Toolkit for safe listening devices and systems

Make Listening Safe Toolkit for safe listening devices and systems

Make Listening Safe Toolkit for safe listening devices and systems Toolkit for safe listening devices and systems ISBN 978-92-4-151528-3 (WHO) ISBN 978-92-61-28411-4 (ITU) © World Health Organization and International Telecommunication Union, 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO or ITU endorses any specific organization, products or services. The unauthorized use of the WHO or ITU names or logos is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Foreword Acknowledgements Executive summary Background Noise as a risk factor for hearing Impact of hearing loss WHO’s Make Listening Safe initiative Rationale for a standard for safe listening devices WHO-ITU H.870 Global standard on safe listening devices and systems Developing the WHO-ITU Global standard Objective of the toolkit Implementation by goverments Rationale What actions can governments take? Implementation by industry partners Rationale What actions can manufacturers take? Role of civil society Rationale What actions can civil society organizations take References and Bibliography Appendices Appendix 1: Situation assessment tool Appendix 2: Format for stakeholders' consultation Appendix 3: Introductory presentation with key messages Appendix 4: Outline of sensitization workshop Appendix 5: Materials for raising awareness Appendix 6: Summary of WHO–ITU global standard Appendix 7: Example of information flow Appendix 8: Key considerations when developing messages and examples Appendix 9: Resources for school - based workshops on safe listening Contents 8 8 9 10 10 11 11 13 16 16 17 22 22 22 28 28 28 32 36 36 48 49 53 54 62 73 76 79 Foreword Globally, a billion teenagers and young adults are at risk of developing hearing loss due to the practice of listening to music at high volumes for prolonged time over their personal audio devices. Once hearing loss due to loud sounds sets in, it cannot be reversed. Such hearing loss, if unaddressed, can greatly impact one’s ability to communicate, gain education or find and hold suitable employment. However, hearing loss that results from loud sounds can be prevented through raised awareness and appropriate prevented measures. To address this issue the World Health Organization (WHO) and the International Telecommunications Union (ITU) have developed the Toolkit for safe listening devices and systems, which provides the necessary practical guidance for the implementation of the Global standard for safe listening devices (ITU-T H.870). The standard outlines key features to regulate the user’s exposure to sound, limit volume and provide information on safe listening. The implementation of the safe listening features recommended here will be key to protect users from hearing loss caused by loud sounds and ensuring that people can continue enjoying the sounds they like listening to. Governments can act by regulating for the standard and manufacturers can develop and market devices that implement the recommendations of the toolkit. Civil society can advocate for the implementation of the standard and raise awareness on safe listening. ITU and WHO call upon Member States, industry partners and civil society to play their part in promoting safe listening and in addressing this emerging health challenge. The use of this toolkit and implementation of the H.870 global standard will promote the responsible use of technology to enhance health and wellbeing among its users. Ms Doreen Bogdan-Martin, ITU Dr Etienne Krug, WHO Dr. Etienne Krug Director, Department for Management of NCDs’, Disability, Violence and Injury Prevention (NVI), World Health Organization Ms. Doreen Bogdan-Martin Director, Telecommunication Development Bureau (BDT), International Telecommunication Union Acknowledgements The World Health Organization (WHO) and International Telecommunications Union (ITU) gratefully acknowledge the following contributors to this handbook. Content development: Elena Altieri, Young-Se An, Simao Campos-Neto, Shelly Chadha, Alarcos Cieza, Nicola Diviani, Catalina Valencia Mayer, Ericka Lara Ovares, Karen Reyes, Sara Rubinelli, Roxana Widmer-Iliescu. Guidance: Etienne Krug, Tamitza Toroyan. Further contributions: Lidia Best, Avi Blau, Brian Fligor, Mark Laureyns, Richard Neitzel, Michael Santucci. Administrative support: Laure Cartillier, Alina Lashko. Editing: Angela Burton. Layout and Design: 7 Estudio Creativo. Executive summary This toolkit provides practical guidance to support Member States, industry partners and civil society groups in the use and implementation of the WHO-ITU H.870 Global standard on safe listening devices and systems. The WHO-ITU Global standard is the result of a collaboration between the World Health Organization (WHO) and the International Telecommunication Union (ITU), and has been developed in response to the growing prevalence of hearing loss and the threat to hearing posed by unsafe listening. The WHO-ITU Global standard has been deve-lo-ped using an evidence-based and consultative process, with the participation of experts in the field of sound, audiology, acoustics, communication, and smartphone technology. This toolkit outlines the need for hearing loss prevention and describes how WHO and ITU have shaped their response to this. It summarizes the WHO-ITU Global standard in a simplified way and provides a step-wise approach for implementation by three main partners in the field of hearing loss prevention: • Governments • Industry • Civil society A section tailored to each partner outlines the steps necessary for effective implementation of the WHO-ITU Global standard. A variety of tools are included to help with this: a situation assessment tool; an outline of planning workshops; and sample awareness-raising commu-ni-cations and slide presentations. The aim of the toolkit is to make it easy for partners to adopt, implement and monitor the WHO-ITU Global standard. Its overall goal is to ensure that all users of personal audio systems are empowered with information on safe listening and have the option to make safe listening choices in order to protect their hearing. Background 8Background WHO estimates that over a billion young people worldwide are at risk of hearing loss due to unsafe listening practices (1). Action is therefore urgently needed. In recent years, there has been a rapid growth in access to technology and an ever-increasing number of people are using such technology to communicate. In addition, there has been a significant increase in the number of people exposed to loud sounds through use of personal audio systems as well as in entertainment venues, which put them at high risk of damaging their hearing. Overall, the number of people with hearing loss is growing at a rapid pace. It is estimated that there are currently around 466 million people with disabling hearing loss globally (2). Of this total, 432 million (93%) are adults and 34 million (7%) are children. Recent WHO projections suggest that unless action is taken, there will be 630 million people living with disabling hearing loss by 2030. This number is expected to grow to over 900 million by 2050 (2) along with a proportionate rise in the current annual cost of more than US$ 750 billion (in international dollars) globally if hearing loss is not addressed (1,3). Several risk factors affect a person’s hearing throughout life. While some of the risk factors associated with hearing loss are declining in parts of the world (e.g. rubella and meningitis), preventable factors such as noise (which are mainly a consequence of our modern way of life) are on the rise. Noise-induced hearing loss can be caused by a variety of environments and behaviours. For example, 40% of those frequenting such discotheques, clubs, sporting events or music concerts are exposed to potentially damaging sound levels (4). There is evidence that those exposed over the past 20 years to loud sounds in social settings are three times more likely to suffer hearing loss than those unexposed. Noise as a risk factor for hearing Ears are the organs that process sounds, enabling the brain to interpret what the individual is hearing. The ear is divided into three parts – outer ear, middle ear, and inner ear (see Figure 1). Usually sound is perceived by the sensory cells located in the inner ear, and when these cells are exposed frequently to loud sounds they can be permanently damaged, affecting individual’s hearing. Figure 1: Structure of the ear. 9The widespread uptake of personal audio devices such as smartphones and MP3 players has added to this risk. Smartphone use in developing countries has grown from 45% in 2013 to 54% in 2015 (7) and in in developed countries this figure stands at 87%. It is estimated that 50% of those listening to music over their personal audio devices do so at levels that put their hearing at risk (4). This toolkit focusses on hearing loss caused by unsafe listening using personal audio devices. Unsafe listening practices were identified as a major contributor to hearing loss by the Scientific Committee on Emerging and Newly Identified Health Risks in 2008. The committee indicated that 5–10% of listeners are likely to develop hearing loss due to their personal preferences of volume levels and duration of listening. (8) The availability of evidence varied across countries, but one study revealed that more than 40 million adults in the Americas between the ages of 20 and 69 are affected by noise-induced hearing loss due to non-occupational causes (5). Impact of hearing loss Noise-induced hearing loss in young children impairs language acquisition (6,7), learning disabilities, anxiety and attention seeking behaviours are also common in children exposed to loud sounds. (11) Chronic noise exposure in classrooms affects academic performance in areas such as reading ability, comprehension, short and long term memory, and motivation. On average, children who are exposed to noisy learning environments have lower assessment scores on standardized tests, which in the long term might affect their academic and profes-sional development (4, 8). In adults, unaddressed hearing loss can mean loss of earnings and difficulty in finding and retaining jobs. In Europe, for example, people with unaddressed hearing loss are twice as likely to be unemployed compared to their normal hearing peers. When employed they often earn lower wages, for example in the USA, wages are found to be between 50% and 70% lower for adults with unaddressed hearing loss. It affects social relationships and can be a cause for stress in domestic relationships. Noise exposure in young people also contributes to age-related hearing loss that can lead to significant communication difficulties, with the subsequent emotional and cognitive effect this might imply (9). Recent evidence suggests that outcomes such as depression, isolation, frustration, cognitive decline, and decreased personal safety are twice as common among seniors with hearing loss than those without hearing loss (10, 11, 12, 13). While noise-induced hearing loss is irreversible, it can nonetheless be prevented. In the case of hearing loss caused by the unsafe use of personal audio devices, there are simple, effective practices such as keeping the volume within safe listening levels and limiting the time spent engaged in noisy activities that, if followed, can have a protective effect on people’s hearing. 10 Taking preventive action is mostly in the realm of listeners themselves by adopting safe listening behaviours. However, government, health care providers, manufacturers and civil society can create an environment which enables safe listening. WHO’s Make Listening Safe initiative In 2015, responding to this growing public health issue, WHO launched the Make Listening Safe initiative, with the overall vision of ensuring that people of all ages can enjoy listening with full protection of their hearing. The aim of this global initiative is to reduce the risk of hearing loss due to unsafe exposure to sounds in recreational settings through: • regulating exposure to loud sounds through personal audio systems; • undertaking a public awareness campaign to change listening behaviours among the target population; • developing a regulatory framework for safe listening in recreational settings. To achieve the first objective, ITU and WHO collaborated in developing the WHO-ITU Global standard for safe listening devices and systems. Rationale for a standard for safe listening devices Experience from other fields of public health (for example reducing tobacco use or improving road safety) show that policies, regulations and their enforcement can eventually influence people’s behaviours. This is the case for mandatory graphic warnings on cigarette packages, for example, and for fines for ignoring mandatory seatbelt-wearing laws, for example. In line with these experiences (14), it is believed that the design and implementation of specific legislation that regulates the amount of sound energy received through a personal audio system can help prevent hearing loss by ensuring a lower level of sound exposure in people using these devices. Currently, there is one example of regulation that targets sound exposure through personal music players, which is the 2009 directive from the European Commission limiting the output level of personal music players and making it essential to provide a warning to listeners. Legal and regulatory interventions have proved to be an effective strategy for many sentinel public health achievements. An strong example is legislation worldwide on smoking bans that has been effective in reducing the incidence of passive and active smoking as well as the rate of acute coronary syndrome in populations concerned (15). Legislation and its enforcement is shown to be a key intervention for road safety, which can lead to reduction in speeding and drunk driving (16, 17). On the basis of these examples it makes sense to put in place regulations or legislation that address exposure to loud sounds as a public health issue in order to bring about a sustained change in listening habits. 11 WHO-ITU H.870 Global standard on safe listening devices and systems The WHO-ITU Global standard (18) builds on recommendations made by the European Commission (19) and provides evidence-based guidance for promoting safe listening among users of personal audio systems. In principle, the WHO-ITU Global standard proposes ways in which the technology used for listening (personal audio systems) can become a part of the solution of the u nsafe listening challenge. The rapid emergence of sophisticated technology that can track behaviour and health status, and provide personalized feedback, can be implemented to promote safe listening practices, while continuing to provide an enjoyable experience to the listener. Smartphone technology, in which smart mobile devices are connected to powerful computational resources, can thus provide a platform to deliver targeted, customized, safe listening interventions in a timely enough way for maximum effect. Through the use of technology and the creation of targeted protective features, the WHO-ITU Global standard aims to create a safe environment around those who listen to music through personal devices. The protective features recommended by the WHO-ITU Global standard will, among other things, aim at limiting the intensity and duration of users’ exposure to loud music. However, since users can decide to overrule technology (e.g. by deactivating the protective features), the WHO-ITU Global standard also includes recommendations for integrating into the protective features an educational component aimed at helping users to track, interpret and learn from their behaviours. Based on behavioural change theory and models, for users it might be easier to adopt and sustain a safe listening behaviour if they receive information and cues on the types of behaviour that put them at risk, the potential consequences, and what to do about it. Developing the WHO-ITU Global standard The WHO-ITU Global standard is based on current evidence and is the result of collaboration over a period of 2 years with a wide-raging group of experts and stakeholders, including audiologists, academia, sound engineers, professional associations, manufacturers of devices and headsets, regulatory bodies working at global or European level, and members of thetarget age range (12–35 years). Convened alternately by WHO and ITU, this wide-ranging group has provided inputs and feedback to the text of the WHO-ITU Global standard. All background papers and evidence compiled is publicly available. Before entering into force, the WHO-ITU Global standard prepared by the group was posted online for additional comments and inputs from the 193 Member States of the International Telecommunication Union, as well as from its hundreds of sector members. 12 1 Pa2h: pascal squared hours is the unit used to measure sound energy. The WHO-ITU Global standard consists of two integral components: a technical specification and a communication/educational element. The two are closely linked and both must be implemented together in order to be effective. 1. Technical aspects addressed in the WHO-ITU Global standard: It is also recommended that the device allows the user to select their reference exposure as one of two modes: Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h1 per 7 days as the reference exposure (i.e. 80 dBA SPL for 40 hours per week). Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (i.e. 75 dBA SPL for 40 hours per week). The mode choice is given when using the player for the first time (or when the device is reset to factory settings) Mode choice can be changed at any later time, e.g. via a device settings menu. Volume limiting: This is a feature where by a volume-limiting message and option is automatically provided every time the user reaches 100% of their weekly allowance. The message should allow them the option to “continue listening” if they do not wish the device volume to reduce. When the message is not acknowledged, the default action will be to reduce the volume output to a pre-set level. If possible, users should be given the option to customize this level (the level at which they would like their device to limit the volume) according to their preference. The feature may also be used by individual users in order to limit their own sound exposure, if they wish to do so, by fixing the maximum output on their device. Parental control: It is recommended that the device should offer an option whereby maximum sound output can be fixed and locked in the settings, possibly through use of a password. This would allow parents (or other adults) to limit the maximum sound output of the child’s device in a way that cannot be changed by the child. Dosimetry: The WHO-ITU Global standard recommends that each device includes a system that tracks the user’s exposure time and estimates sound level and percentage used of a reference exposure (sound allowance) This acoustic dosimetry must include all media playback through the device (whether stored on the device or streamed) during times when the user is using earphones or headphones. (Voice calls are excluded as they are separately specified by other standards) Dosimetry The calculation and assessment of the amount of sound received by the ear, as compared to the reference exposure (or sound allowance) 13 2. Communication aspects addressed by the WHO-ITU Global standard: The WHO-ITU Global standard intends to provide users with information and guidance to enable them to make safe listening choices by tracking, interpreting and learning from their own behaviours. Such a component includes: – Personal usage information which is based on the tracking system mentioned in technical component. This will help the user to know: • their own listening habits (use of daily and weekly sound allowance); • how to use safe listening features of the specific devices. – Personalized recommendations and cues for actions for safe listening, customized based on each user’s listening profile. – General information on: • safe listening and ways to practice it; • the risk associated with unsafe listening; • the risk of hearing loss due to loud sounds from sources other than the personal audio system. Objective of the toolkit This toolkit aims to provide a practical guide on the implementation and follow-up of the WHO-ITU Global standard that should be used as the basis for regulations or legislation by all Member States, or adopted voluntary by manufacturers in order to protect users from noise-induced hearing loss. The WHO-ITU Global standard is designed to support countries, industries and civil society in approaching noise-induced hearing loss prevention in a strategic, evidence-based and user-friendly way. This toolkit is organised in three sections. Each section is targeted to a group whose action is essential to ensure that the WHO-ITU Global standard is adopted and users protected. This includes: • government, specifically the ministries and departments working in the field of health, technology, commerce, industry, consumer protection and any other department related to disability or accessibility issues; • industry, specifically manufacturers of personal audio systems; • civil society organizations working in the field of hearing or consumer rights. 14 Each section provides the rationale for the stakeholders to take action on safe listening; they list possibilities of how the WHO-ITU Global standard can be implemented or promoted by that particular group; and suggests tools for taking action. The processes, steps and tools are provided for guidance and can be adapted, translated or modified by stakeholders to suit the needs of individual countries and manufacturers. Implementation by governments 16 The section is intended as guidance for (among others): • public officials responsible for drafting policies, advising ministries, setting the priority agenda in the field of health, for example in adolescent health; education; technology; information and communication technology; telecommunication; as well as regulatory or standardization bodies; consumer protection agencies; and managers of hearing programmes or adolescent health within ministries of health; • officials responsible for school health or purchase of equipment within ministries of education; • officials in charge of accessibility issues within government departments. Rationale Hearing loss is increasing in all regions worldwide, posing a public health challenge that carries a significant financial cost. WHO estimates that unaddressed hearing loss costs the world approximately US$ 750 billion each year (in international dollars). Investment in hearing loss prevention can help governments save already-scarce resources. Ministries of education and of technology should advocate for and support hearing loss prevention, in part achieved through implementation of the WHO-ITU Global standard, to fulfil their mandates for protecting technology users in general and in particular children using technologies to learn. The increasing access to technology worldwide and its improper use is posing a huge challenge in this respect. To mitigate the associated risk, it is essential that people learn how to use technology properly so that its harmful impacts can be minimized. The WHO-ITU Global standard makes it possible to use technology interfaces as a platform for prevention of noise-induced hearing loss. Implementation by governments 17 What actions can governments take? Implementation of the WHO-ITU Global standard can be promoted through: 1. Legislation: The WHO-ITU Global standard should be integrated in regulations and legislation related to the manufacturing, importing and selling of personal audio devices. 2. Other policies: 3. Along with legislation and other policies to implement the WHO-ITU Global standard for safe listening devices, governments should launch a public awareness campaign to raise awareness on: • the risks posed by loud sounds, especially those experienced in recreational settings; • safe listening practices that can reduce the risk of hearing loss among listeners. a. Government regulation: The relevant government department (technology, health, consumer protection etc.) should define a mechanism to enforce such policies or regulations that ensure all personal audio devices and systems sold within its jurisdiction comply with the WHO-ITU Global standard and protect users from noise-induced hearing loss. b. Procurement policies: Government departments that regularly procure technologies on a big scale (through tenders and public procurement) should ensure that all devices procured by them are aligned with the WHO-ITU Global standard. In 2003, ITU defined an international standard for video compression (Recommendation ITU-T H.264), which has been widely adopted by industry. France developed a regulation and Brazil issued a presidential decree mandating the use of ITU-T H.264 for over the air broadcast services, resulting in benefits for end users: not only quality of images broadcasted over TV in these countries was significant improved, but also lower cost for the necessary set top box receivers. Where the department of technology has an advisory role and informs decisions made by other departments (concerning relevant devices), they should recommend the alignment of these procurement policies as per the features defined in the WHO-ITU Global standard. Public procurement has been used as a tool to further public policies in many fields and has the potential to deliver on societal goals (20). 18 Engaging partners All stakeholders in the field should be involved, including: • different government departments such as technology, health, education, commerce and industry; environment, youth; • civil society groups including associations of hard of hearing; NGOs, professional societies, • youth organizations; • manufacturers; • consumer electronics associations; • major retail groups; • consumer protection organizations; • others as may be relevant in the context of the country. Proposed steps A step-wise approach, as proposed below, is recommended to ensure the inclusion of the WHO-ITU Global standard in relevant policies and regulations. Step 1: Assessment and policy development a. Conduct a situation assessment: The initiating department should carry out a situation assessment in order to understand: • the safe listening features in the devices currently sold in the country; • current statistics on hearing loss in the country/region, especially hearing loss caused by loud sounds, if available; • existing policies related to hearing loss prevention, noise control and safe listening; who the main stakeholders are, including government departments, civil society groups, youth organizations, manufacturers. A format for conducting a situation assessment can be found in Appendix 1. b. Organize a planning consultation: Following the situation assessment, the initiating department/ministry should organize a meeting to plan for the implementation of the WHO-ITU Global standard and get a buy-in from all relevant stakeholders. This meeting should include all key stakeholders identified in step 1. During this meeting, results of the situation assessment should be presented, the WHO-ITU Global standard outlined, and further steps for its implementation proposed. An outline of stakeholders’ consultation is provided in Appendix 2. c. Develop the policy on safe listening devices: The initiating department should draft the legislation, policy or regulation and discuss it with the relevant ministerial/government departments. It should then be shared with stakeholders to get their feedback, which should be addressed prior to finalization and approval of the policy document. d. Determine ways and means for raising awareness among the target group: Along with development of the policy for safe listening devices, the initiating department should outline a strategy for raising awareness on safe listening and informing users about the new safe listening features proposed in the regulations. This should be done in consultation with relevant health professionals and communication experts. The country can make use of the validated WHO awareness materials that can be adapted and translated for use in the country. Step 2: Launch and communication a. Organize a sensitization workshop: Once the policy or legislation is finalized, a sensitization workshop should be held by the initiating department in collaboration with other departments involved. The purpose of such a workshop is to inform manufacturers and key retail groups of the rationale and intent of the regulations and to gain their support in their implementation. An outline of the workshop is provided as Appendix 4, for guidance. b. Undertake media outreach: A press announcement should be made to launch the new regulations. This should be accompanied by a media campaign through all channels relevant in the context of the country and the target group, e.g. social media, print media, digital media etc. Governments can launch these regulations on the World Hearing Day in order to maximize the advocacy effort. Step 3: Implementation and monitoring a. Monitor policy implementation: Implementation of the policy, regulation or legislation should be monitored by the government through established mechanisms. b. Undertake evaluation and revision: The policy, regulation or legislation and its implementation should be evaluated at regular pre-designated intervals (e.g. every 2 years). This evaluation should further be discussed with the stakeholders and revisions made, depending on the feedback received. 19 Additional actions Wherever possible, the government should make efforts to do the following: a. Monitor epidemiology of hearing loss: The relevant department in the Ministry of Health should regularly assess hearing loss prevalence in the target population through a population-based prevalence study. Such a study should ideally be done at the start of the initiative and repeated every 5 years. b. Carry out research: Relevant departments should assess the occurrence of hearing loss among users of personal audio devices. Tools the following tools are available to guide governments in application of the WHO-ITU Global standard: • Situation assessment/analysis tool (Appendix 1) • Format for stakeholders consultation (Appendix 2) • Introductory presentation with key messages (Appendix 3) • Format for sensitization workshop (Appendix 4) • Materials for raising awareness (Appendix 5) Planning: situation assessment, discussions,policy development, awareness raising Monitoring implementation: monitoring, evaluation, feedback, revision Supporting actions: assessment of hearing loss and listening behaviour outcomes Launching: sensitization workshop, media outreach 20 Implementation by industry partners The section is intended as guidance for: • Manufacturers of personal audio systems including: – Smartphones – MP3 players – Other devices with music playing capability – Headphones/earphones Rationale Investing in the hearing health of their customers makes good business sense for an industry that relies on considerably on its clients’ ability to hear. At present, the increasing use of technology is part of the threat to good hearing. The easy access to such technology without any information or education on safe listening practices is putting at risk the hearing of millions of young people across the world. With the growing penetration of technology, this challenge is likely to grow too, unless concrete steps are taken. At the same time, technology is being used successfully to raise awareness on various health issues and promote healthy lifestyles. This has led to an increasing number of health-related applications made available to users through certain devices. Following this approach, the appropriate use of technology can reduce the risk it poses to hearing. Hence, as part of risk mitigation and in line with principles of responsible business, manufacturers of personal audio devices must share the responsibility of promoting safe listening practices, and to offset any potential harm from the use of their products. This can be done by proper implementation of the WHO-ITU Global standard. Safe listening will reduce the risk posed to hearing and can potentially reduce the occurrence of hearing loss. What actions can manufacturers take? Manufacturers should take the following actions. • Lead the field of safe listening by voluntary implementation of the WHO-ITU Global standard by ensuring that the personal audio devices manufactured by them comply with: – requirements of the WHO-ITU Global standard; – optional features within the WHO-ITU Global standard. 22 Implementation by industry partners • Improve the accuracy of the ‘dose/allowance’ measurement by: – striving to improve the testing algorithm and minimize measurement errors; – ensuring that the algorithms are compatible with a large variety of commonly used headphones/earphones available in the market (including those manufactured by other companies). • Experiment with and create a user interface that is both appealing and informative. The user interface should: – present information on safe listening in an engaging manner that appeals to the user; – provide information on the user’s listening parameters and use of sound allowance in an easily understandable format; – provide access to reliable and validated sources of information on safe listening. Engaging partners All stakeholders in the field should be involved, including: • other manufacturers that have implemented the WHO-ITU Global standard; • retailers that sell devices manufactured by the company; • consumer groups, target group; • government: when applying for any government contracts, the manufacturers can highlight the safe listening features available in their devices; others as may be relevant. A complementary example is the case of digital subscriber line (DSL) technologies that enable broadband Internet access at homes. Amongst others, ITU-developed standard ITU-T G.993.1, which, while it was not mandated by governments, was selected by network operators in their procurement as the technology to enable data rates up 25 Mbit/s between their premises and a user's home. Beyond high speed Internet, this allowed network operators to simplify provisioning of the services and reduce costs. Equipment manufacturers could now bid for a larger number of contracts and offer units to end-users via retail channels. It benefitted users through reduced operation costs and allowing them to choose from a variety of equipment providers (knowing that interoperability was guaranteed). 23 Proposed steps Step 1: Planning a. Carry out an internal assessment: Manufacturers should assess the current state of play relating to safe listening features in the devices they manufacture different parts of the world. b. Download and understand the WHO-ITU Global standard: This can be found at https://itu.int/rec/T-REC-H.870. A summary outline is included in Appendix 6 of this document. Staff working on safety measures and acoustics in the company should read the full WHO-ITU Global standard and applicable references, and understand their implications. c. Discuss implementation: Hold internal discussions regarding the method of including the proposed safe listening features in devices and devise a complete implementation plan. Step 2: Development and testing of safe listening features a. Develop and test a user interface: The WHO-ITU Global standard provides guidance on what sort of information should be conveyed through the device interface. Wherever possible, manufacturers should research this aspect and develop a user-friendly interface for safe listening features, in line with the WHO-ITU Global standard. Where manufacturers cannot or do not wish to undertake such research, they can follow the suggestions provided in Appendix 7 b. Develop and test messages and cues for action: Such messages and instructions have to be included within the user interface. It is important to test these, taking into consideration cultural, linguistic and regional contexts. Where a manufacturer is unable to or does not wish to engage in developing and testing an interface and messages, they could adopt the examples outlined within the tools (see Appendix 7 and Appendix 8) c. Check that your device conforms to the WHO-ITU Global standard: Once the H.870 safe listening specifications are implemented in your company’s products, they should be tested for compliance using a pre-established conformance assessment plan. Step 3: Publicizing and promoting a. Inform and train retailers: Once products that implement the WHO-ITU Global standard are available, retailers should be informed about these features and trained to promote them. b. Popularize the safe listening features of your device: Wherever possible, advertisements and websites should highlight the safe listening features, which will help raise awareness on safe listening and highlight the company’s responsible attitude towards its consumers. 