in our email, we aimed at increasing the perceived authority. As students, we might not possess sufficient authority to persuade nightclubs. Therefore, by adding solid empirical evidence to our argument, we wanted to induce a sense of knowledge and authority. As Cialdini (2009) argues the perception of authority or expertise can make people more susceptible to persuasion. People tend to mindlessly believe or obey authority figures because they seem trustworthy and a reliable source of information. Hovland and Weiss (1951) also showed that people are more likely to believe a message conveyed by a trustworthy source. This is what we attempted in our email through the use of scientific evidence.
Another reason to use empirical evidence can be explained based on the Elaboration Likelihood Model (ELM) (Petty & Cacioppo, 1986). According to this model, there are two possible routes to persuasion: the central route and the peripheral route. The central route, firstly, results from a person’s careful and thoughtful consideration of the quality of the information presented in support of an argument. Persuasion through the peripheral route, on the other hand, results from a simple cue in the persuasion context that induced change without necessitating scrutiny of the true quality of the information presented. Persuasion via the central route is showed to be more enduring than persuasion via the peripheral route (Petty & Cacioppo, 1986).
According to the ELM, the processing is central and the persuasion lasting if people are motivated and willing to elaborate. In this context, elaboration means the extent to which one thinks about the issue-relevant arguments in a message (Petty & Cacioppo, 1986). To make the addressed nightclubs more motivated to read and consider our proposal, we added data from students who actually go to these nightclubs, taken from our survey. Since these students are the target audience of the clubs, this information could make the issue more relevant to them. Petty and Cacioppo (1986) argue that when personal relevance increases, people become more motivated to make the cognitive effort of processing the issue-relevant arguments presented. Personal relevance is, therefore, an important determinant of the route to persuasion.
For our project, we therefore mainly used a combination of the Theory of Planned Behaviour, the effect of familiarity on liking and the Elaboration Likelihood Model as persuasion strategies.

Final notes
As we explained earlier, we did not approach students directly but contacted nightclubs in the area around campus. In the future, a campaign by the Students Union or individual students should directly target students, informing them about the harms of loud music and the benefits of earplugs. This should address social norm and existing attitude to eventually change their behaviour.
The fact that neither the nightclubs nor the well-being officer of the Students Union answered our emails can be seen as proof for the lack of awareness for the problem we addressed. As evidence shows (see above), many people do not consider the harms of loud music a problematic health issue, which might partially account for the non-response. Well-designed campaigns might change this in the future and make clubbing an even more enjoyable experience. 

References

Ajzen, I. (1991). The theory of planned behaviour. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T 

Chung, J. H., Des Roches, C. M., Meunier, J., & Eavey, R. D. (2005). Evaluation of noise-induced hearing loss in young people using a web-based survey technique. Pediatrics, 115(4), 861–867. https://doi.org/10.1542/peds.2004-0173

Gilles, A., Ridder, D. de, van Hal, G., Wouters, K., Kleine Punte, A., & van de Heyning, P. (2012). Prevalence of Leisure Noise-Induced Tinnitus and the Attitude Toward Noise in University Students. Otology & Neurotology, 1. https://doi.org/10.1097/MAO.0b013e31825d640a

Han, B. I., Lee, H. W., Kim, T. Y., Lim, J. S., & Shin, K. S. (2009). Tinnitus: characteristics, causes, mechanisms, and treatments. Journal of Clinical Neurology (Seoul, Korea), 5(1), 11–19. https://doi.org/10.3988/jcn.2009.5.1.11

Hovland, C., & Weiss, W. (1951). The Influence of Source Credibility on Communication Effectiveness. The Public Opinion Quarterly, 15(4), 635-650. Retrieved from http://www.jstor.org.kuleuven.ezproxy.kuleuven.be/stable/2745952

Monahan, J. L., Murphy, S. T., & Zajonc, R. B. (2000). Subliminal Mere Exposure: Specific, General, and Diffuse Effects. Psychological Science, 11(6), 462–466. https://doi.org/10.1111/1467-9280.00289

Moore, D. R., Zobay, O., Mackinnon, R. C., Whitmer, W. M., & Akeroyd, M. A. (2017). Lifetime leisure music exposure associated with increased frequency of tinnitus. Hearing Research, 347, 18–27. https://doi.org/10.1016/j.heares.2016.10.030

Passchier-Vermeer, W., & Passchier, W. F. (2000). Noise Exposure and Public Health. Enviromental Health Perspectives, 108(1), 123–131. Retrieved from http.//ehpnetl.niehs.nih.gov/docs/2000/suppl-1/123-131passchier-vermeer/abstract.html

Petty, R. E. and Cacioppo, J. T. (1986).The Elaboration Likelihood Model of Persuasion. Advances in Experimental Social Psychology, 19, 123-205.

Quintanilla-Dieck, M. d. L., Artunduaga, M. A., & Eavey, R. D. (2009). Intentional exposure to loud music: the second MTV.com survey reveals an opportunity to educate. The Journal of Pediatrics, 155(4), 550–555. https://doi.org/10.1016/j.jpeds.2009.04.053

Rabinowitz, P. M. (2000). Noise-induced hearing loss. American Family Physician, 61(9), 2759–2760.

Rawool, V. W., & Colligon-Wayne, L. A. (2008). Auditory lifestyles and beliefs related to hearing loss among college students in the USA. Noise and Health, 10(38), 1. https://doi.org/10.4103/1463-1741.39002

Toivonen, M., Pääkkönen, R., Savolainen, S., & Lehtomaki, K. (2002). Noise Attenuation and Proper Insertion of Earplugs into Ear Canals. The Annals of Occupational Hygiene. Advance online publication. https://doi.org/10.1093/annhyg/mef065

Vogel, I., Brug, J., van der Ploeg, C. P. B., & Raat, H. (2010). Young people: taking few precautions against hearing loss in discotheques. The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine, 46(5), 499–502. https://doi.org/10.1016/j.jadohealth.2009.10.013

Zhao, F., Manchaiah, V. K. C., French, D., & Price, S. M. (2010). Music exposure and hearing disorders: an overview. International Journal of Audiology, 49(1), 54–64. https://doi.org/10.3109/14992020903202520

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