24 Planning: situation assessment, understanding the standards, internal discussions Publicizing and promoting: informing retailers, advertisements, websites Review and revision: feedback, updates, revisions Development and testing: user interface, messages, compliance testing Step 4: Reviewing and revision a. Gather feedback from users: Manufacturers should regularly seek feedback from users regarding the relevance, user friendliness and clarity of safe listening features in their devices. b. Undertake revisions and improvements: The user interface and messaging should be revised periodically based on user feedback. c. Keep up to date with the latest version of the WHO-ITU Global standard: Manufacturers should revise the features as and when the WHO-ITU Global standard is revised. Tools The following tools are available to guide manufacturers in application of the WHO-ITU Global standard: • Summary of the WHO-ITU Global standard (Appendix 6) • Example of information flow (Appendix 7) • Key considerations when developing messages and generic examples (Appendix 8) • List of information sources (Appendix 5) 25 26 Role of civil society The section is intended as guidance for professional associations and civil society organizations and groups working on: • hearing loss prevention; • noise control • consumer rights. Rationale Exposure to loud sounds is a key contributor to preventable hearing loss. It is estimated that 50% of people using personal audio systems do so in a way that puts their hearing at risk. Implementation the WHO-ITU Global standard can promote safe listening behaviours and reduce the risk personal audio systems pose to hearing. Civil society partners should advocate with policy makers for their implementation as a means to prevent hearing loss. What actions can civil society organizations take? Civil society organizations should undertake the following actions: • Advocacy work to persuade governments to develop regulations to implement the WHO-ITU Global standard. • Awareness campaigns to sensitize people regarding hearing loss prevention and safe listening. • Sensitization of manufacturers of devices to motivate them to voluntarily implement the WHO-ITU Global standard in the products they sell. Engaging partners All stakeholders in the field should be involved, including: • Other organizations working in the field of hearing loss prevention, noise control and consumer protection. • Departments of health, education and technology. • Local schools. • Media. • Corporate social responsibility (CSR) departments of manufacturing organizations. • Others that may be considered relevant. 28 Role of civil society Proposed steps Step 1: Plan: a. Identify and brainstorm with other stakeholders to plan actions. b. Determine the target audience they will address e.g. policy makers, manufacturers, schools and universities, the community at large, others. c. Identify the key messages to convey to these audiences and the impact they want to have (e.g. policy development by government; implementation of safe listening features by manufacturers; use of safe listening apps by young people etc.). d. Establish what would be the most effective strategy to convey these messages e.g. through a meeting, media event, awareness sessions etc. Step 2: Prepare a. Review and adapt the WHO advocacy and awareness resources on safe listening to the local context and translate, if required. b. Review other available materials on safe listening. c. Finalize the resources and materials to be used. Step 3: Advocate with the target group identified through available means. This could include: a. Media outreach; b. Social media; c. Websites; d. Webcasts; e. Workshops on safe listening in schools and universities; f. Public events. Step 4: Follow up with the target group and monitor outcomes and impact in terms of: a. Policies established or actions initiated by governments; b. Implementation of safe listening features by manufacturers; c. Use of safe listening applications/features by users of personal audio devices; d. Change in listening habits of users. 29 Tools The following tools are available to guide civil society organizations in promoting the WHO-ITU Global standard: • Awareness-raising materials for policy makers and the general population (Appendix 5) • Social media materials (Appendix 5); • Resources for school-based workshops on safe listening (Appendix 9). Planning: identify stakeholders, brainstorming, determine target audience, identify key messages, strategize Advocate: with the target group Follow up and monitor outcomes Prepare: review and adapt available advocacy materials 30 References and Bibliography References 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva: World Health Organization; 2017 2. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload /noiseprevention.pdf, accessed 21 November 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012;39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008;123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002;65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007;77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018;144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013;173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 2018;Apr 13. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013;No v;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Rev Panam Salud Publica. 2014 Oct;36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recommendation ITU-T H.870. Guidelines for safe listening devices/systems. 2018 (https://itu.int/rec/T-REC-H.870, accessed 15 January 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014;14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017;30. 10.1108/IJPSM-03-2017-0066 32 References 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva: World Health Organization; 2017 2. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload /noiseprevention.pdf, accessed 21 November 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012;39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008;123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002;65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007;77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018;144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013;173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 2018;Apr 13. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013;No v;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Rev Panam Salud Publica. 2014 Oct;36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recommendation ITU-T H.870. Guidelines for safe listening devices/systems. 2018 (https://itu.int/rec/T-REC-H.870, accessed 15 January 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014;14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017;30. 10.1108/IJPSM-03-2017-0066 33 34 Bibliography Arenas J, Suter A. Comparison of occupational noise legislation in the Americas: An overview and analysis. Noise and Health. 2014;16(72), 306–319 Berglund B, Lindvall T, Schwela DH. Guidelines for community noise. Geneva: World Health Organization; 1999. Consumers: EU acts to limit health risks from exposure to noise from personal music players [Press release]. Brussels; European Commission: February 19 2018 (http://europa.eu/rapid/press-release_IP-09-1364_en.htm, accessed 24 August 2018). Gurgel RK, Ward PD, Schwartz S, Norton MC, Foster NL, Tschanz JT. Relationship of hearing loss and dementia: a prospective, population-based study. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2014;35(5):775–781 Joy G, Middendorf P. Noise exposure and hearing conservation in U.S. coal mines – a surveillance report. Journal of Occupational and Environmental Hygiene. 2007;4(1), 26 Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics. 2010;125(6):e1348−55 Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies,http://www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-conti nues-to-climb-in-emerging-economies/2016 Tikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S. Interventions to prevent occupational noise‐induced hearing loss. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD006396. DOI: 10.1002/14651858.CD006396.pub4 Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017;390(10098):934 Appendices 36 Appendix 1 This situation assessment tool has been developed to help governmental departments and ministries gather relevant information to prevent unsafe listening, and to promote and regulate safe listening practices in their country under the WHO-ITU H.870 Global standard on safe listening devices and systems. Information to complete this assessment can be obtained from existing peerreviewed literature, World Health Organization (WHO) statistics, national statistics, and Ministry of Health documents. Technical assistance in conducting a situation assessment or using the results is available from WHO. [Country name] National data profile compiled by: National Data Coordinator Name of the person in charge of this Situation assessment Designation and qualification Institution Address Email Telephone numbers Respondent’s details (this form can be duplicated for each person interviewed) Name Position/Title Institution Email Telephone numbers Fax Situation assessment tool 37 Population profile Name of the area (state, region, province, district) (if relevant) for which this situation assesment is being undertaken Total number of mobile device users in the country/area Total number of mobile device users between the ages of 12 and 35 years Total number of smartphone users in the country/area Total number of smartphone users between the ages of 12 and 35 years Sex distribution of mobile device users (%) Male: % Female:% % Rural-urban distribution of mobile device users (%) Rural:% Urban:% Literacy rate among mobile device users (as a % of total population) Any other population-related factor that needs to be considered in mobile device services Area: State: (optional) Region: (optional) Province: (optional) District: (optional) Section A. General country information Mobile device usage Languages used by mobile device users Total number of personal audio devices sold in the country/area: Number of smartphones sold: Number of MP3 players: Number of other related devices (personal audio players) % of population/area reached by internet services:% Number of companies that sell personal audio devices in the country/area Name of mobile device brands sold in your country [] Samsung [] Motorola [] Apple [] Alcatel [] Sony [] Nokia [] Huawei [] Google [] LG [] Other (please specify): Names of leading retailers that sell mobile devices in the country/area What is the percentage of people with disabling hearing loss due to noise-induced hearing loss and other relevant causes? Overall:% Age group 12 to 35 years:% Any other age group (as reported in literature):% Names Names of leading mobile phone service providers that operate in the country/area Names Hearing loss Prevalence of disabling hearing loss: Overall:% Age group 12 to 35 years:% Any other age group (as reported in literature): % If information on disabling hearing loss is not available, indicate the definition used in estimation of prevalence: 38 39 Lead agency profile Coordination Legislation Other (please specify) Monitoring and evaluation Is there a government agency or department that takes responsibility for overseeing and/or coordinating hearing care activities/plans (i.e. a lead agency) in your country? Where is this agency located within the government structure (please tick one)? The agency is a single government ministry/department, or situated within one government ministry/department (please specify ministry and department, if relevant) [] Stand-alone entity [] Other (please specify) [] Don’t know For which of the following functions is the lead agency responsible? (please tick all that apply) [] Yes [] No [] Don’t know Is funding allocated in the government’s budget for the lead agency to carry out the functions listed above? [] Yes (please name this agency) [] No (please skip to Section B) [] Don't know (please skip to Section B) [] Coordination of intergovernmental working processes at central government level [] Coordination of hearing care decision-making across central government [] Coordination across different levels of government (e.g. central, regional, local) [] Coordination of national mass media initiatives [] Establishing and supporting data systems that are used to monitor safe listening devices [] Compilation and dissemination of national statistics [] Periodic review of legislation, rules and standards against best practice, and recommendations for improvement [] Development and/or revision of legislation Section B. Leadership and governance 40 Section C. Strategy and targets National strategy profile Is there a national strategy for deafness and hearing loss prevention in your country? If yes, does this strategy include prevention of recreational noise-induced hearing loss? Is there a regulation regarding safe listening features in personal audio devices? If answer to any of the above is yes, do any strategies that exist include volume regulations on personal audio devices such as mobile phones, mp3 players, tablets, etc? Is there an awareness programme regarding noise control in environmental/recreational settings? If yes, does the awareness programme include a focus on safe listening? Are funds available to implement part or all of any strategies that exist? If a national strategy exists, does it set measurable targets to increase the number of personal music players with safe listening features? [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please submit relevant source documents) [] No [] Don't know [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please submit relevant source documents) [] No [] Don't know [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please provide details/source documents as annex) [] No [] Don't know [] Yes [] No [] Don’t know If yes, please provide the targets and their timeframes: • Device targeted increase: • Time period relating to device target (please specify start and end years that these targets relate to, e.g. (2002–2012) (2016-2020) [] Yes, fully funded [] Partially funded [] Not funded [] Don’t know Does the national strategy include recommendations for any of the following: Reducing volume level [] Yes [] No [] Don’t know Allowing users to keep track of their sound usage [] Yes [] No [] Don't know Showing messages to the user when reaching unsafe volume levels [] Yes [] No [] Don’t know Showing messages about safe listening practices [] Yes [] No [] Don't know Encouraging the use of earplugs in loud environments such as bars, sporting events and concerts [] Yes [] No [] Don't know 41 42 Please mention all potential and existing stakeholders in your country that are or could be involved in ear and hearing care services. Identify the lead or responsible position or person, where possible, and give contact details. Stakeholder profile Government departments List in order of perceived priority for collaboration in developing and implementing a safe listening strategy Name of Department Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Section D. Stakeholder analysis 43 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Professionals and academics List in order of experience and interest in the development and implementation of the safe listening strategy Name of Institute or association 44 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Name of Institute or association Civil society groups, including disabled persons’ organizations List in order of perceived priority for collaboration in developing and implementing the safe listening strategy 45 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Name of agency UN agencies 46 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Industry partners List in order of perceived priority, based on need for collaboration and possible interest of the stakeholder, in developing and implementing the Safe Listening strategy Name of Company 47 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Any others (can include any other groups that are interested in hearing loss prevention, noise control, audiology, acoustics or consumer rights) 48 Appendix 2 Outline of stakeholders planning meeting for regulations on safe listening The following stakeholder groups should be invited to the meeting: • Relevant government departments: technology, health, education, commerce and industry, environment, youth • Civil society groups including associations of hard of hearing; ngos, professional societies • Youth organizations • All manufacturers • Consumer electronics associations • Major retail groups • Consumer protection organizations • WHO and ITU representatives Purpose: • To inform stakeholders about the global standards and the country’s intention to implement them • To gain buy-in from relevant stakeholders in this respect • To discuss the way forward regarding adoption of standards and their implementation • To agree on timelines • To discuss customization and adaptation of the awareness materials The following outline is suggested: • Introductions • Need for safe listening • Current status in the country regarding regulations on safe listening • Global standards for safe listening • Perspectives required to implement safe listening strategies and regulations: – Government (Technology, health, any other) – Users (one representative to present user view) – Industry (umbrella organization or a company with leadership in this field to speak on behalf of industry) – Hearing care profession (one member from a professional, hearing-related organization to speak) – Civil society view (one speaker from a relevant civil society group to speak) • Possibilities regarding adoption and implementation of the Standard in the country (including timelines): discussion • Need for raising awareness and available tools • Determining the next steps for: – developing a regulation/legislation; – developing an awareness campaign and adapting awareness materials. WHO estimates that 1.1 billion young people worldwide could be at risk of hearing loss as a result of unsafe listening practices. Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD, Finucane M. Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries. Eur J Public Health 2013; 23: 146-52 (http://dx.doi.org/10.1093/eurpub/ckr176, accessed 19 January 2019). Hearing loss is on the rise! Overarching messages • Rise and ageing of the global population • 466 million people globally are currently living with disabling hearing loss • 630 million people estimated to be living with disabling hearing loss by 2030 • Over 900 million estimated to be living with disabling hearing loss by 2050 How do we hear? Appendix 3 Make listening safe initiative: Introductory presentation 49 Recreational noise, unsafe listening practices and the impact of hearing loss • Those exposed to loud sounds in social settings over the past 20 years are over three times more at risk of hearing loss compared to those unexposed. • 50% of people listening to music over their personal audio devices do so at levels which put their hearing at risk. • 5–10% of listeners are likely to develop hearing loss due to their personal volume preferences and duration of listening. • Depression, isolation, frustration, cognitive decline and decreased personal safety are twice as common among seniors with hearing loss than those without hearing loss. Noise-induced hearing loss is irreversible Photos from top to bottom by Thibault Trillet, Kevin Grieve, Simon Matzinger, Adobe PhotoStock. 50 Make listening safe initiative Smartphone technology can  provide a platform to  deliver targeted, customized safe listening interventions while continuing to provide an enjoyable experience to the listener. Technical aspects Acoustic dosimetry • Tracking users’ exposure time to sound • Estimating sound level • Estimating % used of a reference exposure, or sound allowance • Mode 1: (WHO) standard level for adults: 85 dBA SPL for 40 hours per week • Mode 2: (WHO) standard level for sensitive users (e.g. children): 80 dBA SPL for 40 hours per week Prevention This means creating an environment that enables the exercise of safe listening practices, including through: • Regulating exposure to loud sounds through personal audio systems.  • Undertaking public awareness campaigns to change listening behaviours among people aged 12 to 35 years. • Developing a regulatory framework for safe listening in recreational settings.  WHO-ITU H.870 Global standards for safe listening devices and systems 51 Volume limiting • Volume limiting message • "Continue listening" option • Default action: to reduce the volume output to a predetermined level • Customizing option Parental control  • Maximum sound output can be fixed and locked in the device’s settings Make listening safe toolkit Practical guide for implementation and follow-up of global safe listening standards in recreational settings to be adopted by all countries worldwide • Designed to support countries, industries and civil society in approaching noise-induced hearing loss prevention in a strategic, evidence-based and user-friendly way. • Targets three key stakeholders that can be instrumental in implementing the standards • Government: ministries/departments working in the field of health or technology • Industry: manufacturers of personal audio devices and systems • Civil society organizations: field of hearing or consumer rights The processes, steps and tools are provided for guidance and can be adapted, translated or modified by stakeholders to suit the needs of individual countries and manufacturers.   Personal usage information • Listening habits, including sound allowance • How to use safe listening features  Personalized recommendations and cues • Actions for safe listening • Customized advice based on user's listening profile General information • Safe listening and ways to practice it   • Risk associated with unsafe listening • Risk of hearing loss due to loud sounds from sources other than personal audio devices and systems Communication aspects 52 53 Appendix 4 Outline of sensitization workshop for regulations on safe listening The following groups should be invited to participate in the workshop: • Relevant government departments: technology, health, education, commerce and industry, environment, youth • All manufacturers • Consumer electronics associations • Major retail groups Purpose: To sensitize manufacturers and retailers regarding regulations on safe listening devices and to to guide them regarding implementation, timelines and reporting. The following outline is suggested: • Introductions • Rationale for safe listening standards • Outline of national regulations on standards: essential and optional components • Timelines for implementation • Monitoring/reporting mechanism on implementation • Manufacturers’ issues and concerns • Awareness materials that can be used for by manufacturers for distribution, social media and websites 54 Appendix 5 Advocacy materials Goal These awareness materials are designed to inform people about the risk of hearing loss due to unsafe listening; the concept of safe listening; and available tools to promote its practice. Who are these materials for? These evidence-based advocacy materials are intended to provide key stakeholders (government, industry and civil society organizations) with tools to raise awareness among policymakers and the public about safe listening. Advocacy materials WHO’s resources to promote safe listening are available at: www.who.int/deafness/make-listening-safe/advocacy-materials/en/ Communication objectives • Raise awareness and engage the public on the importance of safe listening practices. • Create a conversation on the risk of hearing loss due to loud sounds from sources such as personal audio systems and mobile devices. • Raise awareness about the risks of unsafe listening practices among teenagers and young adults. • Build an understanding of the importance of multisectoral engagement and action for implementing the WHO-ITU H.870 Global standard for safe listening devices and systems. • Promote examples of good multisectoral engagement leading to successful interventions that have addressed the issue of exposure to loud sounds in recreational settings. Overarching messages • Noise-induced hearing loss is irreversible! • Prevention is one of the most effective strategies to reduce the occurrence of noise-induced hearing loss. • Keeping the volume within safe levels and limiting the time spent engaged in noisy activities can reduce the risk of hearing loss. • Smartphone technology can be used as a means to promote and practice safe listening.  • The design and implementation of specific legislation can lead to a lower level of sound exposure 55 Infographic Share information and materials on social media Our social media channels • Follow us on Twitter, Facebook and Instagram @WHO and tag us in your posts Twitter official hashtag • #SafeListening Twitter official hashtag • #WHO • #HearingCare • #HearTheFuture • #WorldHearingDay 56 Poster 57 Brochure Tips for safe listening 58 Press release Related document 59 Videos Facebook posts Instagram posts 60 Tweets 61 FAQs 1. Introduction 2. How is loudness measured? What is dB? 3. What is safe listening? 4. How do loud sounds affect my ears? 5. How can I tell if my hearing has been affected? 6. Once I have lost my hearing can I get it back? 7. Is there a way to use a mobile phone to monitor my listening levels? 8. How can I monitor sound exposure or daily allowance for music that is not stored on my device? 9. What can I do to make my listening safe? 10. What can I do as a parent to ensure safe listening? 11. What can I do as a teacher to ensure safe listening? 12. What can I do as a physician to ensure safe listening? 13. What can I do as a manager of an entertainment venue to ensure safe listening? 14. What can I do as a manufacturer of personal audio devices to ensure safe listening? 15. What can governments do to ensure safe listening? Relevant websites • World Health Organization (WHO) http://www.who.int/deafness/make-listening-safe/en/ • Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/hearingloss/default.html • Action on Hearing Loss https://www.actiononhearingloss.org.uk/ • European Union of the Deaf https://www.eud.eu/ • Hear The World Foundation https://www.hear-the-world.com/en • American Speech Language Hearing Association – Listen To Your Buds campaign https://www.asha.org/buds/ • Dangerous Decibels http://dangerousdecibels.org/ Media interest If you are a journalist interested in covering issues related to the Make Listening Safe initiative please email us at whopbd@who.int 62 2 The full text of the H.870 Guidelines for safe listening devices/systems is available at https://www.itu.int/rec/T- REC-H.870-201808-I/en Appendix 6 Summary of WHO–ITU global standard H.870 for safe listening devices and systems Safe listening refers to listening behaviour that does not put a person’s hearing at risk. The risk of hearing loss depends on the level (loudness), duration (time period) and frequency of exposure to loud sounds. Such exposure may be through personal audio devices, in entertainment venues, or outside (for example in traffic), in the workplace, or at home. The WHO–ITU H.870 standard describes requirements for personal and portable audio systems, especially those for playing music, with the aim of protecting people from developing hearing loss as a result of their use. It provides a glossary for common terms to help understanding, as well as background information on sound, hearing and hearing loss. The Standard recommends criteria for avoiding unsafe listening: one for adults and the other for children, both based on the equal energy principle. Importantly, the Standard provides guidelines on health communication for safe-listening so that appropriate warning messages can be delivered effectively when necessary. Examples of such messages can be found in the Standard’s Appendix VII. Finally, the Standard also provides information about implementation of dosimetry and related issues. The key aspects of the WHO–ITU H.870 standard for safe listening devices/systems are summarized below. 63 1. Scope of the standard This document describes requirements for personal/portable audio systems, especially those used for playing music, in order to reduce the risk of hearing loss posed to the users of these devices. Figure 6.1: Architecture of a personal audio system In such devices, “source” can be either stored or retrieved remotely, e.g., streaming from a local server or the Internet (see Figure 6.1) A PAS is intended for use by an ordinary person and; • is designed to allow the user to listen to audio or audiovisual content / material; and • uses a listening device, such as headphones or earphones that can be worn in or on or around the ears; and • has a player that can be body worn (of a size suitable to be carried in a clothing pocket) and is intended for the user to walk around with while in continuous use (for example, on a street, in a subway, at an airport, etc.) Examples are portable CD players, MP3 audio players, mobile phones with MP3 type features, PDAs or similar equipment. For the purposes of this Standard, the following types of devices are excluded: • Communication devices (walkie-talkies, etc.) • Rehabilitative and medical devices (e.g. hearing aids, FM systems, and other assistive listening devices (ALD) approved as part of hearing aids and cochlear implants systems, etc.) • Personal sound amplification devices • Professional audio equipment and devices • Portable game consoles Personal Audio Device Personal Audio System Listening Device Effect Effect Volume ControlSource DAC Transducer 64 2. Equal energy principle The recommendations of this Standard are based on the equal energy principle. This is the assumption that the total effect of sound on ear and hearing is proportional to the total amount of sound energy received by the ear, irrespective of the distribution of that energy in time. According to this principle, equal amounts of sound energy is expected to cause equal amounts of sound induced permanent threshold shift regardless of the distribution of the energy across time. In practical terms this implies that listening to lower volumes for long periods of time can have the same impact as listening to very loud volumes for a short duration e.g. listening to a 100 dB sound for 16 minutes will have the same impact as listening to an 80 dB sound for 40 hours. Based on this principle, “dose” of sound energy is defined as the squared A-weighted sound pressure, , integrated over the exposure time Mathematically, this is expressed as: Where is the A-weighted and diffuse-field corrected sound pressure. The unit of this value is Pascal squared hours, or Pa2 h. 3. Reference exposure/sound allowance, operational modes It is recommended that each device includes a system that tracks the user’s exposure time and loudness level, and estimates the percentage used of a reference exposure (also referred to as sound allowance) This must take account of all media played through the device (i.e. whether it is stored on the device itself, or streamed) during times when the user is using ear/headphones. Voice calls may be excluded as they are separately specified by other standards. It is also recommended that the device allow the user to select their reference exposure as one of two operational modes: Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h per 7 days as the reference exposure (derived from 80dBA for 40 hours a week) Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (derived from 75dB for 40 hours a week) The user should be allowed to select either of the two modes when using the player for the first time (or when the device is reset to factory settings). It should be possible for the user to change the mode choice at a later time, e.g. via a device settings menu. 65 Sound allowance Refers to a dose estimate of sound exposure over a certain rolling period of time (e.g., daily or weekly), commonly expressed as a percentage of the reference exposure. A 100% weekly sound allowance is equivalent to the weekly reference exposure, based on the mode selected. Examples of weekly listening time duration based on sound allowance for the modes described earlier can be found in Table 1 and Table 2. Table 1: Example of weekly listening Table 2: Example of weekly listening dB(A) SPL Weekly (1.6 Pa h )2 4.5 minutes107 104 101 98 95 92 89 86 83 80 9.5 minutes 37.5 minutes 75 minutes 2.5 hours 5 hours 10 hours 20 hours 20 hours 40 hours dB(A) SPL Weekly (0.51 Pa h )2 107 104 101 98 95 92 89 86 83 80 24 minutes 12 minutes 6 minutes 3 minutes 1.5 minutes 48 minutes 6 hours 24 minutes 3 hours 15 minutes 1 hours 36 minutes 12 hours 30 minutes 77 25 hours 75 40 hours time for Mode 1 time for Mode 2 66 4. Measurement methods/acoustic dosimetry Standard H.870 defines dose in the context of acoustic audiometry. Under mode 1, 1.6 Pa2h constitutes 100% weekly sound allowance, corresponding to 100% calculated sound dose (CSD) as defined in [EN 50332-3]. For mode 2, 0.51 Pa2h is the total weekly sound allowance or reference exposure. Standard H.870 also refers to other related standards that describe a dose measurement system in a portable music player (PMP). [IEC 61252] describes acoustic dosimeters to be worn on the body including [EN 50332-1], [EN 50332-2] and [EN 50332-3]. Appendix II of H.870 gives an example of how a dosimeter can be implemented in a personal audio system when measuring the digital media signal and considering known or assumed properties of headphones. It is based on the equal energy principle in hearing loss risk assessment, where the squared A-weighted sound pressure, integrated over the exposure time, constitutes the dose. The dosimeter functionality is tested by playing the programme simulation sound according to [EN 50332-1] and [IEC 60268-1] and measuring the time until the dose estimate reaches 100% CSD, using interpolation and tolerances as described in [EN 50332-3]. Such testing may be performed in the acoustic domain (when a certain headset is used) or in the electrical domain using a 32 Ω resistive load (when the headset characteristics are unknown). See measurement setup information in [ITU-T P.381]. Uncertainties: In estimating sound dose there are a number of sources for uncertainties and margin of error can be very high. It is therefore suggested to refrain from signalling “safe” and “green” to the user based on dose readings below a certain limit. The dose estimation is however relevant in accounting for the general trends: • Higher signal level means higher risk • Longer exposure means higher risk • The spectral content of the music is accounted for 67 Refers to the hardware components (such as screen) that allows a human being to interact with an electronic device. 5. Health communication A key aspect of the Standard is to provide user with a tool that will allow them to monitor their own personal sound exposure. Such a tool should give users the choice of safe listening, and empower them to make informed choices for listening through greater awareness. This section of the Standard summary outlines its health communication aspects that should be applied for complete implementation of standards for safe listening devices. Specifically, it presents evidence-based recommendations on how to communicate the risks of unsafe listening and support users in adopting appropriate behaviour in this respect. Purpose of including health communication as part of the standards for safe listening personal audio systems The intent is to provide users with information and guidance to enable them to make safe listening choices. These include providing: • Personal usage information, in order for the user to know: – their own listening habits (use of daily and weekly sound allowance); – how to use safe listening features of the specific devices. • Personalized recommendations and cues for actions for safe listening, customized based on each user’s listening profile. • General information on: – safe listening and ways to practice it; – the risk associated with unsafe listening; – the risk of hearing loss due to loud sounds from sources other than the personal audio system. This information and guidance must be shared by default with users via their mobile devices in order to reduce the risk of hearing loss. Key recommendations for communication as part of safe listening devices Information and messages on safe listening must be provided through: • the device interface3 (wherever an appropriate visual interface is available); • instruction manuals; • when possible, information about the safe listening features of the device should be included on or in the packaging. 68 6.1 Information delivered through device interface Personal usage information Information regarding various listening parameters defining the users’ listening habits should be accessible to users in order to allow them to keep track of their exposure to sound through the device. For devices with a screen, this could be through an icon on the screen. Through the icon, the user should be able to see their use of daily/weekly sound allowance in an easy to understand presentation, e.g. the person may be able to view how much of the weekly sound allowance has been used and to see how their listening behaviour has been over the past seven days. In devices without screen, the information should be made available through alternate means, such as audio cues. The device (when capable) should display: • the average sound level for the day and week; • the time for which the user has listened in hours and minutes over the day and the week. Figure 6.2 gives a non-normative example of information provided on a smartphone visual interface for safe listening Figure 6.2: Examples of information provided on a smartphone visual interface for safe listening Todays security allowance Sound track #5 Disclosure 51.6% Time left: 01:14:17 Today’ Listening time: 37 min Average dB level (leg) : 93.3 dB 90 80 70 60 50 40 30 20 10 0 52% Todays security allowance 52% Todays security allowance Sound track #5 Disclosure 119.5% Time left: 00:00:00 Today’ Listening time: 1.80 h Average dB level (leg) : 93.5 dB 90 80 70 60 50 40 30 20 10 0 120% Todays security allowance 120% 69 Personalized recommendations and cues for actions and messages: a.The device should give relevant warnings and cues for actions when the user exceeds 100% of the weekly allowance. • The user will receive first a “warning” expressed through text and visuals informing that a threshold has been reached and that from this point on, further listening at the same volume will pose a hearing risk. • The warning will be followed by a “cue for action” in which the user is offered the choice to either accept the risk of continued listening or protect their hearing. The “cue for action” should be linked to active options on the device, such as: – automatic safe volume option, by which the device automatically changes the volume to a safe volume level; – direct access to volume settings; – set up of default volume limits; – “remind me later” option; – “ignore and continue” option. • If the user fails to take any action, the volume will automatically be reduced to below the standard level (80 or 75 dBA as selected). b.The device should provide relevant messages when the sound allowance usage reaches certain pre-determined levels. Refer to Appendix 8 for the suggested levels at which warnings/cues can be given and sample content. Such warnings depend on the device’s capability and should be multimodal, e.g. a mix of visual, vibratory or audible warnings, in order to ensure that the user’s attention can be directed towards these.Figure 6.3 gives non-normative examples of messaging displayed in a smart watch. Figure 6.3: Example of messaging displayed in a smart watch 50% of daily allowance: you have spent 50% of your safe listening allowance for the day. keep the volume low to listen longer. SAFELISTEN Hey! Your last sound dose was 60%. Well done! Keep listening safely. SAFELISTEN Daily messages: the device should provide a daily summary message based on the user’s listening behaviour in recent days, encouraging safe listening habits and discouraging or warning against unsafe listening habits. Examples of such messages are provided in Appendix 8 General information: when the device has a screen, information on what is safe listening and its benefits – as well as the risks posed by unsafe listening – should be displayed on the screen. It is recommended that the availability of this information be indicated on the user interface (home screen) through a distinct and recognizable icon. Figure 6.4 gives a non-normative example of a safe listening icon displayed on a smartphone screen. How does loud music affect my ears? What is safe listening? How can I make listening safe on my device? No, thanks. Play my music Safe listen What are first signs of hearing damage? What does hearing loss sound like? Hearing damage may not be noticeable initially. At first you may only have trouble hearing high-pitched sounds like bells or experience persistent tinnitus. Find out here. Centres for disease control and prevention Hear the word Information What is safe listening? OK, thanks. Play my music Figure 6.5: Examples of screens linking to information on safe listening and external links Figure 6.4: Safe listening icon displayed on a smartphone screen There should be a tutorial informing users about safe listening; the risks of unsafe listening; and the device’s safe listening features and how to use them. The screens should also include links to relevant webpages where the user can find more information. Figure 6.5 gives non-normative examples of screens linking to information on safe listening and external links. 70 71 6.2 Information delivered by means other than the device itself User manual The user manual should clearly state that unsafe listening practices using the device pose the risk of permanent hearing loss. It should also give details of the volume-limiting functions and cues for action. The user manual should also clearly outline how the allowance-assessment system works and refer to its uncertainty. It should indicate that information on the device does not take into account additional sources of sound exposures either from other audio devices or environmental sound exposure. The manual could also provide information regarding hearing protections from loud environmental sounds in order to minimize the risk of hearing loss. Packaging Wherever possible, a clear, concise message or warning should included on the external packaging of the device. It is recommended that such a warning/message be: • concise, simple and clear; • accompanied by a relevant illustration; • positioned on a plain background. Website and advertising Information on safe listening should be included on the manufacturer’s website. Such information should be aligned to the specifications in Standard H.870. A link to WHO website and other relevant, reputable websites could be included. Wherever possible, advertising of products could also provide relevant information. Such information can refer to both the potential harm to hearing through improper use of their device and the advantages of listening safely in order to maintain healthy hearing while enjoying a good listening experience. 7. Volume control Volume limiting: as per Standard H.870, the device should provide the user with a suitable method for volume-limiting. This refers to a feature where a message will be given before or when the user reaches 100% of the weekly allowance, offering them the option to “continue listening”, if they do not wish the device volume to reduce. When the message is not acknowledged, the default action will be to reduce the volume output to the predetermined level. If possible, users should be given the option to customize this level (the level at which they would like their device to limit the volume) according to their preference. Parental control: it is recommended that the device should have the option whereby the maximum sound output can be fixed and locked in the settings, possibly through use of a password. The purpose of this feature is to allow parents (or other adults) to limit the maximum sound output of the child’s device, in a way that cannot be changed by the child. The feature can also be used by individual users in order to limit their own sound exposure, by fixing the maximum output on their device. 72 73 Packaging •A clear, concise message/warning should be included on the external packaging of the devices, wherever possible. •Messages should appear on a plain background and be short, simple, and clear, with a relevant illustration. •The manual should clearly state that unsafe listening via the device may pose the risk of permanent hearing loss. •It should indicate that the device is equipped with safety features to help users protect their hearing. •This message should align with information provided through the device interface. It should contain similar text regarding the risks of hearing loss from unsafe listening and the recommendations for safe listening. •It should also detail the safe listening features within the device. •A visible icon on the device screen will direct users to the general information on safe listening. •This icon will also lead the user to a display (in devices with screens) which provides information regarding individuals' listening parameters and (daily and weekly) usage statistics. •The first use of ear/headphones with the device should direct the user to a tutorial with information on safe listening, how to practice it, and their personal listening profile (same information as available through the icon). •It will describe the standard levels for adults and children and allow the user to select a level. •Users will be given the option to set up how often and at what levels of usage they wish to receive the notifications. • The information on the daily/weekly sound allowance consumption is available to users at any time through the distinctive icon above mentioned. • Calculation should include all sounds played through the music players or online, as long as ear/headphones are used. • The displayed information should include: weekly allowance used and remaining; listening time (for the day/week), and indicate how the user's listening has been for the past 7 days, including current day, where possible. •Warnings and cues for action shall be delivered every time the user reaches 100% of the allowance exposure levels and also as per settings customized by the user. •These should be visual (where possible) and audible/vibratory to ensure that the user's attention be directed towards these. •The notifications should include information on the level of audio usage and the corresponding recommendations for safe listening. •The first time a user connects to an ear/headphones or starts playing music on a given day, the device could give a welcome message based on the usage on the previous days/week. User manual Device interface 1st use Personal Usage Notications Daily alerts Appendix 7 This section and the figure below contains suggested steps for explaining how the communication aspects of the standard can be implemented within devices Figure 7.1: Flow of information as part of standards for safe listening devices Example of information flow Example of how the information on listening parameters can be conveyed to users Through a clearly recognisable icon, users should be able to access a “dedicated space” (screen) on the device where information on the user’s listening habits is stored, visualized and interpreted. In this space, the user should be able to access a graphic representation of his/her overall listening habits or patterns and learn if (and what type of) unsafe listening practices have occurred. The visualization of the user’s listening habits will include: • graphic display of the use of weekly sound allowance; • graphic display of daily sound exposure through a colour-coded display; • duration of listening, over each day and the past 7 days in hours and minutes. 1. Information on use of weekly allowance Use of weekly allowance can be graphically conveyed as illustrated in Figure 7.2 Figure 7.2 – Illustration of how to graphically convey the use of a weekly allowance 2. Information on how the user has used the allowance on any day For the purpose of this display, the maximum daily allowance will be equal to weekly allowance divided by 7 (approximately 15% of the weekly allowance). Usage for the last 7 days (including the present day) would be indicated by a range of colours depicting different levels of usage, e.g. red for over 100% use and green when use is below 50%. For the purpose of this communication, each day would be considered as a separate unit and colour coding for the day would not take the previous days’ exposure into account. Hence, the user would start with green icon each day, regardless of past days’ usage. Used Remaining 60% 40% Listening time (for last 7 days): 4 hours 20 minutes 74 75 3. Listening time Information on the overall time the user spent listening to audio content through the device each day will also be displayed (as shown in Figure 7.3.) Figure 7.3 – Information on the overall daily time the user spent listening to audio content 4. Warnings and cues for actions Warnings accompanied by cues for action should be provided to the user regularly: • When reaching 80% and 100% of the weekly allowance. • Upon reaching 100% of weekly allowance, the device should automatically reduce the volume to the reference level unless the user choses to continue listening at high volume despite the risk communicated. • Each message should be accompanied by a cue for action that will facilitate the listener to reduce the volume or stop listening. • Every day, the user should be provided with a notification informing them of how their listening has been over the last day and suggesting action to be taken that day. This may be an encouraging or warning type of message. Examples of such messages and cues for action are included in annex 8. Date-6 Date-5 Date-4 Date-3 Date-2 Date-1 Date (Today) Time 1h 5m 1h 20m 2h 1m 1h 50m 2h 5m 3h 2m 2h 50m safe unsafe 76 Appendix 8 Key considerations when developing messages and examples Given below are some evidence-based considerations for manufacturers develop messages as part of the safe listening features for their devices. As far as possible, manufacturers should try to develop messages which are appropriate for the cultural and linguistic context of the country. • The aim of such messages is to gain attention, build interest and encourage users to practice safe listening. • They should share actionable information, provide viable alternative behaviours and facilitate safe listening practices. Points to consider while developing such messages/cues are: • They should clearly convey the benefits of safe listening and the risks of not doing so. • There should be 3–4 variations of each message that can convey the information in a non- repetitive manner, designed to address a wide audience. • Text should be simple, clear and jargon-free in order that they can be understood by the majority of users. • Some messages should be positively and others negatively worded. • Written information should be complemented by pictorial information for ease of understanding. • Messages should be based on recommendations from a credible source. • Wherever possible, messages should be pre-tested by the manufacturer before use. The following are some examples of warnings and cues for action for the safe listening features. Examples of warnings and cues based on weekly use Information when user reaches: a. 80% of weekly allowance: friendly warning message: You have already spent 80% of your allowance. Turn down the volume to protect your hearing Reduce volume/Stop listening/Ignore warning/Go to personal usage information. OR Hello! It looks like you have been playing a lot of loud music lately. Why don't you take a short break to protect your hearing? Reduce volume/Stop listening/Ignore warning/Go to personal usage information. 77 b. 100% of weekly allowance: warning message (with an option to pause listening immediately): You are now OVER 100% of your safe listening allowance. Unsafe listening poses a risk to your hearing. Reduce volume/Stop listening/Ignore warning/Go to personal usage information OR Hey! You have played too much loud music recently. Take a break and protect your hearing. Reduce volume/Stop listening/Ignore warning/Go to personal usage information Unless the user agrees to “ignore warning: or to “pause listening”, the default will reduce the volume to below an average of 80 or 75 dB Examples of messages based on daily use Daily message (when opening the app or at player page) which should be based on the user’s use of sound allowance over the last few days: a. Mostly in green (where the user stays below 50% weekly usage most days, not exceeding the allowance on any day): encouraging messages Good job. This is the way to listen well Good job! Keep playing music safely for endless fun Well done. Keep listening safely and have endless fun b. Mostly green or yellow/orange (where the user stays below 80% on most days, not exceeding the allowance on any day): Be careful and listen safely. Hey! It seems that sometimes you enjoy high volume! Be careful and protect your hearing for endless fun! You can listen safely for longer by lowering the volume 78 c. Mostly yellow/orange with occasional red (where the user is not exceeding the allowance on any day): Be careful! Keep the volume down to listen safely for longer Hey! It seems that sometimes you enjoy loud music! Be careful and protect your hearing for endless fun! Hey! You should watch how you listen. d. Mostly red (exceeding the allowance on most days): You are putting your hearing at risk. Keep the volume low to listen safely Hey! You need to watch how you listen. Turn it down. Hey! It seems that you enjoy really loud music! Don't put your hearing at risk and have endless fun. Examples of messages with positive versus negative frame; and emotional versus rational appeal Positive frame: You exceeded your daily allowance for safe listening. Keeping the volume low lets you listen safely for longer without risk to hearing. Turn it down. Negative frame: You exceeded your daily allowance for safe listening. If you keep listening this way, you risk damaging you hearing forever. Turn it down Rational appeal: The evidence says that if you listen to music above the 80 dBA SPL, for 8 hours or its equivalent, you might damage your hearing forever. Turn down the volume. Emotional appeal: Once you lose your hearing, it will not come back. Listen safely. Turn down the volume. 79 Appendix 9 Resources for school-based workshops for safe listening Cheers for Ears Developed by the Ear Science Institute Australia, Cheers for Ears educates school students aged 10 to 12 years old about the dangers of hearing loss and its prevention. The programs use various multimedia materials and provide interactive sessions in schools. Aside from the programs, the team has created a number of activities including: Safe Hearing Suzie, Epic Ear Defence and Cheers for Ears Charlie, the mascot. These activities have been successful in encouraging safe listening among 21,300 children at 226 schools over last three years. There are three aims of the project: “to develop a health promotion program to educate primary school-aged children in the dangers of exposure to dangerous levels of noise and music,” “to develop an application to monitor and track noise exposure from personal music players,” and “to develop an Internet resource as a central information site for all matters related to NIHL and exposure to entertainment-related sounds.” For more information on Cheers for Ears, go to http://www.hearingservices.gov.au/wps/wcm/connect/8c6fc19a-4f10-4307-93f3-d350f50fbe5b/che ers-for-ears.pdf?MOD=AJPERES Resources • Safe Hearing Suzie is a mannequin head with a built-in sound level meter and hearing loss simulator. Suzie shows the decibel level of the sound as well as information on whether the sound is a safe listening volume or not. Therefore, Suzie teaches students about the truths and risks of NIHL. • Epic Ear Defence is an online game that students can actively engage in learning the importance of protecting ears. During the game, players have to use defensive techniques to fight off the incoming loud sounds (enemy). “As more loud sounds escape the player and reach the eardrum, the game begins to subtly simulate hearing loss and tinnitus into the over sound track.” This simulation is an engaging activity that people can enjoy while learning the importance of hearing. • Cheers for Ears Charlie is the mascot, shown as a superhero demonstrating headphones as a way to reduce the risk of NIHL. This mascot appears in different settings such as Hearing Awareness Week, school assemblies, and children’s festivals. • Workshops are delivered to schools, and age-appropriate presentations are used. Classroom activities include poster competition, creating a television or radio advertisement and quiz. Contact Information • For more information, email Natalie Leishman natalie.leishman@earscience.org.au 80 Hear 4 Tomorrow Hear 4 Tomorrow is a classroom-based program to educate primary school children about ear health. It was primarily designed for school teachers as a teaching tool with various curricula. The extensive curriculum is composed of four educational modules: understanding hearing loss, the hearing system and noise, how loud is too loud and protecting our hearing. Each module covers different aspects of hearing health, and students learn noise reduction behaviour. The aim of Hear 4 Tomorrow is “to provide teachers with a resource that enables them to teach hearing health in a way that complements their existing teaching programmes.” For more information on Hear 4 Tomorrow, go to https://hear4tomorrow.nal.gov.au/index.html. Resources • For each module, there is a variety of resources that students experience. – Hearing Loss Simulation allows people to have a hands-on experience of hearing loss at different levels. It demonstrates how the audio might sound for a 35-year-old with NIHL or how the audio might sound like for people with NIHL and tinnitus altogether. By providing different cases of diagnosis, the hearing loss simulation helps them understand hearing loss and its challenges. – Students learn to measure the levels of different noises and the relationship between volume and duration of exposure through the flash cards. – Teaching notes are provided. Contact Information • Hear 4 Tomorrow was developed by the National Acoustic Laboratories, the research division of Australian Hearing. You can contact enquiries@nal.gov.au Dangerous Decibels Dangerous Decibels focusses on three ways to prevent noise-induced hearing loss. The programme gives classroom presentation to schools that teach the concepts of noise-induced hearing loss and preventive strategies. Through an interactive workshop, it highlights the importance of protecting the hearing health and suggests to “walk away,” “turn it down,” and “use earplugs.” This school-based workshop has been tested for effectiveness and they haveshown that such presentation is very effective in modifying behavior, knowledge and attitudes among the primary school students. The aim is to “reduce the incidence and prevalence of noise-induced hearing loss (NIHL) and tinnitus (ringing in the ear) by changing knowledge, attitudes, and behaviors of school-aged children.” The programme has created Jolene, a mannequin equipped with a sound level meter, which attracts children and promotes safe listening. 81 Resources • Jolene and the Jolene cookbook: Jolene was constructed using a used fashion mannequin and a sound level meter wired to a silicon ear. Jolene makes appearances at schools and universities, scientific meetings, health fairs, and many other public events. Jolene has also been used as a research tool to study the beliefs and listening practices regarding personal stereo systems. Jolene cookbook is the production by the National Hearing Conservation Association for people to make their own Jolene. • Coloring Sheets is a set of three coloring sheets for the young kids. They make good take-homes. For more resources, please go to http://dangerousdecibels.org/. Noisy Planet Noisy Planet is a public education campaign, developed by the National Institute on Deafness and Other Communication Disorders (NIDCD). Noisy Planet has numerous teaching toolkits for different groups of people (parents, health teacher, school nurses and health professionals). Their aim is to “increase awareness of the causes and prevention of noise-induced hearing loss.” These educational resources include toolkits, advice and tips for safe listening. According to data from two surveys, the Noisy Planet is very effective in reaching target audiences. Additionally, Wise Ear campaign, also launched by the NIDCD, educates primary school students about preventing noise-induced hearing loss. For more information, go to https://www.noisyplanet.nidcd.nih.gov. Resources • The website provides noisy planet presentation, student activity videos and other resources • There are training videos that show the activities in the presentation. Instructions provide in-depth descriptions of each activity, including the required equipment, number of student volunteers needed, and the estimated time for each activity. Contact Information • For general questions, contact NPInfo@nidcd.nih.gov Listen to Your Buds Developed by American Speech and Hearing Association (ASHA), Listen to Your Buds campaign provides various instructions on how to prevent hearing loss through teaching materials. The campaign is delivering an important health message that all parents and kids need to hear. It aims to “make effective communication a human right, accessible and achievable for all.” The campaign educates the public about the risk of hearing loss in children from the unsafe use of personal audio technology, particularly earbuds or headphones. Furthermore, the Listen To Your Buds concert series visit schools, teaching kids about the importance of technology to protect their hearing health. For more information, go to https://www.asha.org/buds/. 82 Resources • Interactive school-based workshops are held in primary schools. Elementary school students learn how to protect their hearing for a lifetime from renowned musicians. Video: https://www.youtube.com/watch?v=cfkPUnWBmiI • Listen to Your Buds Bookmarks • Listen to Your Buds Colouring Book • Turn Down the Volume Song • Radio Disney PSA (educative narrative to protect hearing) • Self-Test for Hearing Loss Contact Information • There is no direct email address but contacting ASHA is possible by filling out information: https://www.asha.org/Forms/Contact-ASHA/

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Make Listening Safe Toolkit for safe listening devices and systems

Make Listening Safe Toolkit for safe listening devices and systems Toolkit for safe listening devices and systems ISBN 978-92-4-151528-3 (WHO) ISBN 978-92-61-28421-3 (ITU) © World Health Organization and International Telecommunication Union, 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO or ITU endorses any specific organization, products or services. The unauthorized use of the WHO or ITU names or logos is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Foreword Acknowledgements Executive summary Background Noise as a risk factor for hearing Impact of hearing loss WHO’s Make Listening Safe initiative Rationale for a standard for safe listening devices WHO-ITU H.870 Global standard on safe listening devices and systems Developing the WHO-ITU Global standard Objective of the toolkit Implementation by goverments Rationale What actions can governments take? Implementation by industry partners Rationale What actions can manufacturers take? Role of civil society Rationale What actions can civil society organizations take References and Bibliography Appendices Appendix 1: Situation assessment tool Appendix 2: Format for stakeholders' consultation Appendix 3: Introductory presentation with key messages Appendix 4: Outline of sensitization workshop Appendix 5: Materials for raising awareness Appendix 6: Summary of WHO–ITU global standard Appendix 7: Example of information flow Appendix 8: Key considerations when developing messages and examples Appendix 9: Resources for school - based workshops on safe listening Contents 8 8 9 10 10 11 11 13 16 16 17 22 22 22 28 28 28 32 36 36 48 49 53 54 62 73 76 79 Foreword Globally, a billion teenagers and young adults are at risk of developing hearing loss due to the practice of listening to music at high volumes for prolonged time over their personal audio devices. Once hearing loss due to loud sounds sets in, it cannot be reversed. Such hearing loss, if unaddressed, can greatly impact one’s ability to communicate, gain education or find and hold suitable employment. However, hearing loss that results from loud sounds can be prevented through raised awareness and appropriate prevented measures. To address this issue the World Health Organization (WHO) and the International Telecommunications Union (ITU) have developed the Toolkit for safe listening devices and systems, which provides the necessary practical guidance for the implementation of the Global standard for safe listening devices (ITU-T H.870). The standard outlines key features to regulate the user’s exposure to sound, limit volume and provide information on safe listening. The implementation of the safe listening features recommended here will be key to protect users from hearing loss caused by loud sounds and ensuring that people can continue enjoying the sounds they like listening to. Governments can act by regulating for the standard and manufacturers can develop and market devices that implement the recommendations of the toolkit. Civil society can advocate for the implementation of the standard and raise awareness on safe listening. ITU and WHO call upon Member States, industry partners and civil society to play their part in promoting safe listening and in addressing this emerging health challenge. The use of this toolkit and implementation of the H.870 global standard will promote the responsible use of technology to enhance health and wellbeing among its users. Ms Doreen Bogdan-Martin, ITU Dr Etienne Krug, WHO Dr. Etienne Krug Director, Department for Management of NCDs’, Disability, Violence and Injury Prevention (NVI), World Health Organization Ms. Doreen Bogdan-Martin Director, Telecommunication Development Bureau (BDT), International Telecommunication Union Acknowledgements The World Health Organization (WHO) and International Telecommunications Union (ITU) gratefully acknowledge the following contributors to this handbook. Content development: Elena Altieri, Young-Se An, Simao Campos-Neto, Shelly Chadha, Alarcos Cieza, Nicola Diviani, Catalina Valencia Mayer, Ericka Lara Ovares, Karen Reyes, Sara Rubinelli, Roxana Widmer-Iliescu. Guidance: Etienne Krug, Tamitza Toroyan. Further contributions: Lidia Best, Avi Blau, Brian Fligor, Mark Laureyns, Richard Neitzel, Michael Santucci. Administrative support: Laure Cartillier, Alina Lashko. Editing: Angela Burton. Layout and Design: 7 Estudio Creativo. Executive summary This toolkit provides practical guidance to support Member States, industry partners and civil society groups in the use and implementation of the WHO-ITU H.870 Global standard on safe listening devices and systems. The WHO-ITU Global standard is the result of a collaboration between the World Health Organization (WHO) and the International Telecommunication Union (ITU), and has been developed in response to the growing prevalence of hearing loss and the threat to hearing posed by unsafe listening. The WHO-ITU Global standard has been deve-lo-ped using an evidence-based and consultative process, with the participation of experts in the field of sound, audiology, acoustics, communication, and smartphone technology. This toolkit outlines the need for hearing loss prevention and describes how WHO and ITU have shaped their response to this. It summarizes the WHO-ITU Global standard in a simplified way and provides a step-wise approach for implementation by three main partners in the field of hearing loss prevention: • Governments • Industry • Civil society A section tailored to each partner outlines the steps necessary for effective implementation of the WHO-ITU Global standard. A variety of tools are included to help with this: a situation assessment tool; an outline of planning workshops; and sample awareness-raising commu-ni-cations and slide presentations. The aim of the toolkit is to make it easy for partners to adopt, implement and monitor the WHO-ITU Global standard. Its overall goal is to ensure that all users of personal audio systems are empowered with information on safe listening and have the option to make safe listening choices in order to protect their hearing. Background 8Background WHO estimates that over a billion young people worldwide are at risk of hearing loss due to unsafe listening practices (1). Action is therefore urgently needed. In recent years, there has been a rapid growth in access to technology and an ever-increasing number of people are using such technology to communicate. In addition, there has been a significant increase in the number of people exposed to loud sounds through use of personal audio systems as well as in entertainment venues, which put them at high risk of damaging their hearing. Overall, the number of people with hearing loss is growing at a rapid pace. It is estimated that there are currently around 466 million people with disabling hearing loss globally (2). Of this total, 432 million (93%) are adults and 34 million (7%) are children. Recent WHO projections suggest that unless action is taken, there will be 630 million people living with disabling hearing loss by 2030. This number is expected to grow to over 900 million by 2050 (2) along with a proportionate rise in the current annual cost of more than US$ 750 billion (in international dollars) globally if hearing loss is not addressed (1,3). Several risk factors affect a person’s hearing throughout life. While some of the risk factors associated with hearing loss are declining in parts of the world (e.g. rubella and meningitis), preventable factors such as noise (which are mainly a consequence of our modern way of life) are on the rise. Noise-induced hearing loss can be caused by a variety of environments and behaviours. For example, 40% of those frequenting such discotheques, clubs, sporting events or music concerts are exposed to potentially damaging sound levels (4). There is evidence that those exposed over the past 20 years to loud sounds in social settings are three times more likely to suffer hearing loss than those unexposed. Noise as a risk factor for hearing Ears are the organs that process sounds, enabling the brain to interpret what the individual is hearing. The ear is divided into three parts – outer ear, middle ear, and inner ear (see Figure 1). Usually sound is perceived by the sensory cells located in the inner ear, and when these cells are exposed frequently to loud sounds they can be permanently damaged, affecting individual’s hearing. Figure 1: Structure of the ear. 9The widespread uptake of personal audio devices such as smartphones and MP3 players has added to this risk. Smartphone use in developing countries has grown from 45% in 2013 to 54% in 2015 (7) and in in developed countries this figure stands at 87%. It is estimated that 50% of those listening to music over their personal audio devices do so at levels that put their hearing at risk (4). This toolkit focusses on hearing loss caused by unsafe listening using personal audio devices. Unsafe listening practices were identified as a major contributor to hearing loss by the Scientific Committee on Emerging and Newly Identified Health Risks in 2008. The committee indicated that 5–10% of listeners are likely to develop hearing loss due to their personal preferences of volume levels and duration of listening. (8) The availability of evidence varied across countries, but one study revealed that more than 40 million adults in the Americas between the ages of 20 and 69 are affected by noise-induced hearing loss due to non-occupational causes (5). Impact of hearing loss Noise-induced hearing loss in young children impairs language acquisition (6,7), learning disabilities, anxiety and attention seeking behaviours are also common in children exposed to loud sounds. (11) Chronic noise exposure in classrooms affects academic performance in areas such as reading ability, comprehension, short and long term memory, and motivation. On average, children who are exposed to noisy learning environments have lower assessment scores on standardized tests, which in the long term might affect their academic and profes-sional development (4, 8). In adults, unaddressed hearing loss can mean loss of earnings and difficulty in finding and retaining jobs. In Europe, for example, people with unaddressed hearing loss are twice as likely to be unemployed compared to their normal hearing peers. When employed they often earn lower wages, for example in the USA, wages are found to be between 50% and 70% lower for adults with unaddressed hearing loss. It affects social relationships and can be a cause for stress in domestic relationships. Noise exposure in young people also contributes to age-related hearing loss that can lead to significant communication difficulties, with the subsequent emotional and cognitive effect this might imply (9). Recent evidence suggests that outcomes such as depression, isolation, frustration, cognitive decline, and decreased personal safety are twice as common among seniors with hearing loss than those without hearing loss (10, 11, 12, 13). While noise-induced hearing loss is irreversible, it can nonetheless be prevented. In the case of hearing loss caused by the unsafe use of personal audio devices, there are simple, effective practices such as keeping the volume within safe listening levels and limiting the time spent engaged in noisy activities that, if followed, can have a protective effect on people’s hearing. 10 Taking preventive action is mostly in the realm of listeners themselves by adopting safe listening behaviours. However, government, health care providers, manufacturers and civil society can create an environment which enables safe listening. WHO’s Make Listening Safe initiative In 2015, responding to this growing public health issue, WHO launched the Make Listening Safe initiative, with the overall vision of ensuring that people of all ages can enjoy listening with full protection of their hearing. The aim of this global initiative is to reduce the risk of hearing loss due to unsafe exposure to sounds in recreational settings through: • regulating exposure to loud sounds through personal audio systems; • undertaking a public awareness campaign to change listening behaviours among the target population; • developing a regulatory framework for safe listening in recreational settings. To achieve the first objective, ITU and WHO collaborated in developing the WHO-ITU Global standard for safe listening devices and systems. Rationale for a standard for safe listening devices Experience from other fields of public health (for example reducing tobacco use or improving road safety) show that policies, regulations and their enforcement can eventually influence people’s behaviours. This is the case for mandatory graphic warnings on cigarette packages, for example, and for fines for ignoring mandatory seatbelt-wearing laws, for example. In line with these experiences (14), it is believed that the design and implementation of specific legislation that regulates the amount of sound energy received through a personal audio system can help prevent hearing loss by ensuring a lower level of sound exposure in people using these devices. Currently, there is one example of regulation that targets sound exposure through personal music players, which is the 2009 directive from the European Commission limiting the output level of personal music players and making it essential to provide a warning to listeners. Legal and regulatory interventions have proved to be an effective strategy for many sentinel public health achievements. An strong example is legislation worldwide on smoking bans that has been effective in reducing the incidence of passive and active smoking as well as the rate of acute coronary syndrome in populations concerned (15). Legislation and its enforcement is shown to be a key intervention for road safety, which can lead to reduction in speeding and drunk driving (16, 17). On the basis of these examples it makes sense to put in place regulations or legislation that address exposure to loud sounds as a public health issue in order to bring about a sustained change in listening habits. 11 WHO-ITU H.870 Global standard on safe listening devices and systems The WHO-ITU Global standard (18) builds on recommendations made by the European Commission (19) and provides evidence-based guidance for promoting safe listening among users of personal audio systems. In principle, the WHO-ITU Global standard proposes ways in which the technology used for listening (personal audio systems) can become a part of the solution of the u nsafe listening challenge. The rapid emergence of sophisticated technology that can track behaviour and health status, and provide personalized feedback, can be implemented to promote safe listening practices, while continuing to provide an enjoyable experience to the listener. Smartphone technology, in which smart mobile devices are connected to powerful computational resources, can thus provide a platform to deliver targeted, customized, safe listening interventions in a timely enough way for maximum effect. Through the use of technology and the creation of targeted protective features, the WHO-ITU Global standard aims to create a safe environment around those who listen to music through personal devices. The protective features recommended by the WHO-ITU Global standard will, among other things, aim at limiting the intensity and duration of users’ exposure to loud music. However, since users can decide to overrule technology (e.g. by deactivating the protective features), the WHO-ITU Global standard also includes recommendations for integrating into the protective features an educational component aimed at helping users to track, interpret and learn from their behaviours. Based on behavioural change theory and models, for users it might be easier to adopt and sustain a safe listening behaviour if they receive information and cues on the types of behaviour that put them at risk, the potential consequences, and what to do about it. Developing the WHO-ITU Global standard The WHO-ITU Global standard is based on current evidence and is the result of collaboration over a period of 2 years with a wide-raging group of experts and stakeholders, including audiologists, academia, sound engineers, professional associations, manufacturers of devices and headsets, regulatory bodies working at global or European level, and members of thetarget age range (12–35 years). Convened alternately by WHO and ITU, this wide-ranging group has provided inputs and feedback to the text of the WHO-ITU Global standard. All background papers and evidence compiled is publicly available. Before entering into force, the WHO-ITU Global standard prepared by the group was posted online for additional comments and inputs from the 193 Member States of the International Telecommunication Union, as well as from its hundreds of sector members. 12 1 Pa2h: pascal squared hours is the unit used to measure sound energy. The WHO-ITU Global standard consists of two integral components: a technical specification and a communication/educational element. The two are closely linked and both must be implemented together in order to be effective. 1. Technical aspects addressed in the WHO-ITU Global standard: It is also recommended that the device allows the user to select their reference exposure as one of two modes: Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h1 per 7 days as the reference exposure (i.e. 80 dBA SPL for 40 hours per week). Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (i.e. 75 dBA SPL for 40 hours per week). The mode choice is given when using the player for the first time (or when the device is reset to factory settings) Mode choice can be changed at any later time, e.g. via a device settings menu. Volume limiting: This is a feature where by a volume-limiting message and option is automatically provided every time the user reaches 100% of their weekly allowance. The message should allow them the option to “continue listening” if they do not wish the device volume to reduce. When the message is not acknowledged, the default action will be to reduce the volume output to a pre-set level. If possible, users should be given the option to customize this level (the level at which they would like their device to limit the volume) according to their preference. The feature may also be used by individual users in order to limit their own sound exposure, if they wish to do so, by fixing the maximum output on their device. Parental control: It is recommended that the device should offer an option whereby maximum sound output can be fixed and locked in the settings, possibly through use of a password. This would allow parents (or other adults) to limit the maximum sound output of the child’s device in a way that cannot be changed by the child. Dosimetry: The WHO-ITU Global standard recommends that each device includes a system that tracks the user’s exposure time and estimates sound level and percentage used of a reference exposure (sound allowance) This acoustic dosimetry must include all media playback through the device (whether stored on the device or streamed) during times when the user is using earphones or headphones. (Voice calls are excluded as they are separately specified by other standards) Dosimetry The calculation and assessment of the amount of sound received by the ear, as compared to the reference exposure (or sound allowance) 13 2. Communication aspects addressed by the WHO-ITU Global standard: The WHO-ITU Global standard intends to provide users with information and guidance to enable them to make safe listening choices by tracking, interpreting and learning from their own behaviours. Such a component includes: – Personal usage information which is based on the tracking system mentioned in technical component. This will help the user to know: • their own listening habits (use of daily and weekly sound allowance); • how to use safe listening features of the specific devices. – Personalized recommendations and cues for actions for safe listening, customized based on each user’s listening profile. – General information on: • safe listening and ways to practice it; • the risk associated with unsafe listening; • the risk of hearing loss due to loud sounds from sources other than the personal audio system. Objective of the toolkit This toolkit aims to provide a practical guide on the implementation and follow-up of the WHO-ITU Global standard that should be used as the basis for regulations or legislation by all Member States, or adopted voluntary by manufacturers in order to protect users from noise-induced hearing loss. The WHO-ITU Global standard is designed to support countries, industries and civil society in approaching noise-induced hearing loss prevention in a strategic, evidence-based and user-friendly way. This toolkit is organised in three sections. Each section is targeted to a group whose action is essential to ensure that the WHO-ITU Global standard is adopted and users protected. This includes: • government, specifically the ministries and departments working in the field of health, technology, commerce, industry, consumer protection and any other department related to disability or accessibility issues; • industry, specifically manufacturers of personal audio systems; • civil society organizations working in the field of hearing or consumer rights. 14 Each section provides the rationale for the stakeholders to take action on safe listening; they list possibilities of how the WHO-ITU Global standard can be implemented or promoted by that particular group; and suggests tools for taking action. The processes, steps and tools are provided for guidance and can be adapted, translated or modified by stakeholders to suit the needs of individual countries and manufacturers. Implementation by governments 16 The section is intended as guidance for (among others): • public officials responsible for drafting policies, advising ministries, setting the priority agenda in the field of health, for example in adolescent health; education; technology; information and communication technology; telecommunication; as well as regulatory or standardization bodies; consumer protection agencies; and managers of hearing programmes or adolescent health within ministries of health; • officials responsible for school health or purchase of equipment within ministries of education; • officials in charge of accessibility issues within government departments. Rationale Hearing loss is increasing in all regions worldwide, posing a public health challenge that carries a significant financial cost. WHO estimates that unaddressed hearing loss costs the world approximately US$ 750 billion each year (in international dollars). Investment in hearing loss prevention can help governments save already-scarce resources. Ministries of education and of technology should advocate for and support hearing loss prevention, in part achieved through implementation of the WHO-ITU Global standard, to fulfil their mandates for protecting technology users in general and in particular children using technologies to learn. The increasing access to technology worldwide and its improper use is posing a huge challenge in this respect. To mitigate the associated risk, it is essential that people learn how to use technology properly so that its harmful impacts can be minimized. The WHO-ITU Global standard makes it possible to use technology interfaces as a platform for prevention of noise-induced hearing loss. Implementation by governments 17 What actions can governments take? Implementation of the WHO-ITU Global standard can be promoted through: 1. Legislation: The WHO-ITU Global standard should be integrated in regulations and legislation related to the manufacturing, importing and selling of personal audio devices. 2. Other policies: 3. Along with legislation and other policies to implement the WHO-ITU Global standard for safe listening devices, governments should launch a public awareness campaign to raise awareness on: • the risks posed by loud sounds, especially those experienced in recreational settings; • safe listening practices that can reduce the risk of hearing loss among listeners. a. Government regulation: The relevant government department (technology, health, consumer protection etc.) should define a mechanism to enforce such policies or regulations that ensure all personal audio devices and systems sold within its jurisdiction comply with the WHO-ITU Global standard and protect users from noise-induced hearing loss. b. Procurement policies: Government departments that regularly procure technologies on a big scale (through tenders and public procurement) should ensure that all devices procured by them are aligned with the WHO-ITU Global standard. In 2003, ITU defined an international standard for video compression (Recommendation ITU-T H.264), which has been widely adopted by industry. France developed a regulation and Brazil issued a presidential decree mandating the use of ITU-T H.264 for over the air broadcast services, resulting in benefits for end users: not only quality of images broadcasted over TV in these countries was significant improved, but also lower cost for the necessary set top box receivers. Where the department of technology has an advisory role and informs decisions made by other departments (concerning relevant devices), they should recommend the alignment of these procurement policies as per the features defined in the WHO-ITU Global standard. Public procurement has been used as a tool to further public policies in many fields and has the potential to deliver on societal goals (20). 18 Engaging partners All stakeholders in the field should be involved, including: • different government departments such as technology, health, education, commerce and industry; environment, youth; • civil society groups including associations of hard of hearing; NGOs, professional societies, • youth organizations; • manufacturers; • consumer electronics associations; • major retail groups; • consumer protection organizations; • others as may be relevant in the context of the country. Proposed steps A step-wise approach, as proposed below, is recommended to ensure the inclusion of the WHO-ITU Global standard in relevant policies and regulations. Step 1: Assessment and policy development a. Conduct a situation assessment: The initiating department should carry out a situation assessment in order to understand: • the safe listening features in the devices currently sold in the country; • current statistics on hearing loss in the country/region, especially hearing loss caused by loud sounds, if available; • existing policies related to hearing loss prevention, noise control and safe listening; who the main stakeholders are, including government departments, civil society groups, youth organizations, manufacturers. A format for conducting a situation assessment can be found in Appendix 1. b. Organize a planning consultation: Following the situation assessment, the initiating department/ministry should organize a meeting to plan for the implementation of the WHO-ITU Global standard and get a buy-in from all relevant stakeholders. This meeting should include all key stakeholders identified in step 1. During this meeting, results of the situation assessment should be presented, the WHO-ITU Global standard outlined, and further steps for its implementation proposed. An outline of stakeholders’ consultation is provided in Appendix 2. c. Develop the policy on safe listening devices: The initiating department should draft the legislation, policy or regulation and discuss it with the relevant ministerial/government departments. It should then be shared with stakeholders to get their feedback, which should be addressed prior to finalization and approval of the policy document. d. Determine ways and means for raising awareness among the target group: Along with development of the policy for safe listening devices, the initiating department should outline a strategy for raising awareness on safe listening and informing users about the new safe listening features proposed in the regulations. This should be done in consultation with relevant health professionals and communication experts. The country can make use of the validated WHO awareness materials that can be adapted and translated for use in the country. Step 2: Launch and communication a. Organize a sensitization workshop: Once the policy or legislation is finalized, a sensitization workshop should be held by the initiating department in collaboration with other departments involved. The purpose of such a workshop is to inform manufacturers and key retail groups of the rationale and intent of the regulations and to gain their support in their implementation. An outline of the workshop is provided as Appendix 4, for guidance. b. Undertake media outreach: A press announcement should be made to launch the new regulations. This should be accompanied by a media campaign through all channels relevant in the context of the country and the target group, e.g. social media, print media, digital media etc. Governments can launch these regulations on the World Hearing Day in order to maximize the advocacy effort. Step 3: Implementation and monitoring a. Monitor policy implementation: Implementation of the policy, regulation or legislation should be monitored by the government through established mechanisms. b. Undertake evaluation and revision: The policy, regulation or legislation and its implementation should be evaluated at regular pre-designated intervals (e.g. every 2 years). This evaluation should further be discussed with the stakeholders and revisions made, depending on the feedback received. 19 Additional actions Wherever possible, the government should make efforts to do the following: a. Monitor epidemiology of hearing loss: The relevant department in the Ministry of Health should regularly assess hearing loss prevalence in the target population through a population-based prevalence study. Such a study should ideally be done at the start of the initiative and repeated every 5 years. b. Carry out research: Relevant departments should assess the occurrence of hearing loss among users of personal audio devices. Tools the following tools are available to guide governments in application of the WHO-ITU Global standard: • Situation assessment/analysis tool (Appendix 1) • Format for stakeholders consultation (Appendix 2) • Introductory presentation with key messages (Appendix 3) • Format for sensitization workshop (Appendix 4) • Materials for raising awareness (Appendix 5) Planning: situation assessment, discussions,policy development, awareness raising Monitoring implementation: monitoring, evaluation, feedback, revision Supporting actions: assessment of hearing loss and listening behaviour outcomes Launching: sensitization workshop, media outreach 20 Implementation by industry partners The section is intended as guidance for: • Manufacturers of personal audio systems including: – Smartphones – MP3 players – Other devices with music playing capability – Headphones/earphones Rationale Investing in the hearing health of their customers makes good business sense for an industry that relies on considerably on its clients’ ability to hear. At present, the increasing use of technology is part of the threat to good hearing. The easy access to such technology without any information or education on safe listening practices is putting at risk the hearing of millions of young people across the world. With the growing penetration of technology, this challenge is likely to grow too, unless concrete steps are taken. At the same time, technology is being used successfully to raise awareness on various health issues and promote healthy lifestyles. This has led to an increasing number of health-related applications made available to users through certain devices. Following this approach, the appropriate use of technology can reduce the risk it poses to hearing. Hence, as part of risk mitigation and in line with principles of responsible business, manufacturers of personal audio devices must share the responsibility of promoting safe listening practices, and to offset any potential harm from the use of their products. This can be done by proper implementation of the WHO-ITU Global standard. Safe listening will reduce the risk posed to hearing and can potentially reduce the occurrence of hearing loss. What actions can manufacturers take? Manufacturers should take the following actions. • Lead the field of safe listening by voluntary implementation of the WHO-ITU Global standard by ensuring that the personal audio devices manufactured by them comply with: – requirements of the WHO-ITU Global standard; – optional features within the WHO-ITU Global standard. 22 Implementation by industry partners • Improve the accuracy of the ‘dose/allowance’ measurement by: – striving to improve the testing algorithm and minimize measurement errors; – ensuring that the algorithms are compatible with a large variety of commonly used headphones/earphones available in the market (including those manufactured by other companies). • Experiment with and create a user interface that is both appealing and informative. The user interface should: – present information on safe listening in an engaging manner that appeals to the user; – provide information on the user’s listening parameters and use of sound allowance in an easily understandable format; – provide access to reliable and validated sources of information on safe listening. Engaging partners All stakeholders in the field should be involved, including: • other manufacturers that have implemented the WHO-ITU Global standard; • retailers that sell devices manufactured by the company; • consumer groups, target group; • government: when applying for any government contracts, the manufacturers can highlight the safe listening features available in their devices; others as may be relevant. A complementary example is the case of digital subscriber line (DSL) technologies that enable broadband Internet access at homes. Amongst others, ITU-developed standard ITU-T G.993.1, which, while it was not mandated by governments, was selected by network operators in their procurement as the technology to enable data rates up 25 Mbit/s between their premises and a user's home. Beyond high speed Internet, this allowed network operators to simplify provisioning of the services and reduce costs. Equipment manufacturers could now bid for a larger number of contracts and offer units to end-users via retail channels. It benefitted users through reduced operation costs and allowing them to choose from a variety of equipment providers (knowing that interoperability was guaranteed). 23 Proposed steps Step 1: Planning a. Carry out an internal assessment: Manufacturers should assess the current state of play relating to safe listening features in the devices they manufacture different parts of the world. b. Download and understand the WHO-ITU Global standard: This can be found at https://itu.int/rec/T-REC-H.870. A summary outline is included in Appendix 6 of this document. Staff working on safety measures and acoustics in the company should read the full WHO-ITU Global standard and applicable references, and understand their implications. c. Discuss implementation: Hold internal discussions regarding the method of including the proposed safe listening features in devices and devise a complete implementation plan. Step 2: Development and testing of safe listening features a. Develop and test a user interface: The WHO-ITU Global standard provides guidance on what sort of information should be conveyed through the device interface. Wherever possible, manufacturers should research this aspect and develop a user-friendly interface for safe listening features, in line with the WHO-ITU Global standard. Where manufacturers cannot or do not wish to undertake such research, they can follow the suggestions provided in Appendix 7 b. Develop and test messages and cues for action: Such messages and instructions have to be included within the user interface. It is important to test these, taking into consideration cultural, linguistic and regional contexts. Where a manufacturer is unable to or does not wish to engage in developing and testing an interface and messages, they could adopt the examples outlined within the tools (see Appendix 7 and Appendix 8) c. Check that your device conforms to the WHO-ITU Global standard: Once the H.870 safe listening specifications are implemented in your company’s products, they should be tested for compliance using a pre-established conformance assessment plan. Step 3: Publicizing and promoting a. Inform and train retailers: Once products that implement the WHO-ITU Global standard are available, retailers should be informed about these features and trained to promote them. b. Popularize the safe listening features of your device: Wherever possible, advertisements and websites should highlight the safe listening features, which will help raise awareness on safe listening and highlight the company’s responsible attitude towards its consumers. 24 Planning: situation assessment, understanding the standards, internal discussions Publicizing and promoting: informing retailers, advertisements, websites Review and revision: feedback, updates, revisions Development and testing: user interface, messages, compliance testing Step 4: Reviewing and revision a. Gather feedback from users: Manufacturers should regularly seek feedback from users regarding the relevance, user friendliness and clarity of safe listening features in their devices. b. Undertake revisions and improvements: The user interface and messaging should be revised periodically based on user feedback. c. Keep up to date with the latest version of the WHO-ITU Global standard: Manufacturers should revise the features as and when the WHO-ITU Global standard is revised. Tools The following tools are available to guide manufacturers in application of the WHO-ITU Global standard: • Summary of the WHO-ITU Global standard (Appendix 6) • Example of information flow (Appendix 7) • Key considerations when developing messages and generic examples (Appendix 8) • List of information sources (Appendix 5) 25 26 Role of civil society The section is intended as guidance for professional associations and civil society organizations and groups working on: • hearing loss prevention; • noise control • consumer rights. Rationale Exposure to loud sounds is a key contributor to preventable hearing loss. It is estimated that 50% of people using personal audio systems do so in a way that puts their hearing at risk. Implementation the WHO-ITU Global standard can promote safe listening behaviours and reduce the risk personal audio systems pose to hearing. Civil society partners should advocate with policy makers for their implementation as a means to prevent hearing loss. What actions can civil society organizations take? Civil society organizations should undertake the following actions: • Advocacy work to persuade governments to develop regulations to implement the WHO-ITU Global standard. • Awareness campaigns to sensitize people regarding hearing loss prevention and safe listening. • Sensitization of manufacturers of devices to motivate them to voluntarily implement the WHO-ITU Global standard in the products they sell. Engaging partners All stakeholders in the field should be involved, including: • Other organizations working in the field of hearing loss prevention, noise control and consumer protection. • Departments of health, education and technology. • Local schools. • Media. • Corporate social responsibility (CSR) departments of manufacturing organizations. • Others that may be considered relevant. 28 Role of civil society Proposed steps Step 1: Plan: a. Identify and brainstorm with other stakeholders to plan actions. b. Determine the target audience they will address e.g. policy makers, manufacturers, schools and universities, the community at large, others. c. Identify the key messages to convey to these audiences and the impact they want to have (e.g. policy development by government; implementation of safe listening features by manufacturers; use of safe listening apps by young people etc.). d. Establish what would be the most effective strategy to convey these messages e.g. through a meeting, media event, awareness sessions etc. Step 2: Prepare a. Review and adapt the WHO advocacy and awareness resources on safe listening to the local context and translate, if required. b. Review other available materials on safe listening. c. Finalize the resources and materials to be used. Step 3: Advocate with the target group identified through available means. This could include: a. Media outreach; b. Social media; c. Websites; d. Webcasts; e. Workshops on safe listening in schools and universities; f. Public events. Step 4: Follow up with the target group and monitor outcomes and impact in terms of: a. Policies established or actions initiated by governments; b. Implementation of safe listening features by manufacturers; c. Use of safe listening applications/features by users of personal audio devices; d. Change in listening habits of users. 29 Tools The following tools are available to guide civil society organizations in promoting the WHO-ITU Global standard: • Awareness-raising materials for policy makers and the general population (Appendix 5) • Social media materials (Appendix 5); • Resources for school-based workshops on safe listening (Appendix 9). Planning: identify stakeholders, brainstorming, determine target audience, identify key messages, strategize Advocate: with the target group Follow up and monitor outcomes Prepare: review and adapt available advocacy materials 30 References and Bibliography References 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva: World Health Organization; 2017 2. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload /noiseprevention.pdf, accessed 21 November 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012;39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008;123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002;65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007;77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018;144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013;173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 2018;Apr 13. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013;No v;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Rev Panam Salud Publica. 2014 Oct;36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recommendation ITU-T H.870. Guidelines for safe listening devices/systems. 2018 (https://itu.int/rec/T-REC-H.870, accessed 15 January 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014;14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017;30. 10.1108/IJPSM-03-2017-0066 32 References 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva: World Health Organization; 2017 2. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload /noiseprevention.pdf, accessed 21 November 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012;39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008;123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002;65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007;77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018;144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013;173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 2018;Apr 13. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013;No v;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Rev Panam Salud Publica. 2014 Oct;36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recommendation ITU-T H.870. Guidelines for safe listening devices/systems. 2018 (https://itu.int/rec/T-REC-H.870, accessed 15 January 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014;14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017;30. 10.1108/IJPSM-03-2017-0066 33 34 Bibliography Arenas J, Suter A. Comparison of occupational noise legislation in the Americas: An overview and analysis. Noise and Health. 2014;16(72), 306–319 Berglund B, Lindvall T, Schwela DH. Guidelines for community noise. Geneva: World Health Organization; 1999. Consumers: EU acts to limit health risks from exposure to noise from personal music players [Press release]. Brussels; European Commission: February 19 2018 (http://europa.eu/rapid/press-release_IP-09-1364_en.htm, accessed 24 August 2018). Gurgel RK, Ward PD, Schwartz S, Norton MC, Foster NL, Tschanz JT. Relationship of hearing loss and dementia: a prospective, population-based study. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2014;35(5):775–781 Joy G, Middendorf P. Noise exposure and hearing conservation in U.S. coal mines – a surveillance report. Journal of Occupational and Environmental Hygiene. 2007;4(1), 26 Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics. 2010;125(6):e1348−55 Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies,http://www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-conti nues-to-climb-in-emerging-economies/2016 Tikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S. Interventions to prevent occupational noise‐induced hearing loss. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD006396. DOI: 10.1002/14651858.CD006396.pub4 Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017;390(10098):934 Appendices 36 Appendix 1 This situation assessment tool has been developed to help governmental departments and ministries gather relevant information to prevent unsafe listening, and to promote and regulate safe listening practices in their country under the WHO-ITU H.870 Global standard on safe listening devices and systems. Information to complete this assessment can be obtained from existing peerreviewed literature, World Health Organization (WHO) statistics, national statistics, and Ministry of Health documents. Technical assistance in conducting a situation assessment or using the results is available from WHO. [Country name] National data profile compiled by: National Data Coordinator Name of the person in charge of this Situation assessment Designation and qualification Institution Address Email Telephone numbers Respondent’s details (this form can be duplicated for each person interviewed) Name Position/Title Institution Email Telephone numbers Fax Situation assessment tool 37 Population profile Name of the area (state, region, province, district) (if relevant) for which this situation assesment is being undertaken Total number of mobile device users in the country/area Total number of mobile device users between the ages of 12 and 35 years Total number of smartphone users in the country/area Total number of smartphone users between the ages of 12 and 35 years Sex distribution of mobile device users (%) Male: % Female:% % Rural-urban distribution of mobile device users (%) Rural:% Urban:% Literacy rate among mobile device users (as a % of total population) Any other population-related factor that needs to be considered in mobile device services Area: State: (optional) Region: (optional) Province: (optional) District: (optional) Section A. General country information Mobile device usage Languages used by mobile device users Total number of personal audio devices sold in the country/area: Number of smartphones sold: Number of MP3 players: Number of other related devices (personal audio players) % of population/area reached by internet services:% Number of companies that sell personal audio devices in the country/area Name of mobile device brands sold in your country [] Samsung [] Motorola [] Apple [] Alcatel [] Sony [] Nokia [] Huawei [] Google [] LG [] Other (please specify): Names of leading retailers that sell mobile devices in the country/area What is the percentage of people with disabling hearing loss due to noise-induced hearing loss and other relevant causes? Overall:% Age group 12 to 35 years:% Any other age group (as reported in literature):% Names Names of leading mobile phone service providers that operate in the country/area Names Hearing loss Prevalence of disabling hearing loss: Overall:% Age group 12 to 35 years:% Any other age group (as reported in literature): % If information on disabling hearing loss is not available, indicate the definition used in estimation of prevalence: 38 39 Lead agency profile Coordination Legislation Other (please specify) Monitoring and evaluation Is there a government agency or department that takes responsibility for overseeing and/or coordinating hearing care activities/plans (i.e. a lead agency) in your country? Where is this agency located within the government structure (please tick one)? The agency is a single government ministry/department, or situated within one government ministry/department (please specify ministry and department, if relevant) [] Stand-alone entity [] Other (please specify) [] Don’t know For which of the following functions is the lead agency responsible? (please tick all that apply) [] Yes [] No [] Don’t know Is funding allocated in the government’s budget for the lead agency to carry out the functions listed above? [] Yes (please name this agency) [] No (please skip to Section B) [] Don't know (please skip to Section B) [] Coordination of intergovernmental working processes at central government level [] Coordination of hearing care decision-making across central government [] Coordination across different levels of government (e.g. central, regional, local) [] Coordination of national mass media initiatives [] Establishing and supporting data systems that are used to monitor safe listening devices [] Compilation and dissemination of national statistics [] Periodic review of legislation, rules and standards against best practice, and recommendations for improvement [] Development and/or revision of legislation Section B. Leadership and governance 40 Section C. Strategy and targets National strategy profile Is there a national strategy for deafness and hearing loss prevention in your country? If yes, does this strategy include prevention of recreational noise-induced hearing loss? Is there a regulation regarding safe listening features in personal audio devices? If answer to any of the above is yes, do any strategies that exist include volume regulations on personal audio devices such as mobile phones, mp3 players, tablets, etc? Is there an awareness programme regarding noise control in environmental/recreational settings? If yes, does the awareness programme include a focus on safe listening? Are funds available to implement part or all of any strategies that exist? If a national strategy exists, does it set measurable targets to increase the number of personal music players with safe listening features? [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please submit relevant source documents) [] No [] Don't know [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please submit relevant source documents) [] No [] Don't know [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please provide details/source documents as annex) [] No [] Don't know [] Yes [] No [] Don’t know If yes, please provide the targets and their timeframes: • Device targeted increase: • Time period relating to device target (please specify start and end years that these targets relate to, e.g. (2002–2012) (2016-2020) [] Yes, fully funded [] Partially funded [] Not funded [] Don’t know Does the national strategy include recommendations for any of the following: Reducing volume level [] Yes [] No [] Don’t know Allowing users to keep track of their sound usage [] Yes [] No [] Don't know Showing messages to the user when reaching unsafe volume levels [] Yes [] No [] Don’t know Showing messages about safe listening practices [] Yes [] No [] Don't know Encouraging the use of earplugs in loud environments such as bars, sporting events and concerts [] Yes [] No [] Don't know 41 42 Please mention all potential and existing stakeholders in your country that are or could be involved in ear and hearing care services. Identify the lead or responsible position or person, where possible, and give contact details. Stakeholder profile Government departments List in order of perceived priority for collaboration in developing and implementing a safe listening strategy Name of Department Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Section D. Stakeholder analysis 43 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Professionals and academics List in order of experience and interest in the development and implementation of the safe listening strategy Name of Institute or association 44 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Name of Institute or association Civil society groups, including disabled persons’ organizations List in order of perceived priority for collaboration in developing and implementing the safe listening strategy 45 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Name of agency UN agencies 46 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Industry partners List in order of perceived priority, based on need for collaboration and possible interest of the stakeholder, in developing and implementing the Safe Listening strategy Name of Company 47 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Any others (can include any other groups that are interested in hearing loss prevention, noise control, audiology, acoustics or consumer rights) 48 Appendix 2 Outline of stakeholders planning meeting for regulations on safe listening The following stakeholder groups should be invited to the meeting: • Relevant government departments: technology, health, education, commerce and industry, environment, youth • Civil society groups including associations of hard of hearing; ngos, professional societies • Youth organizations • All manufacturers • Consumer electronics associations • Major retail groups • Consumer protection organizations • WHO and ITU representatives Purpose: • To inform stakeholders about the global standards and the country’s intention to implement them • To gain buy-in from relevant stakeholders in this respect • To discuss the way forward regarding adoption of standards and their implementation • To agree on timelines • To discuss customization and adaptation of the awareness materials The following outline is suggested: • Introductions • Need for safe listening • Current status in the country regarding regulations on safe listening • Global standards for safe listening • Perspectives required to implement safe listening strategies and regulations: – Government (Technology, health, any other) – Users (one representative to present user view) – Industry (umbrella organization or a company with leadership in this field to speak on behalf of industry) – Hearing care profession (one member from a professional, hearing-related organization to speak) – Civil society view (one speaker from a relevant civil society group to speak) • Possibilities regarding adoption and implementation of the Standard in the country (including timelines): discussion • Need for raising awareness and available tools • Determining the next steps for: – developing a regulation/legislation; – developing an awareness campaign and adapting awareness materials. WHO estimates that 1.1 billion young people worldwide could be at risk of hearing loss as a result of unsafe listening practices. Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD, Finucane M. Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries. Eur J Public Health 2013; 23: 146-52 (http://dx.doi.org/10.1093/eurpub/ckr176, accessed 19 January 2019). Hearing loss is on the rise! Overarching messages • Rise and ageing of the global population • 466 million people globally are currently living with disabling hearing loss • 630 million people estimated to be living with disabling hearing loss by 2030 • Over 900 million estimated to be living with disabling hearing loss by 2050 How do we hear? Appendix 3 Make listening safe initiative: Introductory presentation 49 Recreational noise, unsafe listening practices and the impact of hearing loss • Those exposed to loud sounds in social settings over the past 20 years are over three times more at risk of hearing loss compared to those unexposed. • 50% of people listening to music over their personal audio devices do so at levels which put their hearing at risk. • 5–10% of listeners are likely to develop hearing loss due to their personal volume preferences and duration of listening. • Depression, isolation, frustration, cognitive decline and decreased personal safety are twice as common among seniors with hearing loss than those without hearing loss. Noise-induced hearing loss is irreversible Photos from top to bottom by Thibault Trillet, Kevin Grieve, Simon Matzinger, Adobe PhotoStock. 50 Make listening safe initiative Smartphone technology can  provide a platform to  deliver targeted, customized safe listening interventions while continuing to provide an enjoyable experience to the listener. Technical aspects Acoustic dosimetry • Tracking users’ exposure time to sound • Estimating sound level • Estimating % used of a reference exposure, or sound allowance • Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h1 per 7 days as the reference exposure (i.e. 80 dBA SPL for 40 hours per week). • Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (i.e. 75 dBA SPL for 40 hours per week). Prevention This means creating an environment that enables the exercise of safe listening practices, including through: • Regulating exposure to loud sounds through personal audio systems.  • Undertaking public awareness campaigns to change listening behaviours among people aged 12 to 35 years. • Developing a regulatory framework for safe listening in recreational settings.  WHO-ITU H.870 Global standards for safe listening devices and systems 51 Volume limiting • Volume limiting message • "Continue listening" option • Default action: to reduce the volume output to a predetermined level • Customizing option Parental control  • Maximum sound output can be fixed and locked in the device’s settings Make listening safe toolkit Practical guide for implementation and follow-up of global safe listening standards in recreational settings to be adopted by all countries worldwide • Designed to support countries, industries and civil society in approaching noise-induced hearing loss prevention in a strategic, evidence-based and user-friendly way. • Targets three key stakeholders that can be instrumental in implementing the standards • Government: ministries/departments working in the field of health or technology • Industry: manufacturers of personal audio devices and systems • Civil society organizations: field of hearing or consumer rights The processes, steps and tools are provided for guidance and can be adapted, translated or modified by stakeholders to suit the needs of individual countries and manufacturers.   Personal usage information • Listening habits, including sound allowance • How to use safe listening features  Personalized recommendations and cues • Actions for safe listening • Customized advice based on user's listening profile General information • Safe listening and ways to practice it   • Risk associated with unsafe listening • Risk of hearing loss due to loud sounds from sources other than personal audio devices and systems Communication aspects 52 53 Appendix 4 Outline of sensitization workshop for regulations on safe listening The following groups should be invited to participate in the workshop: • Relevant government departments: technology, health, education, commerce and industry, environment, youth • All manufacturers • Consumer electronics associations • Major retail groups Purpose: To sensitize manufacturers and retailers regarding regulations on safe listening devices and to to guide them regarding implementation, timelines and reporting. The following outline is suggested: • Introductions • Rationale for safe listening standards • Outline of national regulations on standards: essential and optional components • Timelines for implementation • Monitoring/reporting mechanism on implementation • Manufacturers’ issues and concerns • Awareness materials that can be used for by manufacturers for distribution, social media and websites 54 Appendix 5 Advocacy materials Goal These awareness materials are designed to inform people about the risk of hearing loss due to unsafe listening; the concept of safe listening; and available tools to promote its practice. Who are these materials for? These evidence-based advocacy materials are intended to provide key stakeholders (government, industry and civil society organizations) with tools to raise awareness among policymakers and the public about safe listening. Advocacy materials WHO’s resources to promote safe listening are available at: www.who.int/deafness/make-listening-safe/advocacy-materials/en/ Communication objectives • Raise awareness and engage the public on the importance of safe listening practices. • Create a conversation on the risk of hearing loss due to loud sounds from sources such as personal audio systems and mobile devices. • Raise awareness about the risks of unsafe listening practices among teenagers and young adults. • Build an understanding of the importance of multisectoral engagement and action for implementing the WHO-ITU H.870 Global standard for safe listening devices and systems. • Promote examples of good multisectoral engagement leading to successful interventions that have addressed the issue of exposure to loud sounds in recreational settings. Overarching messages • Noise-induced hearing loss is irreversible! • Prevention is one of the most effective strategies to reduce the occurrence of noise-induced hearing loss. • Keeping the volume within safe levels and limiting the time spent engaged in noisy activities can reduce the risk of hearing loss. • Smartphone technology can be used as a means to promote and practice safe listening.  • The design and implementation of specific legislation can lead to a lower level of sound exposure 55 Infographic Share information and materials on social media Our social media channels • Follow us on Twitter, Facebook and Instagram @WHO and tag us in your posts Twitter official hashtag • #SafeListening Twitter official hashtag • #WHO • #HearingCare • #HearTheFuture • #WorldHearingDay 56 Poster 57 Brochure Tips for safe listening 58 Press release Related document 59 Videos Facebook posts Instagram posts 60 Tweets 61 FAQs 1. Introduction 2. How is loudness measured? What is dB? 3. What is safe listening? 4. How do loud sounds affect my ears? 5. How can I tell if my hearing has been affected? 6. Once I have lost my hearing can I get it back? 7. Is there a way to use a mobile phone to monitor my listening levels? 8. How can I monitor sound exposure or daily allowance for music that is not stored on my device? 9. What can I do to make my listening safe? 10. What can I do as a parent to ensure safe listening? 11. What can I do as a teacher to ensure safe listening? 12. What can I do as a physician to ensure safe listening? 13. What can I do as a manager of an entertainment venue to ensure safe listening? 14. What can I do as a manufacturer of personal audio devices to ensure safe listening? 15. What can governments do to ensure safe listening? Relevant websites • World Health Organization (WHO) http://www.who.int/deafness/make-listening-safe/en/ • Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/hearingloss/default.html • Action on Hearing Loss https://www.actiononhearingloss.org.uk/ • European Union of the Deaf https://www.eud.eu/ • Hear The World Foundation https://www.hear-the-world.com/en • American Speech Language Hearing Association – Listen To Your Buds campaign https://www.asha.org/buds/ • Dangerous Decibels http://dangerousdecibels.org/ Media interest If you are a journalist interested in covering issues related to the Make Listening Safe initiative please email us at whopbd@who.int 62 2 The full text of the H.870 Guidelines for safe listening devices/systems is available at https://www.itu.int/rec/T- REC-H.870-201808-I/en Appendix 6 Summary of WHO–ITU global standard H.870 for safe listening devices and systems Safe listening refers to listening behaviour that does not put a person’s hearing at risk. The risk of hearing loss depends on the level (loudness), duration (time period) and frequency of exposure to loud sounds. Such exposure may be through personal audio devices, in entertainment venues, or outside (for example in traffic), in the workplace, or at home. The WHO–ITU H.870 standard describes requirements for personal and portable audio systems, especially those for playing music, with the aim of protecting people from developing hearing loss as a result of their use. It provides a glossary for common terms to help understanding, as well as background information on sound, hearing and hearing loss. The Standard recommends criteria for avoiding unsafe listening: one for adults and the other for children, both based on the equal energy principle. Importantly, the Standard provides guidelines on health communication for safe-listening so that appropriate warning messages can be delivered effectively when necessary. Examples of such messages can be found in the Standard’s Appendix VII. Finally, the Standard also provides information about implementation of dosimetry and related issues. The key aspects of the WHO–ITU H.870 standard for safe listening devices/systems are summarized below. 63 1. Scope of the standard This document describes requirements for personal/portable audio systems, especially those used for playing music, in order to reduce the risk of hearing loss posed to the users of these devices. Figure 6.1: Architecture of a personal audio system In such devices, “source” can be either stored or retrieved remotely, e.g., streaming from a local server or the Internet (see Figure 6.1) A PAS is intended for use by an ordinary person and; • is designed to allow the user to listen to audio or audiovisual content / material; and • uses a listening device, such as headphones or earphones that can be worn in or on or around the ears; and • has a player that can be body worn (of a size suitable to be carried in a clothing pocket) and is intended for the user to walk around with while in continuous use (for example, on a street, in a subway, at an airport, etc.) Examples are portable CD players, MP3 audio players, mobile phones with MP3 type features, PDAs or similar equipment. For the purposes of this Standard, the following types of devices are excluded: • Communication devices (walkie-talkies, etc.) • Rehabilitative and medical devices (e.g. hearing aids, FM systems, and other assistive listening devices (ALD) approved as part of hearing aids and cochlear implants systems, etc.) • Personal sound amplification devices • Professional audio equipment and devices • Portable game consoles Personal Audio Device Personal Audio System Listening Device Effect Effect Volume ControlSource DAC Transducer 64 2. Equal energy principle The recommendations of this Standard are based on the equal energy principle. This is the assumption that the total effect of sound on ear and hearing is proportional to the total amount of sound energy received by the ear, irrespective of the distribution of that energy in time. According to this principle, equal amounts of sound energy is expected to cause equal amounts of sound induced permanent threshold shift regardless of the distribution of the energy across time. In practical terms this implies that listening to lower volumes for long periods of time can have the same impact as listening to very loud volumes for a short duration e.g. listening to a 100 dB sound for 16 minutes will have the same impact as listening to an 80 dB sound for 40 hours. Based on this principle, “dose” of sound energy is defined as the squared A-weighted sound pressure, , integrated over the exposure time Mathematically, this is expressed as: Where is the A-weighted and diffuse-field corrected sound pressure. The unit of this value is Pascal squared hours, or Pa2 h. 3. Reference exposure/sound allowance, operational modes It is recommended that each device includes a system that tracks the user’s exposure time and loudness level, and estimates the percentage used of a reference exposure (also referred to as sound allowance) This must take account of all media played through the device (i.e. whether it is stored on the device itself, or streamed) during times when the user is using ear/headphones. Voice calls may be excluded as they are separately specified by other standards. It is also recommended that the device allow the user to select their reference exposure as one of two operational modes: Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h per 7 days as the reference exposure (derived from 80dBA for 40 hours a week) Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (derived from 75dB for 40 hours a week) The user should be allowed to select either of the two modes when using the player for the first time (or when the device is reset to factory settings). It should be possible for the user to change the mode choice at a later time, e.g. via a device settings menu. 65 Sound allowance Refers to a dose estimate of sound exposure over a certain rolling period of time (e.g., daily or weekly), commonly expressed as a percentage of the reference exposure. A 100% weekly sound allowance is equivalent to the weekly reference exposure, based on the mode selected. Examples of weekly listening time duration based on sound allowance for the modes described earlier can be found in Table 1 and Table 2. Table 1: Example of weekly listening Table 2: Example of weekly listening dB(A) SPL Weekly (0.51 Pa h )2 107 104 101 98 95 92 89 86 83 80 24 minutes 12 minutes 6 minutes 3 minutes 1.5 minutes 48 minutes 6 hours 24 minutes 3 hours 15 minutes 1 hours 36 minutes 12 hours 30 minutes 77 25 hours 75 40 hours time for Mode 1 time for Mode 2 dB(A) SPL Weekly (1.6 Pa h )2 107 4.5 minutes 104 9.5 minutes 101 18.75 minutes 98 37.5 minutes 95 75 minutes 92 2.5 hours 89 5 hours 86 10 hours 83 20 hours 80 40 hours 66 4. Measurement methods/acoustic dosimetry Standard H.870 defines dose in the context of acoustic dosimetry. Under mode 1, 1.6 Pa2h constitutes 100% weekly sound allowance, corresponding to 100% calculated sound dose (CSD) as defined in [EN 50332-3]. For mode 2, 0.51 Pa2h is the total weekly sound allowance or reference exposure. Standard H.870 also refers to other related standards that describe a dose measurement system in a portable music player (PMP). [IEC 61252] describes acoustic dosimeters to be worn on the body including [EN 50332-1], [EN 50332-2] and [EN 50332-3]. Appendix II of H.870 gives an example of how a dosimeter can be implemented in a personal audio system when measuring the digital media signal and considering known or assumed properties of headphones. It is based on the equal energy principle in hearing loss risk assessment, where the squared A-weighted sound pressure, integrated over the exposure time, constitutes the dose. The dosimeter functionality is tested by playing the programme simulation sound according to [EN 50332-1] and [IEC 60268-1] and measuring the time until the dose estimate reaches 100% CSD, using interpolation and tolerances as described in [EN 50332-3]. Such testing may be performed in the acoustic domain (when a certain headset is used) or in the electrical domain using a 32 Ω resistive load (when the headset characteristics are unknown). See measurement setup information in [ITU-T P.381]. Uncertainties: In estimating sound dose there are a number of sources for uncertainties and margin of error can be very high. It is therefore suggested to refrain from signalling “safe” and “green” to the user based on dose readings below a certain limit. The dose estimation is however relevant in accounting for the general trends: • Higher signal level means higher risk • Longer exposure means higher risk • The spectral content of the music is accounted for 67 Refers to the hardware components (such as screen) that allows a human being to interact with an electronic device. 5. Health communication A key aspect of the Standard is to provide user with a tool that will allow them to monitor their own personal sound exposure. Such a tool should give users the choice of safe listening, and empower them to make informed choices for listening through greater awareness. This section of the Standard summary outlines its health communication aspects that should be applied for complete implementation of standards for safe listening devices. Specifically, it presents evidence-based recommendations on how to communicate the risks of unsafe listening and support users in adopting appropriate behaviour in this respect. Purpose of including health communication as part of the standards for safe listening personal audio systems The intent is to provide users with information and guidance to enable them to make safe listening choices. These include providing: • Personal usage information, in order for the user to know: – their own listening habits (use of daily and weekly sound allowance); – how to use safe listening features of the specific devices. • Personalized recommendations and cues for actions for safe listening, customized based on each user’s listening profile. • General information on: – safe listening and ways to practice it; – the risk associated with unsafe listening; – the risk of hearing loss due to loud sounds from sources other than the personal audio system. This information and guidance must be shared by default with users via their mobile devices in order to reduce the risk of hearing loss. Key recommendations for communication as part of safe listening devices Information and messages on safe listening must be provided through: • the device interface3 (wherever an appropriate visual interface is available); • instruction manuals; • when possible, information about the safe listening features of the device should be included on or in the packaging. 68 6.1 Information delivered through device interface Personal usage information Information regarding various listening parameters defining the users’ listening habits should be accessible to users in order to allow them to keep track of their exposure to sound through the device. For devices with a screen, this could be through an icon on the screen. Through the icon, the user should be able to see their use of daily/weekly sound allowance in an easy to understand presentation, e.g. the person may be able to view how much of the weekly sound allowance has been used and to see how their listening behaviour has been over the past seven days. In devices without screen, the information should be made available through alternate means, such as audio cues. The device (when capable) should display: • the average sound level for the day and week; • the time for which the user has listened in hours and minutes over the day and the week. Figure 6.2 gives a non-normative example of information provided on a smartphone visual interface for safe listening Figure 6.2: Examples of information provided on a smartphone visual interface for safe listening Todays security allowance Sound track #5 Disclosure 51.6% Time left: 01:14:17 Today’ Listening time: 37 min Average dB level (leg) : 93.3 dB 90 80 70 60 50 40 30 20 10 0 52% Todays security allowance 52% Todays security allowance Sound track #5 Disclosure 119.5% Time left: 00:00:00 Today’ Listening time: 1.80 h Average dB level (leg) : 93.5 dB 90 80 70 60 50 40 30 20 10 0 120% Todays security allowance 120% 69 Personalized recommendations and cues for actions and messages: a.The device should give relevant warnings and cues for actions when the user exceeds 100% of the weekly allowance. • The user will receive first a “warning” expressed through text and visuals informing that a threshold has been reached and that from this point on, further listening at the same volume will pose a hearing risk. • The warning will be followed by a “cue for action” in which the user is offered the choice to either accept the risk of continued listening or protect their hearing. The “cue for action” should be linked to active options on the device, such as: – automatic safe volume option, by which the device automatically changes the volume to a safe volume level; – direct access to volume settings; – set up of default volume limits; – “remind me later” option; – “ignore and continue” option. • If the user fails to take any action, the volume will automatically be reduced to below the standard level (80 or 75 dBA as selected). b.The device should provide relevant messages when the sound allowance usage reaches certain pre-determined levels. Refer to Appendix 8 for the suggested levels at which warnings/cues can be given and sample content. Such warnings depend on the device’s capability and should be multimodal, e.g. a mix of visual, vibratory or audible warnings, in order to ensure that the user’s attention can be directed towards these.Figure 6.3 gives non-normative examples of messaging displayed in a smart watch. Figure 6.3: Example of messaging displayed in a smart watch 50% of daily allowance: you have spent 50% of your safe listening allowance for the day. keep the volume low to listen longer. SAFELISTEN Hey! Your last sound dose was 60%. Well done! Keep listening safely. SAFELISTEN Daily messages: the device should provide a daily summary message based on the user’s listening behaviour in recent days, encouraging safe listening habits and discouraging or warning against unsafe listening habits. Examples of such messages are provided in Appendix 8 General information: when the device has a screen, information on what is safe listening and its benefits – as well as the risks posed by unsafe listening – should be displayed on the screen. It is recommended that the availability of this information be indicated on the user interface (home screen) through a distinct and recognizable icon. Figure 6.4 gives a non-normative example of a safe listening icon displayed on a smartphone screen. How does loud music affect my ears? What is safe listening? How can I make listening safe on my device? No, thanks. Play my music Safe listen What are first signs of hearing damage? What does hearing loss sound like? Hearing damage may not be noticeable initially. At first you may only have trouble hearing high-pitched sounds like bells or experience persistent tinnitus. Find out here. Centres for disease control and prevention Hear the word Information What is safe listening? OK, thanks. Play my music Figure 6.5: Examples of screens linking to information on safe listening and external links Figure 6.4: Safe listening icon displayed on a smartphone screen There should be a tutorial informing users about safe listening; the risks of unsafe listening; and the device’s safe listening features and how to use them. The screens should also include links to relevant webpages where the user can find more information. Figure 6.5 gives non-normative examples of screens linking to information on safe listening and external links. 70 71 6.2 Information delivered by means other than the device itself User manual The user manual should clearly state that unsafe listening practices using the device pose the risk of permanent hearing loss. It should also give details of the volume-limiting functions and cues for action. The user manual should also clearly outline how the allowance-assessment system works and refer to its uncertainty. It should indicate that information on the device does not take into account additional sources of sound exposures either from other audio devices or environmental sound exposure. The manual could also provide information regarding hearing protections from loud environmental sounds in order to minimize the risk of hearing loss. Packaging Wherever possible, a clear, concise message or warning should included on the external packaging of the device. It is recommended that such a warning/message be: • concise, simple and clear; • accompanied by a relevant illustration; • positioned on a plain background. Website and advertising Information on safe listening should be included on the manufacturer’s website. Such information should be aligned to the specifications in Standard H.870. A link to WHO website and other relevant, reputable websites could be included. Wherever possible, advertising of products could also provide relevant information. Such information can refer to both the potential harm to hearing through improper use of their device and the advantages of listening safely in order to maintain healthy hearing while enjoying a good listening experience. 7. Volume control Volume limiting: as per Standard H.870, the device should provide the user with a suitable method for volume-limiting. This refers to a feature where a message will be given before or when the user reaches 100% of the weekly allowance, offering them the option to “continue listening”, if they do not wish the device volume to reduce. When the message is not acknowledged, the default action will be to reduce the volume output to the predetermined level. If possible, users should be given the option to customize this level (the level at which they would like their device to limit the volume) according to their preference. Parental control: it is recommended that the device should have the option whereby the maximum sound output can be fixed and locked in the settings, possibly through use of a password. The purpose of this feature is to allow parents (or other adults) to limit the maximum sound output of the child’s device, in a way that cannot be changed by the child. The feature can also be used by individual users in order to limit their own sound exposure, by fixing the maximum output on their device. 72 73 Packaging •A clear, concise message/warning should be included on the external packaging of the devices, wherever possible. •Messages should appear on a plain background and be short, simple, and clear, with a relevant illustration. •The manual should clearly state that unsafe listening via the device may pose the risk of permanent hearing loss. •It should indicate that the device is equipped with safety features to help users protect their hearing. •This message should align with information provided through the device interface. It should contain similar text regarding the risks of hearing loss from unsafe listening and the recommendations for safe listening. •It should also detail the safe listening features within the device. •A visible icon on the device screen will direct users to the general information on safe listening. •This icon will also lead the user to a display (in devices with screens) which provides information regarding individuals' listening parameters and (daily and weekly) usage statistics. •The first use of ear/headphones with the device should direct the user to a tutorial with information on safe listening, how to practice it, and their personal listening profile (same information as available through the icon). •It will describe the standard levels for adults and children and allow the user to select a level. •Users will be given the option to set up how often and at what levels of usage they wish to receive the notifications. • The information on the daily/weekly sound allowance consumption is available to users at any time through the distinctive icon above mentioned. • Calculation should include all sounds played through the music players or online, as long as ear/headphones are used. • The displayed information should include: weekly allowance used and remaining; listening time (for the day/week), and indicate how the user's listening has been for the past 7 days, including current day, where possible. •Warnings and cues for action shall be delivered every time the user reaches 100% of the allowance exposure levels and also as per settings customized by the user. •These should be visual (where possible) and audible/vibratory to ensure that the user's attention be directed towards these. •The notifications should include information on the level of audio usage and the corresponding recommendations for safe listening. •The first time a user connects to an ear/headphones or starts playing music on a given day, the device could give a welcome message based on the usage on the previous days/week. User manual Device interface 1st use Personal Usage Notications Daily alerts Appendix 7 This section and the figure below contains suggested steps for explaining how the communication aspects of the standard can be implemented within devices Figure 7.1: Flow of information as part of standards for safe listening devices Example of information flow Example of how the information on listening parameters can be conveyed to users Through a clearly recognisable icon, users should be able to access a “dedicated space” (screen) on the device where information on the user’s listening habits is stored, visualized and interpreted. In this space, the user should be able to access a graphic representation of his/her overall listening habits or patterns and learn if (and what type of) unsafe listening practices have occurred. The visualization of the user’s listening habits will include: • graphic display of the use of weekly sound allowance; • graphic display of daily sound exposure through a colour-coded display; • duration of listening, over each day and the past 7 days in hours and minutes. 1. Information on use of weekly allowance Use of weekly allowance can be graphically conveyed as illustrated in Figure 7.2 Figure 7.2 – Illustration of how to graphically convey the use of a weekly allowance 2. Information on how the user has used the allowance on any day For the purpose of this display, the maximum daily allowance will be equal to weekly allowance divided by 7 (approximately 15% of the weekly allowance). Usage for the last 7 days (including the present day) would be indicated by a range of colours depicting different levels of usage, e.g. red for over 100% use and green when use is below 50%. For the purpose of this communication, each day would be considered as a separate unit and colour coding for the day would not take the previous days’ exposure into account. Hence, the user would start with green icon each day, regardless of past days’ usage. Used Remaining 60% 40% Listening time (for last 7 days): 4 hours 20 minutes 74 75 3. Listening time Information on the overall time the user spent listening to audio content through the device each day will also be displayed (as shown in Figure 7.3.) Figure 7.3 – Information on the overall daily time the user spent listening to audio content 4. Warnings and cues for actions Warnings accompanied by cues for action should be provided to the user regularly: • When reaching 80% and 100% of the weekly allowance. • Upon reaching 100% of weekly allowance, the device should automatically reduce the volume to the reference level unless the user choses to continue listening at high volume despite the risk communicated. • Each message should be accompanied by a cue for action that will facilitate the listener to reduce the volume or stop listening. • Every day, the user should be provided with a notification informing them of how their listening has been over the last day and suggesting action to be taken that day. This may be an encouraging or warning type of message. Examples of such messages and cues for action are included in annex 8. Date-6 Date-5 Date-4 Date-3 Date-2 Date-1 Date (Today) Time 1h 5m 1h 20m 2h 1m 1h 50m 2h 5m 3h 2m 2h 50m safe unsafe 76 Appendix 8 Key considerations when developing messages and examples Given below are some evidence-based considerations for manufacturers develop messages as part of the safe listening features for their devices. As far as possible, manufacturers should try to develop messages which are appropriate for the cultural and linguistic context of the country. • The aim of such messages is to gain attention, build interest and encourage users to practice safe listening. • They should share actionable information, provide viable alternative behaviours and facilitate safe listening practices. Points to consider while developing such messages/cues are: • They should clearly convey the benefits of safe listening and the risks of not doing so. • There should be 3–4 variations of each message that can convey the information in a non- repetitive manner, designed to address a wide audience. • Text should be simple, clear and jargon-free in order that they can be understood by the majority of users. • Some messages should be positively and others negatively worded. • Written information should be complemented by pictorial information for ease of understanding. • Messages should be based on recommendations from a credible source. • Wherever possible, messages should be pre-tested by the manufacturer before use. The following are some examples of warnings and cues for action for the safe listening features. Examples of warnings and cues based on weekly use Information when user reaches: a. 80% of weekly allowance: friendly warning message: You have already spent 80% of your allowance. Turn down the volume to protect your hearing Reduce volume/Stop listening/Ignore warning/Go to personal usage information. OR Hello! It looks like you have been playing a lot of loud music lately. Why don't you take a short break to protect your hearing? Reduce volume/Stop listening/Ignore warning/Go to personal usage information. 77 b. 100% of weekly allowance: warning message (with an option to pause listening immediately): You are now OVER 100% of your safe listening allowance. Unsafe listening poses a risk to your hearing. Reduce volume/Stop listening/Ignore warning/Go to personal usage information OR Hey! You have played too much loud music recently. Take a break and protect your hearing. Reduce volume/Stop listening/Ignore warning/Go to personal usage information Unless the user agrees to “ignore warning: or to “pause listening”, the default will reduce the volume to below an average of 80 or 75 dB Examples of messages based on daily use Daily message (when opening the app or at player page) which should be based on the user’s use of sound allowance over the last few days: a. Mostly in green (where the user stays below 50% weekly usage most days, not exceeding the allowance on any day): encouraging messages Good job. This is the way to listen well Good job! Keep playing music safely for endless fun Well done. Keep listening safely and have endless fun b. Mostly green or yellow/orange (where the user stays below 80% on most days, not exceeding the allowance on any day): Be careful and listen safely. Hey! It seems that sometimes you enjoy high volume! Be careful and protect your hearing for endless fun! You can listen safely for longer by lowering the volume 78 c. Mostly yellow/orange with occasional red (where the user is not exceeding the allowance on any day): Be careful! Keep the volume down to listen safely for longer Hey! It seems that sometimes you enjoy loud music! Be careful and protect your hearing for endless fun! Hey! You should watch how you listen. d. Mostly red (exceeding the allowance on most days): You are putting your hearing at risk. Keep the volume low to listen safely Hey! You need to watch how you listen. Turn it down. Hey! It seems that you enjoy really loud music! Don't put your hearing at risk and have endless fun. Examples of messages with positive versus negative frame; and emotional versus rational appeal Positive frame: You exceeded your daily allowance for safe listening. Keeping the volume low lets you listen safely for longer without risk to hearing. Turn it down. Negative frame: You exceeded your daily allowance for safe listening. If you keep listening this way, you risk damaging you hearing forever. Turn it down Rational appeal: The evidence says that if you listen to music above the 80 dBA SPL, for 8 hours or its equivalent, you might damage your hearing forever. Turn down the volume. Emotional appeal: Once you lose your hearing, it will not come back. Listen safely. Turn down the volume. 79 Appendix 9 Resources for school-based workshops for safe listening Cheers for Ears Developed by the Ear Science Institute Australia, Cheers for Ears educates school students aged 10 to 12 years old about the dangers of hearing loss and its prevention. The programs use various multimedia materials and provide interactive sessions in schools. Aside from the programs, the team has created a number of activities including: Safe Hearing Suzie, Epic Ear Defence and Cheers for Ears Charlie, the mascot. These activities have been successful in encouraging safe listening among 21,300 children at 226 schools over last three years. There are three aims of the project: “to develop a health promotion program to educate primary school-aged children in the dangers of exposure to dangerous levels of noise and music,” “to develop an application to monitor and track noise exposure from personal music players,” and “to develop an Internet resource as a central information site for all matters related to NIHL and exposure to entertainment-related sounds.” For more information on Cheers for Ears, go to http://www.hearingservices.gov.au/wps/wcm/connect/8c6fc19a-4f10-4307-93f3-d350f50fbe5b/che ers-for-ears.pdf?MOD=AJPERES Resources • Safe Hearing Suzie is a mannequin head with a built-in sound level meter and hearing loss simulator. Suzie shows the decibel level of the sound as well as information on whether the sound is a safe listening volume or not. Therefore, Suzie teaches students about the truths and risks of NIHL. • Epic Ear Defence is an online game that students can actively engage in learning the importance of protecting ears. During the game, players have to use defensive techniques to fight off the incoming loud sounds (enemy). “As more loud sounds escape the player and reach the eardrum, the game begins to subtly simulate hearing loss and tinnitus into the over sound track.” This simulation is an engaging activity that people can enjoy while learning the importance of hearing. • Cheers for Ears Charlie is the mascot, shown as a superhero demonstrating headphones as a way to reduce the risk of NIHL. This mascot appears in different settings such as Hearing Awareness Week, school assemblies, and children’s festivals. • Workshops are delivered to schools, and age-appropriate presentations are used. Classroom activities include poster competition, creating a television or radio advertisement and quiz. Contact Information • For more information, email Natalie Leishman natalie.leishman@earscience.org.au 80 Hear 4 Tomorrow Hear 4 Tomorrow is a classroom-based program to educate primary school children about ear health. It was primarily designed for school teachers as a teaching tool with various curricula. The extensive curriculum is composed of four educational modules: understanding hearing loss, the hearing system and noise, how loud is too loud and protecting our hearing. Each module covers different aspects of hearing health, and students learn noise reduction behaviour. The aim of Hear 4 Tomorrow is “to provide teachers with a resource that enables them to teach hearing health in a way that complements their existing teaching programmes.” For more information on Hear 4 Tomorrow, go to https://hear4tomorrow.nal.gov.au/index.html. Resources • For each module, there is a variety of resources that students experience. – Hearing Loss Simulation allows people to have a hands-on experience of hearing loss at different levels. It demonstrates how the audio might sound for a 35-year-old with NIHL or how the audio might sound like for people with NIHL and tinnitus altogether. By providing different cases of diagnosis, the hearing loss simulation helps them understand hearing loss and its challenges. – Students learn to measure the levels of different noises and the relationship between volume and duration of exposure through the flash cards. – Teaching notes are provided. Contact Information • Hear 4 Tomorrow was developed by the National Acoustic Laboratories, the research division of Australian Hearing. You can contact enquiries@nal.gov.au Dangerous Decibels Dangerous Decibels focusses on three ways to prevent noise-induced hearing loss. The programme gives classroom presentation to schools that teach the concepts of noise-induced hearing loss and preventive strategies. Through an interactive workshop, it highlights the importance of protecting the hearing health and suggests to “walk away,” “turn it down,” and “use earplugs.” This school-based workshop has been tested for effectiveness and they haveshown that such presentation is very effective in modifying behavior, knowledge and attitudes among the primary school students. The aim is to “reduce the incidence and prevalence of noise-induced hearing loss (NIHL) and tinnitus (ringing in the ear) by changing knowledge, attitudes, and behaviors of school-aged children.” The programme has created Jolene, a mannequin equipped with a sound level meter, which attracts children and promotes safe listening. 81 Resources • Jolene and the Jolene cookbook: Jolene was constructed using a used fashion mannequin and a sound level meter wired to a silicon ear. Jolene makes appearances at schools and universities, scientific meetings, health fairs, and many other public events. Jolene has also been used as a research tool to study the beliefs and listening practices regarding personal stereo systems. Jolene cookbook is the production by the National Hearing Conservation Association for people to make their own Jolene. • Coloring Sheets is a set of three coloring sheets for the young kids. They make good take-homes. For more resources, please go to http://dangerousdecibels.org/. Noisy Planet Noisy Planet is a public education campaign, developed by the National Institute on Deafness and Other Communication Disorders (NIDCD). Noisy Planet has numerous teaching toolkits for different groups of people (parents, health teacher, school nurses and health professionals). Their aim is to “increase awareness of the causes and prevention of noise-induced hearing loss.” These educational resources include toolkits, advice and tips for safe listening. According to data from two surveys, the Noisy Planet is very effective in reaching target audiences. Additionally, Wise Ear campaign, also launched by the NIDCD, educates primary school students about preventing noise-induced hearing loss. For more information, go to https://www.noisyplanet.nidcd.nih.gov. Resources • The website provides noisy planet presentation, student activity videos and other resources • There are training videos that show the activities in the presentation. Instructions provide in-depth descriptions of each activity, including the required equipment, number of student volunteers needed, and the estimated time for each activity. Contact Information • For general questions, contact NPInfo@nidcd.nih.gov Listen to Your Buds Developed by American Speech and Hearing Association (ASHA), Listen to Your Buds campaign provides various instructions on how to prevent hearing loss through teaching materials. The campaign is delivering an important health message that all parents and kids need to hear. It aims to “make effective communication a human right, accessible and achievable for all.” The campaign educates the public about the risk of hearing loss in children from the unsafe use of personal audio technology, particularly earbuds or headphones. Furthermore, the Listen To Your Buds concert series visit schools, teaching kids about the importance of technology to protect their hearing health. For more information, go to https://www.asha.org/buds/. 82 Resources • Interactive school-based workshops are held in primary schools. Elementary school students learn how to protect their hearing for a lifetime from renowned musicians. Video: https://www.youtube.com/watch?v=cfkPUnWBmiI • Listen to Your Buds Bookmarks • Listen to Your Buds Colouring Book • Turn Down the Volume Song • Radio Disney PSA (educative narrative to protect hearing) • Self-Test for Hearing Loss Contact Information • There is no direct email address but contacting ASHA is possible by filling out information: https://www.asha.org/Forms/Contact-ASHA/

FOR MORE INFORMATION PLEASE CONTACT: Department for Management of NCDs, Disability, Violence and Injury Prevention https://www.who.int/deafness/make-listening-safe/en/ World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland ISBN 978-92-4-151528-3

Make Listening Safe Toolkit for safe listening devices and systems

Make Listening Safe Toolkit for safe listening devices and systems Toolkit for safe listening devices and systems ISBN 978-92-4-151528-3 (WHO) ISBN 978-92-61-28411-4 (ITU) © World Health Organization and International Telecommunication Union, 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO or ITU endorses any specific organization, products or services. The unauthorized use of the WHO or ITU names or logos is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Foreword Acknowledgements Executive summary Background Noise as a risk factor for hearing Impact of hearing loss WHO’s Make Listening Safe initiative Rationale for a standard for safe listening devices WHO-ITU H.870 Global standard on safe listening devices and systems Developing the WHO-ITU Global standard Objective of the toolkit Implementation by goverments Rationale What actions can governments take? Implementation by industry partners Rationale What actions can manufacturers take? Role of civil society Rationale What actions can civil society organizations take References and Bibliography Appendices Appendix 1: Situation assessment tool Appendix 2: Format for stakeholders' consultation Appendix 3: Introductory presentation with key messages Appendix 4: Outline of sensitization workshop Appendix 5: Materials for raising awareness Appendix 6: Summary of WHO–ITU global standard Appendix 7: Example of information flow Appendix 8: Key considerations when developing messages and examples Appendix 9: Resources for school - based workshops on safe listening Contents 8 8 9 10 10 11 11 13 16 16 17 22 22 22 28 28 28 32 36 36 48 49 53 54 62 73 76 79 Foreword Globally, a billion teenagers and young adults are at risk of developing hearing loss due to the practice of listening to music at high volumes for prolonged time over their personal audio devices. Once hearing loss due to loud sounds sets in, it cannot be reversed. Such hearing loss, if unaddressed, can greatly impact one’s ability to communicate, gain education or find and hold suitable employment. However, hearing loss that results from loud sounds can be prevented through raised awareness and appropriate prevented measures. To address this issue the World Health Organization (WHO) and the International Telecommunications Union (ITU) have developed the Toolkit for safe listening devices and systems, which provides the necessary practical guidance for the implementation of the Global standard for safe listening devices (ITU-T H.870). The standard outlines key features to regulate the user’s exposure to sound, limit volume and provide information on safe listening. The implementation of the safe listening features recommended here will be key to protect users from hearing loss caused by loud sounds and ensuring that people can continue enjoying the sounds they like listening to. Governments can act by regulating for the standard and manufacturers can develop and market devices that implement the recommendations of the toolkit. Civil society can advocate for the implementation of the standard and raise awareness on safe listening. ITU and WHO call upon Member States, industry partners and civil society to play their part in promoting safe listening and in addressing this emerging health challenge. The use of this toolkit and implementation of the H.870 global standard will promote the responsible use of technology to enhance health and wellbeing among its users. Ms Doreen Bogdan-Martin, ITU Dr Etienne Krug, WHO Dr. Etienne Krug Director, Department for Management of NCDs’, Disability, Violence and Injury Prevention (NVI), World Health Organization Ms. Doreen Bogdan-Martin Director, Telecommunication Development Bureau (BDT), International Telecommunication Union Acknowledgements The World Health Organization (WHO) and International Telecommunications Union (ITU) gratefully acknowledge the following contributors to this handbook. Content development: Elena Altieri, Young-Se An, Simao Campos-Neto, Shelly Chadha, Alarcos Cieza, Nicola Diviani, Catalina Valencia Mayer, Ericka Lara Ovares, Karen Reyes, Sara Rubinelli, Roxana Widmer-Iliescu. Guidance: Etienne Krug, Tamitza Toroyan. Further contributions: Lidia Best, Avi Blau, Brian Fligor, Mark Laureyns, Richard Neitzel, Michael Santucci. Administrative support: Laure Cartillier, Alina Lashko. Editing: Angela Burton. Layout and Design: 7 Estudio Creativo. Executive summary This toolkit provides practical guidance to support Member States, industry partners and civil society groups in the use and implementation of the WHO-ITU H.870 Global standard on safe listening devices and systems. The WHO-ITU Global standard is the result of a collaboration between the World Health Organization (WHO) and the International Telecommunication Union (ITU), and has been developed in response to the growing prevalence of hearing loss and the threat to hearing posed by unsafe listening. The WHO-ITU Global standard has been deve-lo-ped using an evidence-based and consultative process, with the participation of experts in the field of sound, audiology, acoustics, communication, and smartphone technology. This toolkit outlines the need for hearing loss prevention and describes how WHO and ITU have shaped their response to this. It summarizes the WHO-ITU Global standard in a simplified way and provides a step-wise approach for implementation by three main partners in the field of hearing loss prevention: • Governments • Industry • Civil society A section tailored to each partner outlines the steps necessary for effective implementation of the WHO-ITU Global standard. A variety of tools are included to help with this: a situation assessment tool; an outline of planning workshops; and sample awareness-raising commu-ni-cations and slide presentations. The aim of the toolkit is to make it easy for partners to adopt, implement and monitor the WHO-ITU Global standard. Its overall goal is to ensure that all users of personal audio systems are empowered with information on safe listening and have the option to make safe listening choices in order to protect their hearing. Background 8Background WHO estimates that over a billion young people worldwide are at risk of hearing loss due to unsafe listening practices (1). Action is therefore urgently needed. In recent years, there has been a rapid growth in access to technology and an ever-increasing number of people are using such technology to communicate. In addition, there has been a significant increase in the number of people exposed to loud sounds through use of personal audio systems as well as in entertainment venues, which put them at high risk of damaging their hearing. Overall, the number of people with hearing loss is growing at a rapid pace. It is estimated that there are currently around 466 million people with disabling hearing loss globally (2). Of this total, 432 million (93%) are adults and 34 million (7%) are children. Recent WHO projections suggest that unless action is taken, there will be 630 million people living with disabling hearing loss by 2030. This number is expected to grow to over 900 million by 2050 (2) along with a proportionate rise in the current annual cost of more than US$ 750 billion (in international dollars) globally if hearing loss is not addressed (1,3). Several risk factors affect a person’s hearing throughout life. While some of the risk factors associated with hearing loss are declining in parts of the world (e.g. rubella and meningitis), preventable factors such as noise (which are mainly a consequence of our modern way of life) are on the rise. Noise-induced hearing loss can be caused by a variety of environments and behaviours. For example, 40% of those frequenting such discotheques, clubs, sporting events or music concerts are exposed to potentially damaging sound levels (4). There is evidence that those exposed over the past 20 years to loud sounds in social settings are three times more likely to suffer hearing loss than those unexposed. Noise as a risk factor for hearing Ears are the organs that process sounds, enabling the brain to interpret what the individual is hearing. The ear is divided into three parts – outer ear, middle ear, and inner ear (see Figure 1). Usually sound is perceived by the sensory cells located in the inner ear, and when these cells are exposed frequently to loud sounds they can be permanently damaged, affecting individual’s hearing. Figure 1: Structure of the ear. 9The widespread uptake of personal audio devices such as smartphones and MP3 players has added to this risk. Smartphone use in developing countries has grown from 45% in 2013 to 54% in 2015 (7) and in in developed countries this figure stands at 87%. It is estimated that 50% of those listening to music over their personal audio devices do so at levels that put their hearing at risk (4). This toolkit focusses on hearing loss caused by unsafe listening using personal audio devices. Unsafe listening practices were identified as a major contributor to hearing loss by the Scientific Committee on Emerging and Newly Identified Health Risks in 2008. The committee indicated that 5–10% of listeners are likely to develop hearing loss due to their personal preferences of volume levels and duration of listening. (8) The availability of evidence varied across countries, but one study revealed that more than 40 million adults in the Americas between the ages of 20 and 69 are affected by noise-induced hearing loss due to non-occupational causes (5). Impact of hearing loss Noise-induced hearing loss in young children impairs language acquisition (6,7), learning disabilities, anxiety and attention seeking behaviours are also common in children exposed to loud sounds. (11) Chronic noise exposure in classrooms affects academic performance in areas such as reading ability, comprehension, short and long term memory, and motivation. On average, children who are exposed to noisy learning environments have lower assessment scores on standardized tests, which in the long term might affect their academic and profes-sional development (4, 8). In adults, unaddressed hearing loss can mean loss of earnings and difficulty in finding and retaining jobs. In Europe, for example, people with unaddressed hearing loss are twice as likely to be unemployed compared to their normal hearing peers. When employed they often earn lower wages, for example in the USA, wages are found to be between 50% and 70% lower for adults with unaddressed hearing loss. It affects social relationships and can be a cause for stress in domestic relationships. Noise exposure in young people also contributes to age-related hearing loss that can lead to significant communication difficulties, with the subsequent emotional and cognitive effect this might imply (9). Recent evidence suggests that outcomes such as depression, isolation, frustration, cognitive decline, and decreased personal safety are twice as common among seniors with hearing loss than those without hearing loss (10, 11, 12, 13). While noise-induced hearing loss is irreversible, it can nonetheless be prevented. In the case of hearing loss caused by the unsafe use of personal audio devices, there are simple, effective practices such as keeping the volume within safe listening levels and limiting the time spent engaged in noisy activities that, if followed, can have a protective effect on people’s hearing. 10 Taking preventive action is mostly in the realm of listeners themselves by adopting safe listening behaviours. However, government, health care providers, manufacturers and civil society can create an environment which enables safe listening. WHO’s Make Listening Safe initiative In 2015, responding to this growing public health issue, WHO launched the Make Listening Safe initiative, with the overall vision of ensuring that people of all ages can enjoy listening with full protection of their hearing. The aim of this global initiative is to reduce the risk of hearing loss due to unsafe exposure to sounds in recreational settings through: • regulating exposure to loud sounds through personal audio systems; • undertaking a public awareness campaign to change listening behaviours among the target population; • developing a regulatory framework for safe listening in recreational settings. To achieve the first objective, ITU and WHO collaborated in developing the WHO-ITU Global standard for safe listening devices and systems. Rationale for a standard for safe listening devices Experience from other fields of public health (for example reducing tobacco use or improving road safety) show that policies, regulations and their enforcement can eventually influence people’s behaviours. This is the case for mandatory graphic warnings on cigarette packages, for example, and for fines for ignoring mandatory seatbelt-wearing laws, for example. In line with these experiences (14), it is believed that the design and implementation of specific legislation that regulates the amount of sound energy received through a personal audio system can help prevent hearing loss by ensuring a lower level of sound exposure in people using these devices. Currently, there is one example of regulation that targets sound exposure through personal music players, which is the 2009 directive from the European Commission limiting the output level of personal music players and making it essential to provide a warning to listeners. Legal and regulatory interventions have proved to be an effective strategy for many sentinel public health achievements. An strong example is legislation worldwide on smoking bans that has been effective in reducing the incidence of passive and active smoking as well as the rate of acute coronary syndrome in populations concerned (15). Legislation and its enforcement is shown to be a key intervention for road safety, which can lead to reduction in speeding and drunk driving (16, 17). On the basis of these examples it makes sense to put in place regulations or legislation that address exposure to loud sounds as a public health issue in order to bring about a sustained change in listening habits. 11 WHO-ITU H.870 Global standard on safe listening devices and systems The WHO-ITU Global standard (18) builds on recommendations made by the European Commission (19) and provides evidence-based guidance for promoting safe listening among users of personal audio systems. In principle, the WHO-ITU Global standard proposes ways in which the technology used for listening (personal audio systems) can become a part of the solution of the u nsafe listening challenge. The rapid emergence of sophisticated technology that can track behaviour and health status, and provide personalized feedback, can be implemented to promote safe listening practices, while continuing to provide an enjoyable experience to the listener. Smartphone technology, in which smart mobile devices are connected to powerful computational resources, can thus provide a platform to deliver targeted, customized, safe listening interventions in a timely enough way for maximum effect. Through the use of technology and the creation of targeted protective features, the WHO-ITU Global standard aims to create a safe environment around those who listen to music through personal devices. The protective features recommended by the WHO-ITU Global standard will, among other things, aim at limiting the intensity and duration of users’ exposure to loud music. However, since users can decide to overrule technology (e.g. by deactivating the protective features), the WHO-ITU Global standard also includes recommendations for integrating into the protective features an educational component aimed at helping users to track, interpret and learn from their behaviours. Based on behavioural change theory and models, for users it might be easier to adopt and sustain a safe listening behaviour if they receive information and cues on the types of behaviour that put them at risk, the potential consequences, and what to do about it. Developing the WHO-ITU Global standard The WHO-ITU Global standard is based on current evidence and is the result of collaboration over a period of 2 years with a wide-raging group of experts and stakeholders, including audiologists, academia, sound engineers, professional associations, manufacturers of devices and headsets, regulatory bodies working at global or European level, and members of thetarget age range (12–35 years). Convened alternately by WHO and ITU, this wide-ranging group has provided inputs and feedback to the text of the WHO-ITU Global standard. All background papers and evidence compiled is publicly available. Before entering into force, the WHO-ITU Global standard prepared by the group was posted online for additional comments and inputs from the 193 Member States of the International Telecommunication Union, as well as from its hundreds of sector members. 12 1 Pa2h: pascal squared hours is the unit used to measure sound energy. The WHO-ITU Global standard consists of two integral components: a technical specification and a communication/educational element. The two are closely linked and both must be implemented together in order to be effective. 1. Technical aspects addressed in the WHO-ITU Global standard: It is also recommended that the device allows the user to select their reference exposure as one of two modes: Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h1 per 7 days as the reference exposure (i.e. 80 dBA SPL for 40 hours per week). Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (i.e. 75 dBA SPL for 40 hours per week). The mode choice is given when using the player for the first time (or when the device is reset to factory settings) Mode choice can be changed at any later time, e.g. via a device settings menu. Volume limiting: This is a feature where by a volume-limiting message and option is automatically provided every time the user reaches 100% of their weekly allowance. The message should allow them the option to “continue listening” if they do not wish the device volume to reduce. When the message is not acknowledged, the default action will be to reduce the volume output to a pre-set level. If possible, users should be given the option to customize this level (the level at which they would like their device to limit the volume) according to their preference. The feature may also be used by individual users in order to limit their own sound exposure, if they wish to do so, by fixing the maximum output on their device. Parental control: It is recommended that the device should offer an option whereby maximum sound output can be fixed and locked in the settings, possibly through use of a password. This would allow parents (or other adults) to limit the maximum sound output of the child’s device in a way that cannot be changed by the child. Dosimetry: The WHO-ITU Global standard recommends that each device includes a system that tracks the user’s exposure time and estimates sound level and percentage used of a reference exposure (sound allowance) This acoustic dosimetry must include all media playback through the device (whether stored on the device or streamed) during times when the user is using earphones or headphones. (Voice calls are excluded as they are separately specified by other standards) Dosimetry The calculation and assessment of the amount of sound received by the ear, as compared to the reference exposure (or sound allowance) 13 2. Communication aspects addressed by the WHO-ITU Global standard: The WHO-ITU Global standard intends to provide users with information and guidance to enable them to make safe listening choices by tracking, interpreting and learning from their own behaviours. Such a component includes: – Personal usage information which is based on the tracking system mentioned in technical component. This will help the user to know: • their own listening habits (use of daily and weekly sound allowance); • how to use safe listening features of the specific devices. – Personalized recommendations and cues for actions for safe listening, customized based on each user’s listening profile. – General information on: • safe listening and ways to practice it; • the risk associated with unsafe listening; • the risk of hearing loss due to loud sounds from sources other than the personal audio system. Objective of the toolkit This toolkit aims to provide a practical guide on the implementation and follow-up of the WHO-ITU Global standard that should be used as the basis for regulations or legislation by all Member States, or adopted voluntary by manufacturers in order to protect users from noise-induced hearing loss. The WHO-ITU Global standard is designed to support countries, industries and civil society in approaching noise-induced hearing loss prevention in a strategic, evidence-based and user-friendly way. This toolkit is organised in three sections. Each section is targeted to a group whose action is essential to ensure that the WHO-ITU Global standard is adopted and users protected. This includes: • government, specifically the ministries and departments working in the field of health, technology, commerce, industry, consumer protection and any other department related to disability or accessibility issues; • industry, specifically manufacturers of personal audio systems; • civil society organizations working in the field of hearing or consumer rights. 14 Each section provides the rationale for the stakeholders to take action on safe listening; they list possibilities of how the WHO-ITU Global standard can be implemented or promoted by that particular group; and suggests tools for taking action. The processes, steps and tools are provided for guidance and can be adapted, translated or modified by stakeholders to suit the needs of individual countries and manufacturers. Implementation by governments 16 The section is intended as guidance for (among others): • public officials responsible for drafting policies, advising ministries, setting the priority agenda in the field of health, for example in adolescent health; education; technology; information and communication technology; telecommunication; as well as regulatory or standardization bodies; consumer protection agencies; and managers of hearing programmes or adolescent health within ministries of health; • officials responsible for school health or purchase of equipment within ministries of education; • officials in charge of accessibility issues within government departments. Rationale Hearing loss is increasing in all regions worldwide, posing a public health challenge that carries a significant financial cost. WHO estimates that unaddressed hearing loss costs the world approximately US$ 750 billion each year (in international dollars). Investment in hearing loss prevention can help governments save already-scarce resources. Ministries of education and of technology should advocate for and support hearing loss prevention, in part achieved through implementation of the WHO-ITU Global standard, to fulfil their mandates for protecting technology users in general and in particular children using technologies to learn. The increasing access to technology worldwide and its improper use is posing a huge challenge in this respect. To mitigate the associated risk, it is essential that people learn how to use technology properly so that its harmful impacts can be minimized. The WHO-ITU Global standard makes it possible to use technology interfaces as a platform for prevention of noise-induced hearing loss. Implementation by governments 17 What actions can governments take? Implementation of the WHO-ITU Global standard can be promoted through: 1. Legislation: The WHO-ITU Global standard should be integrated in regulations and legislation related to the manufacturing, importing and selling of personal audio devices. 2. Other policies: 3. Along with legislation and other policies to implement the WHO-ITU Global standard for safe listening devices, governments should launch a public awareness campaign to raise awareness on: • the risks posed by loud sounds, especially those experienced in recreational settings; • safe listening practices that can reduce the risk of hearing loss among listeners. a. Government regulation: The relevant government department (technology, health, consumer protection etc.) should define a mechanism to enforce such policies or regulations that ensure all personal audio devices and systems sold within its jurisdiction comply with the WHO-ITU Global standard and protect users from noise-induced hearing loss. b. Procurement policies: Government departments that regularly procure technologies on a big scale (through tenders and public procurement) should ensure that all devices procured by them are aligned with the WHO-ITU Global standard. In 2003, ITU defined an international standard for video compression (Recommendation ITU-T H.264), which has been widely adopted by industry. France developed a regulation and Brazil issued a presidential decree mandating the use of ITU-T H.264 for over the air broadcast services, resulting in benefits for end users: not only quality of images broadcasted over TV in these countries was significant improved, but also lower cost for the necessary set top box receivers. Where the department of technology has an advisory role and informs decisions made by other departments (concerning relevant devices), they should recommend the alignment of these procurement policies as per the features defined in the WHO-ITU Global standard. Public procurement has been used as a tool to further public policies in many fields and has the potential to deliver on societal goals (20). 18 Engaging partners All stakeholders in the field should be involved, including: • different government departments such as technology, health, education, commerce and industry; environment, youth; • civil society groups including associations of hard of hearing; NGOs, professional societies, • youth organizations; • manufacturers; • consumer electronics associations; • major retail groups; • consumer protection organizations; • others as may be relevant in the context of the country. Proposed steps A step-wise approach, as proposed below, is recommended to ensure the inclusion of the WHO-ITU Global standard in relevant policies and regulations. Step 1: Assessment and policy development a. Conduct a situation assessment: The initiating department should carry out a situation assessment in order to understand: • the safe listening features in the devices currently sold in the country; • current statistics on hearing loss in the country/region, especially hearing loss caused by loud sounds, if available; • existing policies related to hearing loss prevention, noise control and safe listening; who the main stakeholders are, including government departments, civil society groups, youth organizations, manufacturers. A format for conducting a situation assessment can be found in Appendix 1. b. Organize a planning consultation: Following the situation assessment, the initiating department/ministry should organize a meeting to plan for the implementation of the WHO-ITU Global standard and get a buy-in from all relevant stakeholders. This meeting should include all key stakeholders identified in step 1. During this meeting, results of the situation assessment should be presented, the WHO-ITU Global standard outlined, and further steps for its implementation proposed. An outline of stakeholders’ consultation is provided in Appendix 2. c. Develop the policy on safe listening devices: The initiating department should draft the legislation, policy or regulation and discuss it with the relevant ministerial/government departments. It should then be shared with stakeholders to get their feedback, which should be addressed prior to finalization and approval of the policy document. d. Determine ways and means for raising awareness among the target group: Along with development of the policy for safe listening devices, the initiating department should outline a strategy for raising awareness on safe listening and informing users about the new safe listening features proposed in the regulations. This should be done in consultation with relevant health professionals and communication experts. The country can make use of the validated WHO awareness materials that can be adapted and translated for use in the country. Step 2: Launch and communication a. Organize a sensitization workshop: Once the policy or legislation is finalized, a sensitization workshop should be held by the initiating department in collaboration with other departments involved. The purpose of such a workshop is to inform manufacturers and key retail groups of the rationale and intent of the regulations and to gain their support in their implementation. An outline of the workshop is provided as Appendix 4, for guidance. b. Undertake media outreach: A press announcement should be made to launch the new regulations. This should be accompanied by a media campaign through all channels relevant in the context of the country and the target group, e.g. social media, print media, digital media etc. Governments can launch these regulations on the World Hearing Day in order to maximize the advocacy effort. Step 3: Implementation and monitoring a. Monitor policy implementation: Implementation of the policy, regulation or legislation should be monitored by the government through established mechanisms. b. Undertake evaluation and revision: The policy, regulation or legislation and its implementation should be evaluated at regular pre-designated intervals (e.g. every 2 years). This evaluation should further be discussed with the stakeholders and revisions made, depending on the feedback received. 19 Additional actions Wherever possible, the government should make efforts to do the following: a. Monitor epidemiology of hearing loss: The relevant department in the Ministry of Health should regularly assess hearing loss prevalence in the target population through a population-based prevalence study. Such a study should ideally be done at the start of the initiative and repeated every 5 years. b. Carry out research: Relevant departments should assess the occurrence of hearing loss among users of personal audio devices. Tools the following tools are available to guide governments in application of the WHO-ITU Global standard: • Situation assessment/analysis tool (Appendix 1) • Format for stakeholders consultation (Appendix 2) • Introductory presentation with key messages (Appendix 3) • Format for sensitization workshop (Appendix 4) • Materials for raising awareness (Appendix 5) Planning: situation assessment, discussions,policy development, awareness raising Monitoring implementation: monitoring, evaluation, feedback, revision Supporting actions: assessment of hearing loss and listening behaviour outcomes Launching: sensitization workshop, media outreach 20 Implementation by industry partners The section is intended as guidance for: • Manufacturers of personal audio systems including: – Smartphones – MP3 players – Other devices with music playing capability – Headphones/earphones Rationale Investing in the hearing health of their customers makes good business sense for an industry that relies on considerably on its clients’ ability to hear. At present, the increasing use of technology is part of the threat to good hearing. The easy access to such technology without any information or education on safe listening practices is putting at risk the hearing of millions of young people across the world. With the growing penetration of technology, this challenge is likely to grow too, unless concrete steps are taken. At the same time, technology is being used successfully to raise awareness on various health issues and promote healthy lifestyles. This has led to an increasing number of health-related applications made available to users through certain devices. Following this approach, the appropriate use of technology can reduce the risk it poses to hearing. Hence, as part of risk mitigation and in line with principles of responsible business, manufacturers of personal audio devices must share the responsibility of promoting safe listening practices, and to offset any potential harm from the use of their products. This can be done by proper implementation of the WHO-ITU Global standard. Safe listening will reduce the risk posed to hearing and can potentially reduce the occurrence of hearing loss. What actions can manufacturers take? Manufacturers should take the following actions. • Lead the field of safe listening by voluntary implementation of the WHO-ITU Global standard by ensuring that the personal audio devices manufactured by them comply with: – requirements of the WHO-ITU Global standard; – optional features within the WHO-ITU Global standard. 22 Implementation by industry partners • Improve the accuracy of the ‘dose/allowance’ measurement by: – striving to improve the testing algorithm and minimize measurement errors; – ensuring that the algorithms are compatible with a large variety of commonly used headphones/earphones available in the market (including those manufactured by other companies). • Experiment with and create a user interface that is both appealing and informative. The user interface should: – present information on safe listening in an engaging manner that appeals to the user; – provide information on the user’s listening parameters and use of sound allowance in an easily understandable format; – provide access to reliable and validated sources of information on safe listening. Engaging partners All stakeholders in the field should be involved, including: • other manufacturers that have implemented the WHO-ITU Global standard; • retailers that sell devices manufactured by the company; • consumer groups, target group; • government: when applying for any government contracts, the manufacturers can highlight the safe listening features available in their devices; others as may be relevant. A complementary example is the case of digital subscriber line (DSL) technologies that enable broadband Internet access at homes. Amongst others, ITU-developed standard ITU-T G.993.1, which, while it was not mandated by governments, was selected by network operators in their procurement as the technology to enable data rates up 25 Mbit/s between their premises and a user's home. Beyond high speed Internet, this allowed network operators to simplify provisioning of the services and reduce costs. Equipment manufacturers could now bid for a larger number of contracts and offer units to end-users via retail channels. It benefitted users through reduced operation costs and allowing them to choose from a variety of equipment providers (knowing that interoperability was guaranteed). 23 Proposed steps Step 1: Planning a. Carry out an internal assessment: Manufacturers should assess the current state of play relating to safe listening features in the devices they manufacture different parts of the world. b. Download and understand the WHO-ITU Global standard: This can be found at https://itu.int/rec/T-REC-H.870. A summary outline is included in Appendix 6 of this document. Staff working on safety measures and acoustics in the company should read the full WHO-ITU Global standard and applicable references, and understand their implications. c. Discuss implementation: Hold internal discussions regarding the method of including the proposed safe listening features in devices and devise a complete implementation plan. Step 2: Development and testing of safe listening features a. Develop and test a user interface: The WHO-ITU Global standard provides guidance on what sort of information should be conveyed through the device interface. Wherever possible, manufacturers should research this aspect and develop a user-friendly interface for safe listening features, in line with the WHO-ITU Global standard. Where manufacturers cannot or do not wish to undertake such research, they can follow the suggestions provided in Appendix 7 b. Develop and test messages and cues for action: Such messages and instructions have to be included within the user interface. It is important to test these, taking into consideration cultural, linguistic and regional contexts. Where a manufacturer is unable to or does not wish to engage in developing and testing an interface and messages, they could adopt the examples outlined within the tools (see Appendix 7 and Appendix 8) c. Check that your device conforms to the WHO-ITU Global standard: Once the H.870 safe listening specifications are implemented in your company’s products, they should be tested for compliance using a pre-established conformance assessment plan. Step 3: Publicizing and promoting a. Inform and train retailers: Once products that implement the WHO-ITU Global standard are available, retailers should be informed about these features and trained to promote them. b. Popularize the safe listening features of your device: Wherever possible, advertisements and websites should highlight the safe listening features, which will help raise awareness on safe listening and highlight the company’s responsible attitude towards its consumers. 24 Planning: situation assessment, understanding the standards, internal discussions Publicizing and promoting: informing retailers, advertisements, websites Review and revision: feedback, updates, revisions Development and testing: user interface, messages, compliance testing Step 4: Reviewing and revision a. Gather feedback from users: Manufacturers should regularly seek feedback from users regarding the relevance, user friendliness and clarity of safe listening features in their devices. b. Undertake revisions and improvements: The user interface and messaging should be revised periodically based on user feedback. c. Keep up to date with the latest version of the WHO-ITU Global standard: Manufacturers should revise the features as and when the WHO-ITU Global standard is revised. Tools The following tools are available to guide manufacturers in application of the WHO-ITU Global standard: • Summary of the WHO-ITU Global standard (Appendix 6) • Example of information flow (Appendix 7) • Key considerations when developing messages and generic examples (Appendix 8) • List of information sources (Appendix 5) 25 26 Role of civil society The section is intended as guidance for professional associations and civil society organizations and groups working on: • hearing loss prevention; • noise control • consumer rights. Rationale Exposure to loud sounds is a key contributor to preventable hearing loss. It is estimated that 50% of people using personal audio systems do so in a way that puts their hearing at risk. Implementation the WHO-ITU Global standard can promote safe listening behaviours and reduce the risk personal audio systems pose to hearing. Civil society partners should advocate with policy makers for their implementation as a means to prevent hearing loss. What actions can civil society organizations take? Civil society organizations should undertake the following actions: • Advocacy work to persuade governments to develop regulations to implement the WHO-ITU Global standard. • Awareness campaigns to sensitize people regarding hearing loss prevention and safe listening. • Sensitization of manufacturers of devices to motivate them to voluntarily implement the WHO-ITU Global standard in the products they sell. Engaging partners All stakeholders in the field should be involved, including: • Other organizations working in the field of hearing loss prevention, noise control and consumer protection. • Departments of health, education and technology. • Local schools. • Media. • Corporate social responsibility (CSR) departments of manufacturing organizations. • Others that may be considered relevant. 28 Role of civil society Proposed steps Step 1: Plan: a. Identify and brainstorm with other stakeholders to plan actions. b. Determine the target audience they will address e.g. policy makers, manufacturers, schools and universities, the community at large, others. c. Identify the key messages to convey to these audiences and the impact they want to have (e.g. policy development by government; implementation of safe listening features by manufacturers; use of safe listening apps by young people etc.). d. Establish what would be the most effective strategy to convey these messages e.g. through a meeting, media event, awareness sessions etc. Step 2: Prepare a. Review and adapt the WHO advocacy and awareness resources on safe listening to the local context and translate, if required. b. Review other available materials on safe listening. c. Finalize the resources and materials to be used. Step 3: Advocate with the target group identified through available means. This could include: a. Media outreach; b. Social media; c. Websites; d. Webcasts; e. Workshops on safe listening in schools and universities; f. Public events. Step 4: Follow up with the target group and monitor outcomes and impact in terms of: a. Policies established or actions initiated by governments; b. Implementation of safe listening features by manufacturers; c. Use of safe listening applications/features by users of personal audio devices; d. Change in listening habits of users. 29 Tools The following tools are available to guide civil society organizations in promoting the WHO-ITU Global standard: • Awareness-raising materials for policy makers and the general population (Appendix 5) • Social media materials (Appendix 5); • Resources for school-based workshops on safe listening (Appendix 9). Planning: identify stakeholders, brainstorming, determine target audience, identify key messages, strategize Advocate: with the target group Follow up and monitor outcomes Prepare: review and adapt available advocacy materials 30 References and Bibliography References 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva: World Health Organization; 2017 2. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload /noiseprevention.pdf, accessed 21 November 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012;39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008;123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002;65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007;77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018;144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013;173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 2018;Apr 13. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013;No v;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Rev Panam Salud Publica. 2014 Oct;36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recommendation ITU-T H.870. Guidelines for safe listening devices/systems. 2018 (https://itu.int/rec/T-REC-H.870, accessed 15 January 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014;14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017;30. 10.1108/IJPSM-03-2017-0066 32 References 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva: World Health Organization; 2017 2. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload /noiseprevention.pdf, accessed 21 November 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012;39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008;123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002;65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007;77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018;144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013;173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 2018;Apr 13. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013;No v;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Rev Panam Salud Publica. 2014 Oct;36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recommendation ITU-T H.870. Guidelines for safe listening devices/systems. 2018 (https://itu.int/rec/T-REC-H.870, accessed 15 January 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014;14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017;30. 10.1108/IJPSM-03-2017-0066 33 34 Bibliography Arenas J, Suter A. Comparison of occupational noise legislation in the Americas: An overview and analysis. Noise and Health. 2014;16(72), 306–319 Berglund B, Lindvall T, Schwela DH. Guidelines for community noise. Geneva: World Health Organization; 1999. Consumers: EU acts to limit health risks from exposure to noise from personal music players [Press release]. Brussels; European Commission: February 19 2018 (http://europa.eu/rapid/press-release_IP-09-1364_en.htm, accessed 24 August 2018). Gurgel RK, Ward PD, Schwartz S, Norton MC, Foster NL, Tschanz JT. Relationship of hearing loss and dementia: a prospective, population-based study. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2014;35(5):775–781 Joy G, Middendorf P. Noise exposure and hearing conservation in U.S. coal mines – a surveillance report. Journal of Occupational and Environmental Hygiene. 2007;4(1), 26 Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics. 2010;125(6):e1348−55 Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies,http://www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-conti nues-to-climb-in-emerging-economies/2016 Tikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S. Interventions to prevent occupational noise‐induced hearing loss. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD006396. DOI: 10.1002/14651858.CD006396.pub4 Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017;390(10098):934 Appendices 36 Appendix 1 This situation assessment tool has been developed to help governmental departments and ministries gather relevant information to prevent unsafe listening, and to promote and regulate safe listening practices in their country under the WHO-ITU H.870 Global standard on safe listening devices and systems. Information to complete this assessment can be obtained from existing peerreviewed literature, World Health Organization (WHO) statistics, national statistics, and Ministry of Health documents. Technical assistance in conducting a situation assessment or using the results is available from WHO. [Country name] National data profile compiled by: National Data Coordinator Name of the person in charge of this Situation assessment Designation and qualification Institution Address Email Telephone numbers Respondent’s details (this form can be duplicated for each person interviewed) Name Position/Title Institution Email Telephone numbers Fax Situation assessment tool 37 Population profile Name of the area (state, region, province, district) (if relevant) for which this situation assesment is being undertaken Total number of mobile device users in the country/area Total number of mobile device users between the ages of 12 and 35 years Total number of smartphone users in the country/area Total number of smartphone users between the ages of 12 and 35 years Sex distribution of mobile device users (%) Male: % Female:% % Rural-urban distribution of mobile device users (%) Rural:% Urban:% Literacy rate among mobile device users (as a % of total population) Any other population-related factor that needs to be considered in mobile device services Area: State: (optional) Region: (optional) Province: (optional) District: (optional) Section A. General country information Mobile device usage Languages used by mobile device users Total number of personal audio devices sold in the country/area: Number of smartphones sold: Number of MP3 players: Number of other related devices (personal audio players) % of population/area reached by internet services:% Number of companies that sell personal audio devices in the country/area Name of mobile device brands sold in your country [] Samsung [] Motorola [] Apple [] Alcatel [] Sony [] Nokia [] Huawei [] Google [] LG [] Other (please specify): Names of leading retailers that sell mobile devices in the country/area What is the percentage of people with disabling hearing loss due to noise-induced hearing loss and other relevant causes? Overall:% Age group 12 to 35 years:% Any other age group (as reported in literature):% Names Names of leading mobile phone service providers that operate in the country/area Names Hearing loss Prevalence of disabling hearing loss: Overall:% Age group 12 to 35 years:% Any other age group (as reported in literature): % If information on disabling hearing loss is not available, indicate the definition used in estimation of prevalence: 38 39 Lead agency profile Coordination Legislation Other (please specify) Monitoring and evaluation Is there a government agency or department that takes responsibility for overseeing and/or coordinating hearing care activities/plans (i.e. a lead agency) in your country? Where is this agency located within the government structure (please tick one)? The agency is a single government ministry/department, or situated within one government ministry/department (please specify ministry and department, if relevant) [] Stand-alone entity [] Other (please specify) [] Don’t know For which of the following functions is the lead agency responsible? (please tick all that apply) [] Yes [] No [] Don’t know Is funding allocated in the government’s budget for the lead agency to carry out the functions listed above? [] Yes (please name this agency) [] No (please skip to Section B) [] Don't know (please skip to Section B) [] Coordination of intergovernmental working processes at central government level [] Coordination of hearing care decision-making across central government [] Coordination across different levels of government (e.g. central, regional, local) [] Coordination of national mass media initiatives [] Establishing and supporting data systems that are used to monitor safe listening devices [] Compilation and dissemination of national statistics [] Periodic review of legislation, rules and standards against best practice, and recommendations for improvement [] Development and/or revision of legislation Section B. Leadership and governance 40 Section C. Strategy and targets National strategy profile Is there a national strategy for deafness and hearing loss prevention in your country? If yes, does this strategy include prevention of recreational noise-induced hearing loss? Is there a regulation regarding safe listening features in personal audio devices? If answer to any of the above is yes, do any strategies that exist include volume regulations on personal audio devices such as mobile phones, mp3 players, tablets, etc? Is there an awareness programme regarding noise control in environmental/recreational settings? If yes, does the awareness programme include a focus on safe listening? Are funds available to implement part or all of any strategies that exist? If a national strategy exists, does it set measurable targets to increase the number of personal music players with safe listening features? [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please submit relevant source documents) [] No [] Don't know [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please submit relevant source documents) [] No [] Don't know [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please provide details/source documents as annex) [] No [] Don't know [] Yes [] No [] Don’t know If yes, please provide the targets and their timeframes: • Device targeted increase: • Time period relating to device target (please specify start and end years that these targets relate to, e.g. (2002–2012) (2016-2020) [] Yes, fully funded [] Partially funded [] Not funded [] Don’t know Does the national strategy include recommendations for any of the following: Reducing volume level [] Yes [] No [] Don’t know Allowing users to keep track of their sound usage [] Yes [] No [] Don't know Showing messages to the user when reaching unsafe volume levels [] Yes [] No [] Don’t know Showing messages about safe listening practices [] Yes [] No [] Don't know Encouraging the use of earplugs in loud environments such as bars, sporting events and concerts [] Yes [] No [] Don't know 41 42 Please mention all potential and existing stakeholders in your country that are or could be involved in ear and hearing care services. Identify the lead or responsible position or person, where possible, and give contact details. Stakeholder profile Government departments List in order of perceived priority for collaboration in developing and implementing a safe listening strategy Name of Department Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Section D. Stakeholder analysis 43 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Professionals and academics List in order of experience and interest in the development and implementation of the safe listening strategy Name of Institute or association 44 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Name of Institute or association Civil society groups, including disabled persons’ organizations List in order of perceived priority for collaboration in developing and implementing the safe listening strategy 45 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Name of agency UN agencies 46 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Industry partners List in order of perceived priority, based on need for collaboration and possible interest of the stakeholder, in developing and implementing the Safe Listening strategy Name of Company 47 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Any others (can include any other groups that are interested in hearing loss prevention, noise control, audiology, acoustics or consumer rights) 48 Appendix 2 Outline of stakeholders planning meeting for regulations on safe listening The following stakeholder groups should be invited to the meeting: • Relevant government departments: technology, health, education, commerce and industry, environment, youth • Civil society groups including associations of hard of hearing; ngos, professional societies • Youth organizations • All manufacturers • Consumer electronics associations • Major retail groups • Consumer protection organizations • WHO and ITU representatives Purpose: • To inform stakeholders about the global standards and the country’s intention to implement them • To gain buy-in from relevant stakeholders in this respect • To discuss the way forward regarding adoption of standards and their implementation • To agree on timelines • To discuss customization and adaptation of the awareness materials The following outline is suggested: • Introductions • Need for safe listening • Current status in the country regarding regulations on safe listening • Global standards for safe listening • Perspectives required to implement safe listening strategies and regulations: – Government (Technology, health, any other) – Users (one representative to present user view) – Industry (umbrella organization or a company with leadership in this field to speak on behalf of industry) – Hearing care profession (one member from a professional, hearing-related organization to speak) – Civil society view (one speaker from a relevant civil society group to speak) • Possibilities regarding adoption and implementation of the Standard in the country (including timelines): discussion • Need for raising awareness and available tools • Determining the next steps for: – developing a regulation/legislation; – developing an awareness campaign and adapting awareness materials. WHO estimates that 1.1 billion young people worldwide could be at risk of hearing loss as a result of unsafe listening practices. Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD, Finucane M. Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries. Eur J Public Health 2013; 23: 146-52 (http://dx.doi.org/10.1093/eurpub/ckr176, accessed 19 January 2019). Hearing loss is on the rise! Overarching messages • Rise and ageing of the global population • 466 million people globally are currently living with disabling hearing loss • 630 million people estimated to be living with disabling hearing loss by 2030 • Over 900 million estimated to be living with disabling hearing loss by 2050 How do we hear? Appendix 3 Make listening safe initiative: Introductory presentation 49 Recreational noise, unsafe listening practices and the impact of hearing loss • Those exposed to loud sounds in social settings over the past 20 years are over three times more at risk of hearing loss compared to those unexposed. • 50% of people listening to music over their personal audio devices do so at levels which put their hearing at risk. • 5–10% of listeners are likely to develop hearing loss due to their personal volume preferences and duration of listening. • Depression, isolation, frustration, cognitive decline and decreased personal safety are twice as common among seniors with hearing loss than those without hearing loss. Noise-induced hearing loss is irreversible Photos from top to bottom by Thibault Trillet, Kevin Grieve, Simon Matzinger, Adobe PhotoStock. 50 Make listening safe initiative Smartphone technology can  provide a platform to  deliver targeted, customized safe listening interventions while continuing to provide an enjoyable experience to the listener. Technical aspects Acoustic dosimetry • Tracking users’ exposure time to sound • Estimating sound level • Estimating % used of a reference exposure, or sound allowance • Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h1 per 7 days as the reference exposure (i.e. 80 dBA SPL for 40 hours per week). • Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (i.e. 75 dBA SPL for 40 hours per week). Prevention This means creating an environment that enables the exercise of safe listening practices, including through: • Regulating exposure to loud sounds through personal audio systems.  • Undertaking public awareness campaigns to change listening behaviours among people aged 12 to 35 years. • Developing a regulatory framework for safe listening in recreational settings.  WHO-ITU H.870 Global standards for safe listening devices and systems 51 Volume limiting • Volume limiting message • "Continue listening" option • Default action: to reduce the volume output to a predetermined level • Customizing option Parental control  • Maximum sound output can be fixed and locked in the device’s settings Make listening safe toolkit Practical guide for implementation and follow-up of global safe listening standards in recreational settings to be adopted by all countries worldwide • Designed to support countries, industries and civil society in approaching noise-induced hearing loss prevention in a strategic, evidence-based and user-friendly way. • Targets three key stakeholders that can be instrumental in implementing the standards • Government: ministries/departments working in the field of health or technology • Industry: manufacturers of personal audio devices and systems • Civil society organizations: field of hearing or consumer rights The processes, steps and tools are provided for guidance and can be adapted, translated or modified by stakeholders to suit the needs of individual countries and manufacturers.   Personal usage information • Listening habits, including sound allowance • How to use safe listening features  Personalized recommendations and cues • Actions for safe listening • Customized advice based on user's listening profile General information • Safe listening and ways to practice it   • Risk associated with unsafe listening • Risk of hearing loss due to loud sounds from sources other than personal audio devices and systems Communication aspects 52 53 Appendix 4 Outline of sensitization workshop for regulations on safe listening The following groups should be invited to participate in the workshop: • Relevant government departments: technology, health, education, commerce and industry, environment, youth • All manufacturers • Consumer electronics associations • Major retail groups Purpose: To sensitize manufacturers and retailers regarding regulations on safe listening devices and to to guide them regarding implementation, timelines and reporting. The following outline is suggested: • Introductions • Rationale for safe listening standards • Outline of national regulations on standards: essential and optional components • Timelines for implementation • Monitoring/reporting mechanism on implementation • Manufacturers’ issues and concerns • Awareness materials that can be used for by manufacturers for distribution, social media and websites 54 Appendix 5 Advocacy materials Goal These awareness materials are designed to inform people about the risk of hearing loss due to unsafe listening; the concept of safe listening; and available tools to promote its practice. Who are these materials for? These evidence-based advocacy materials are intended to provide key stakeholders (government, industry and civil society organizations) with tools to raise awareness among policymakers and the public about safe listening. Advocacy materials WHO’s resources to promote safe listening are available at: www.who.int/deafness/make-listening-safe/advocacy-materials/en/ Communication objectives • Raise awareness and engage the public on the importance of safe listening practices. • Create a conversation on the risk of hearing loss due to loud sounds from sources such as personal audio systems and mobile devices. • Raise awareness about the risks of unsafe listening practices among teenagers and young adults. • Build an understanding of the importance of multisectoral engagement and action for implementing the WHO-ITU H.870 Global standard for safe listening devices and systems. • Promote examples of good multisectoral engagement leading to successful interventions that have addressed the issue of exposure to loud sounds in recreational settings. Overarching messages • Noise-induced hearing loss is irreversible! • Prevention is one of the most effective strategies to reduce the occurrence of noise-induced hearing loss. • Keeping the volume within safe levels and limiting the time spent engaged in noisy activities can reduce the risk of hearing loss. • Smartphone technology can be used as a means to promote and practice safe listening.  • The design and implementation of specific legislation can lead to a lower level of sound exposure 55 Infographic Share information and materials on social media Our social media channels • Follow us on Twitter, Facebook and Instagram @WHO and tag us in your posts Twitter official hashtag • #SafeListening Twitter official hashtag • #WHO • #HearingCare • #HearTheFuture • #WorldHearingDay 56 Poster 57 Brochure Tips for safe listening 58 Press release Related document 59 Videos Facebook posts Instagram posts 60 Tweets 61 FAQs 1. Introduction 2. How is loudness measured? What is dB? 3. What is safe listening? 4. How do loud sounds affect my ears? 5. How can I tell if my hearing has been affected? 6. Once I have lost my hearing can I get it back? 7. Is there a way to use a mobile phone to monitor my listening levels? 8. How can I monitor sound exposure or daily allowance for music that is not stored on my device? 9. What can I do to make my listening safe? 10. What can I do as a parent to ensure safe listening? 11. What can I do as a teacher to ensure safe listening? 12. What can I do as a physician to ensure safe listening? 13. What can I do as a manager of an entertainment venue to ensure safe listening? 14. What can I do as a manufacturer of personal audio devices to ensure safe listening? 15. What can governments do to ensure safe listening? Relevant websites • World Health Organization (WHO) http://www.who.int/deafness/make-listening-safe/en/ • Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/hearingloss/default.html • Action on Hearing Loss https://www.actiononhearingloss.org.uk/ • European Union of the Deaf https://www.eud.eu/ • Hear The World Foundation https://www.hear-the-world.com/en • American Speech Language Hearing Association – Listen To Your Buds campaign https://www.asha.org/buds/ • Dangerous Decibels http://dangerousdecibels.org/ Media interest If you are a journalist interested in covering issues related to the Make Listening Safe initiative please email us at whopbd@who.int 62 2 The full text of the H.870 Guidelines for safe listening devices/systems is available at https://www.itu.int/rec/T- REC-H.870-201808-I/en Appendix 6 Summary of WHO–ITU global standard H.870 for safe listening devices and systems Safe listening refers to listening behaviour that does not put a person’s hearing at risk. The risk of hearing loss depends on the level (loudness), duration (time period) and frequency of exposure to loud sounds. Such exposure may be through personal audio devices, in entertainment venues, or outside (for example in traffic), in the workplace, or at home. The WHO–ITU H.870 standard describes requirements for personal and portable audio systems, especially those for playing music, with the aim of protecting people from developing hearing loss as a result of their use. It provides a glossary for common terms to help understanding, as well as background information on sound, hearing and hearing loss. The Standard recommends criteria for avoiding unsafe listening: one for adults and the other for children, both based on the equal energy principle. Importantly, the Standard provides guidelines on health communication for safe-listening so that appropriate warning messages can be delivered effectively when necessary. Examples of such messages can be found in the Standard’s Appendix VII. Finally, the Standard also provides information about implementation of dosimetry and related issues. The key aspects of the WHO–ITU H.870 standard for safe listening devices/systems are summarized below. 63 1. Scope of the standard This document describes requirements for personal/portable audio systems, especially those used for playing music, in order to reduce the risk of hearing loss posed to the users of these devices. Figure 6.1: Architecture of a personal audio system In such devices, “source” can be either stored or retrieved remotely, e.g., streaming from a local server or the Internet (see Figure 6.1) A PAS is intended for use by an ordinary person and; • is designed to allow the user to listen to audio or audiovisual content / material; and • uses a listening device, such as headphones or earphones that can be worn in or on or around the ears; and • has a player that can be body worn (of a size suitable to be carried in a clothing pocket) and is intended for the user to walk around with while in continuous use (for example, on a street, in a subway, at an airport, etc.) Examples are portable CD players, MP3 audio players, mobile phones with MP3 type features, PDAs or similar equipment. For the purposes of this Standard, the following types of devices are excluded: • Communication devices (walkie-talkies, etc.) • Rehabilitative and medical devices (e.g. hearing aids, FM systems, and other assistive listening devices (ALD) approved as part of hearing aids and cochlear implants systems, etc.) • Personal sound amplification devices • Professional audio equipment and devices • Portable game consoles Personal Audio Device Personal Audio System Listening Device Effect Effect Volume ControlSource DAC Transducer 64 2. Equal energy principle The recommendations of this Standard are based on the equal energy principle. This is the assumption that the total effect of sound on ear and hearing is proportional to the total amount of sound energy received by the ear, irrespective of the distribution of that energy in time. According to this principle, equal amounts of sound energy is expected to cause equal amounts of sound induced permanent threshold shift regardless of the distribution of the energy across time. In practical terms this implies that listening to lower volumes for long periods of time can have the same impact as listening to very loud volumes for a short duration e.g. listening to a 100 dB sound for 16 minutes will have the same impact as listening to an 80 dB sound for 40 hours. Based on this principle, “dose” of sound energy is defined as the squared A-weighted sound pressure, , integrated over the exposure time Mathematically, this is expressed as: Where is the A-weighted and diffuse-field corrected sound pressure. The unit of this value is Pascal squared hours, or Pa2 h. 3. Reference exposure/sound allowance, operational modes It is recommended that each device includes a system that tracks the user’s exposure time and loudness level, and estimates the percentage used of a reference exposure (also referred to as sound allowance) This must take account of all media played through the device (i.e. whether it is stored on the device itself, or streamed) during times when the user is using ear/headphones. Voice calls may be excluded as they are separately specified by other standards. It is also recommended that the device allow the user to select their reference exposure as one of two operational modes: Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h per 7 days as the reference exposure (derived from 80dBA for 40 hours a week) Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (derived from 75dB for 40 hours a week) The user should be allowed to select either of the two modes when using the player for the first time (or when the device is reset to factory settings). It should be possible for the user to change the mode choice at a later time, e.g. via a device settings menu. 65 Sound allowance Refers to a dose estimate of sound exposure over a certain rolling period of time (e.g., daily or weekly), commonly expressed as a percentage of the reference exposure. A 100% weekly sound allowance is equivalent to the weekly reference exposure, based on the mode selected. Examples of weekly listening time duration based on sound allowance for the modes described earlier can be found in Table 1 and Table 2. Table 1: Example of weekly listening Table 2: Example of weekly listening dB(A) SPL Weekly (0.51 Pa h )2 107 104 101 98 95 92 89 86 83 80 24 minutes 12 minutes 6 minutes 3 minutes 1.5 minutes 48 minutes 6 hours 24 minutes 3 hours 15 minutes 1 hours 36 minutes 12 hours 30 minutes 77 25 hours 75 40 hours time for Mode 1 time for Mode 2 dB(A) SPL Weekly (1.6 Pa h )2 107 4.5 minutes 104 9.5 minutes 101 18.75 minutes 98 37.5 minutes 95 75 minutes 92 2.5 hours 89 5 hours 86 10 hours 83 20 hours 80 40 hours 66 4. Measurement methods/acoustic dosimetry Standard H.870 defines dose in the context of acoustic dosimetry. Under mode 1, 1.6 Pa2h constitutes 100% weekly sound allowance, corresponding to 100% calculated sound dose (CSD) as defined in [EN 50332-3]. For mode 2, 0.51 Pa2h is the total weekly sound allowance or reference exposure. Standard H.870 also refers to other related standards that describe a dose measurement system in a portable music player (PMP). [IEC 61252] describes acoustic dosimeters to be worn on the body including [EN 50332-1], [EN 50332-2] and [EN 50332-3]. Appendix II of H.870 gives an example of how a dosimeter can be implemented in a personal audio system when measuring the digital media signal and considering known or assumed properties of headphones. It is based on the equal energy principle in hearing loss risk assessment, where the squared A-weighted sound pressure, integrated over the exposure time, constitutes the dose. The dosimeter functionality is tested by playing the programme simulation sound according to [EN 50332-1] and [IEC 60268-1] and measuring the time until the dose estimate reaches 100% CSD, using interpolation and tolerances as described in [EN 50332-3]. Such testing may be performed in the acoustic domain (when a certain headset is used) or in the electrical domain using a 32 Ω resistive load (when the headset characteristics are unknown). See measurement setup information in [ITU-T P.381]. Uncertainties: In estimating sound dose there are a number of sources for uncertainties and margin of error can be very high. It is therefore suggested to refrain from signalling “safe” and “green” to the user based on dose readings below a certain limit. The dose estimation is however relevant in accounting for the general trends: • Higher signal level means higher risk • Longer exposure means higher risk • The spectral content of the music is accounted for 67 Refers to the hardware components (such as screen) that allows a human being to interact with an electronic device. 5. Health communication A key aspect of the Standard is to provide user with a tool that will allow them to monitor their own personal sound exposure. Such a tool should give users the choice of safe listening, and empower them to make informed choices for listening through greater awareness. This section of the Standard summary outlines its health communication aspects that should be applied for complete implementation of standards for safe listening devices. Specifically, it presents evidence-based recommendations on how to communicate the risks of unsafe listening and support users in adopting appropriate behaviour in this respect. Purpose of including health communication as part of the standards for safe listening personal audio systems The intent is to provide users with information and guidance to enable them to make safe listening choices. These include providing: • Personal usage information, in order for the user to know: – their own listening habits (use of daily and weekly sound allowance); – how to use safe listening features of the specific devices. • Personalized recommendations and cues for actions for safe listening, customized based on each user’s listening profile. • General information on: – safe listening and ways to practice it; – the risk associated with unsafe listening; – the risk of hearing loss due to loud sounds from sources other than the personal audio system. This information and guidance must be shared by default with users via their mobile devices in order to reduce the risk of hearing loss. Key recommendations for communication as part of safe listening devices Information and messages on safe listening must be provided through: • the device interface3 (wherever an appropriate visual interface is available); • instruction manuals; • when possible, information about the safe listening features of the device should be included on or in the packaging. 68 6.1 Information delivered through device interface Personal usage information Information regarding various listening parameters defining the users’ listening habits should be accessible to users in order to allow them to keep track of their exposure to sound through the device. For devices with a screen, this could be through an icon on the screen. Through the icon, the user should be able to see their use of daily/weekly sound allowance in an easy to understand presentation, e.g. the person may be able to view how much of the weekly sound allowance has been used and to see how their listening behaviour has been over the past seven days. In devices without screen, the information should be made available through alternate means, such as audio cues. The device (when capable) should display: • the average sound level for the day and week; • the time for which the user has listened in hours and minutes over the day and the week. Figure 6.2 gives a non-normative example of information provided on a smartphone visual interface for safe listening Figure 6.2: Examples of information provided on a smartphone visual interface for safe listening Today’s sound allowance Sound track #5 Disclosure 51.6% Time left: 01:14:17 Today’ Listening time: 37 min Average dB level (leg) : 93.3 dB 90 80 70 60 50 40 30 20 10 0 52% Today’s sound allowance 52% Today’s sound allowance Sound track #5 Disclosure 119.5% Time left: 00:00:00 Today’ Listening time: 1.80 h Average dB level (leg) : 93.5 dB 90 80 70 60 50 40 30 20 10 0 120% Today’s sound allowance 120% 69 Personalized recommendations and cues for actions and messages: a.The device should give relevant warnings and cues for actions when the user exceeds 100% of the weekly allowance. • The user will receive first a “warning” expressed through text and visuals informing that a threshold has been reached and that from this point on, further listening at the same volume will pose a hearing risk. • The warning will be followed by a “cue for action” in which the user is offered the choice to either accept the risk of continued listening or protect their hearing. The “cue for action” should be linked to active options on the device, such as: – automatic safe volume option, by which the device automatically changes the volume to a safe volume level; – direct access to volume settings; – set up of default volume limits; – “remind me later” option; – “ignore and continue” option. • If the user fails to take any action, the volume will automatically be reduced to below the standard level (80 or 75 dBA as selected). b.The device should provide relevant messages when the sound allowance usage reaches certain pre-determined levels. Refer to Appendix 8 for the suggested levels at which warnings/cues can be given and sample content. Such warnings depend on the device’s capability and should be multimodal, e.g. a mix of visual, vibratory or audible warnings, in order to ensure that the user’s attention can be directed towards these.Figure 6.3 gives non-normative examples of messaging displayed in a smart watch. Figure 6.3: Example of messaging displayed in a smart watch 50% of daily allowance: you have spent 50% of your safe listening allowance for the day. keep the volume low to listen longer. SAFELISTEN Hey! Your last sound dose was 60%. Well done! Keep listening safely. SAFELISTEN Daily messages: the device should provide a daily summary message based on the user’s listening behaviour in recent days, encouraging safe listening habits and discouraging or warning against unsafe listening habits. Examples of such messages are provided in Appendix 8 General information: when the device has a screen, information on what is safe listening and its benefits – as well as the risks posed by unsafe listening – should be displayed on the screen. It is recommended that the availability of this information be indicated on the user interface (home screen) through a distinct and recognizable icon. Figure 6.4 gives a non-normative example of a safe listening icon displayed on a smartphone screen. How does loud music affect my ears? What is safe listening? How can I make listening safe on my device? No, thanks. Play my music Safe listen What are first signs of hearing damage? What does hearing loss sound like? Hearing damage may not be noticeable initially. At first you may only have trouble hearing high-pitched sounds like bells or experience persistent tinnitus. Find out here. Centres for disease control and prevention Hear the word Information What is safe listening? OK, thanks. Play my music Figure 6.5: Examples of screens linking to information on safe listening and external links Figure 6.4: Safe listening icon displayed on a smartphone screen There should be a tutorial informing users about safe listening; the risks of unsafe listening; and the device’s safe listening features and how to use them. The screens should also include links to relevant webpages where the user can find more information. Figure 6.5 gives non-normative examples of screens linking to information on safe listening and external links. 70 71 6.2 Information delivered by means other than the device itself User manual The user manual should clearly state that unsafe listening practices using the device pose the risk of permanent hearing loss. It should also give details of the volume-limiting functions and cues for action. The user manual should also clearly outline how the allowance-assessment system works and refer to its uncertainty. It should indicate that information on the device does not take into account additional sources of sound exposures either from other audio devices or environmental sound exposure. The manual could also provide information regarding hearing protections from loud environmental sounds in order to minimize the risk of hearing loss. Packaging Wherever possible, a clear, concise message or warning should included on the external packaging of the device. It is recommended that such a warning/message be: • concise, simple and clear; • accompanied by a relevant illustration; • positioned on a plain background. Website and advertising Information on safe listening should be included on the manufacturer’s website. Such information should be aligned to the specifications in Standard H.870. A link to WHO website and other relevant, reputable websites could be included. Wherever possible, advertising of products could also provide relevant information. Such information can refer to both the potential harm to hearing through improper use of their device and the advantages of listening safely in order to maintain healthy hearing while enjoying a good listening experience. 7. Volume control Volume limiting: as per Standard H.870, the device should provide the user with a suitable method for volume-limiting. This refers to a feature where a message will be given before or when the user reaches 100% of the weekly allowance, offering them the option to “continue listening”, if they do not wish the device volume to reduce. When the message is not acknowledged, the default action will be to reduce the volume output to the predetermined level. If possible, users should be given the option to customize this level (the level at which they would like their device to limit the volume) according to their preference. Parental control: it is recommended that the device should have the option whereby the maximum sound output can be fixed and locked in the settings, possibly through use of a password. The purpose of this feature is to allow parents (or other adults) to limit the maximum sound output of the child’s device, in a way that cannot be changed by the child. The feature can also be used by individual users in order to limit their own sound exposure, by fixing the maximum output on their device. 72 73 Packaging •A clear, concise message/warning should be included on the external packaging of the devices, wherever possible. •Messages should appear on a plain background and be short, simple, and clear, with a relevant illustration. •The manual should clearly state that unsafe listening via the device may pose the risk of permanent hearing loss. •It should indicate that the device is equipped with safety features to help users protect their hearing. •This message should align with information provided through the device interface. It should contain similar text regarding the risks of hearing loss from unsafe listening and the recommendations for safe listening. •It should also detail the safe listening features within the device. •A visible icon on the device screen will direct users to the general information on safe listening. •This icon will also lead the user to a display (in devices with screens) which provides information regarding individuals' listening parameters and (daily and weekly) usage statistics. •The first use of ear/headphones with the device should direct the user to a tutorial with information on safe listening, how to practice it, and their personal listening profile (same information as available through the icon). •It will describe the standard levels for adults and children and allow the user to select a level. •Users will be given the option to set up how often and at what levels of usage they wish to receive the notifications. • The information on the daily/weekly sound allowance consumption is available to users at any time through the distinctive icon above mentioned. • Calculation should include all sounds played through the music players or online, as long as ear/headphones are used. • The displayed information should include: weekly allowance used and remaining; listening time (for the day/week), and indicate how the user's listening has been for the past 7 days, including current day, where possible. •Warnings and cues for action shall be delivered every time the user reaches 100% of the allowance exposure levels and also as per settings customized by the user. •These should be visual (where possible) and audible/vibratory to ensure that the user's attention be directed towards these. •The notifications should include information on the level of audio usage and the corresponding recommendations for safe listening. •The first time a user connects to an ear/headphones or starts playing music on a given day, the device could give a welcome message based on the usage on the previous days/week. User manual Device interface 1st use Personal Usage Notications Daily alerts Appendix 7 This section and the figure below contains suggested steps for explaining how the communication aspects of the standard can be implemented within devices Figure 7.1: Flow of information as part of standards for safe listening devices Example of information flow Example of how the information on listening parameters can be conveyed to users Through a clearly recognisable icon, users should be able to access a “dedicated space” (screen) on the device where information on the user’s listening habits is stored, visualized and interpreted. In this space, the user should be able to access a graphic representation of his/her overall listening habits or patterns and learn if (and what type of) unsafe listening practices have occurred. The visualization of the user’s listening habits will include: • graphic display of the use of weekly sound allowance; • graphic display of daily sound exposure through a colour-coded display; • duration of listening, over each day and the past 7 days in hours and minutes. 1. Information on use of weekly allowance Use of weekly allowance can be graphically conveyed as illustrated in Figure 7.2 Figure 7.2 – Illustration of how to graphically convey the use of a weekly allowance 2. Information on how the user has used the allowance on any day For the purpose of this display, the maximum daily allowance will be equal to weekly allowance divided by 7 (approximately 15% of the weekly allowance). Usage for the last 7 days (including the present day) would be indicated by a range of colours depicting different levels of usage, e.g. red for over 100% use and green when use is below 50%. For the purpose of this communication, each day would be considered as a separate unit and colour coding for the day would not take the previous days’ exposure into account. Hence, the user would start with green icon each day, regardless of past days’ usage. Used Remaining 60% 40% Listening time (for last 7 days): 4 hours 20 minutes 74 75 3. Listening time Information on the overall time the user spent listening to audio content through the device each day will also be displayed (as shown in Figure 7.3.) Figure 7.3 – Information on the overall daily time the user spent listening to audio content 4. Warnings and cues for actions Warnings accompanied by cues for action should be provided to the user regularly: • When reaching 80% and 100% of the weekly allowance. • Upon reaching 100% of weekly allowance, the device should automatically reduce the volume to the reference level unless the user choses to continue listening at high volume despite the risk communicated. • Each message should be accompanied by a cue for action that will facilitate the listener to reduce the volume or stop listening. • Every day, the user should be provided with a notification informing them of how their listening has been over the last day and suggesting action to be taken that day. This may be an encouraging or warning type of message. Examples of such messages and cues for action are included in annex 8. Date-6 Date-5 Date-4 Date-3 Date-2 Date-1 Date (Today) Time 1h 5m 1h 20m 2h 1m 1h 50m 2h 5m 3h 2m 2h 50m safe unsafe 76 Appendix 8 Key considerations when developing messages and examples Given below are some evidence-based considerations for manufacturers develop messages as part of the safe listening features for their devices. As far as possible, manufacturers should try to develop messages which are appropriate for the cultural and linguistic context of the country. • The aim of such messages is to gain attention, build interest and encourage users to practice safe listening. • They should share actionable information, provide viable alternative behaviours and facilitate safe listening practices. Points to consider while developing such messages/cues are: • They should clearly convey the benefits of safe listening and the risks of not doing so. • There should be 3–4 variations of each message that can convey the information in a non- repetitive manner, designed to address a wide audience. • Text should be simple, clear and jargon-free in order that they can be understood by the majority of users. • Some messages should be positively and others negatively worded. • Written information should be complemented by pictorial information for ease of understanding. • Messages should be based on recommendations from a credible source. • Wherever possible, messages should be pre-tested by the manufacturer before use. The following are some examples of warnings and cues for action for the safe listening features. Examples of warnings and cues based on weekly use Information when user reaches: a. 80% of weekly allowance: friendly warning message: You have already spent 80% of your allowance. Turn down the volume to protect your hearing Reduce volume/Stop listening/Ignore warning/Go to personal usage information. OR Hello! It looks like you have been playing a lot of loud music lately. Why don't you take a short break to protect your hearing? Reduce volume/Stop listening/Ignore warning/Go to personal usage information. 77 b. 100% of weekly allowance: warning message (with an option to pause listening immediately): You are now OVER 100% of your safe listening allowance. Unsafe listening poses a risk to your hearing. Reduce volume/Stop listening/Ignore warning/Go to personal usage information OR Hey! You have played too much loud music recently. Take a break and protect your hearing. Reduce volume/Stop listening/Ignore warning/Go to personal usage information Unless the user agrees to “ignore warning: or to “pause listening”, the default will reduce the volume to below an average of 80 or 75 dB Examples of messages based on daily use Daily message (when opening the app or at player page) which should be based on the user’s use of sound allowance over the last few days: a. Mostly in green (where the user stays below 50% weekly usage most days, not exceeding the allowance on any day): encouraging messages Good job. This is the way to listen well Good job! Keep playing music safely for endless fun Well done. Keep listening safely and have endless fun b. Mostly green or yellow/orange (where the user stays below 80% on most days, not exceeding the allowance on any day): Be careful and listen safely. Hey! It seems that sometimes you enjoy high volume! Be careful and protect your hearing for endless fun! You can listen safely for longer by lowering the volume 78 c. Mostly yellow/orange with occasional red (where the user is not exceeding the allowance on any day): Be careful! Keep the volume down to listen safely for longer Hey! It seems that sometimes you enjoy loud music! Be careful and protect your hearing for endless fun! Hey! You should watch how you listen. d. Mostly red (exceeding the allowance on most days): You are putting your hearing at risk. Keep the volume low to listen safely Hey! You need to watch how you listen. Turn it down. Hey! It seems that you enjoy really loud music! Don't put your hearing at risk and have endless fun. Examples of messages with positive versus negative frame; and emotional versus rational appeal Positive frame: You exceeded your daily allowance for safe listening. Keeping the volume low lets you listen safely for longer without risk to hearing. Turn it down. Negative frame: You exceeded your daily allowance for safe listening. If you keep listening this way, you risk damaging you hearing forever. Turn it down Rational appeal: The evidence says that if you listen to music above the 80 dBA SPL, for 8 hours or its equivalent, you might damage your hearing forever. Turn down the volume. Emotional appeal: Once you lose your hearing, it will not come back. Listen safely. Turn down the volume. 79 Appendix 9 Resources for school-based workshops for safe listening Cheers for Ears Developed by the Ear Science Institute Australia, Cheers for Ears educates school students aged 10 to 12 years old about the dangers of hearing loss and its prevention. The programs use various multimedia materials and provide interactive sessions in schools. Aside from the programs, the team has created a number of activities including: Safe Hearing Suzie, Epic Ear Defence and Cheers for Ears Charlie, the mascot. These activities have been successful in encouraging safe listening among 21,300 children at 226 schools over last three years. There are three aims of the project: “to develop a health promotion program to educate primary school-aged children in the dangers of exposure to dangerous levels of noise and music,” “to develop an application to monitor and track noise exposure from personal music players,” and “to develop an Internet resource as a central information site for all matters related to NIHL and exposure to entertainment-related sounds.” For more information on Cheers for Ears, go to http://www.hearingservices.gov.au/wps/wcm/connect/8c6fc19a-4f10-4307-93f3-d350f50fbe5b/che ers-for-ears.pdf?MOD=AJPERES Resources • Safe Hearing Suzie is a mannequin head with a built-in sound level meter and hearing loss simulator. Suzie shows the decibel level of the sound as well as information on whether the sound is a safe listening volume or not. Therefore, Suzie teaches students about the truths and risks of NIHL. • Epic Ear Defence is an online game that students can actively engage in learning the importance of protecting ears. During the game, players have to use defensive techniques to fight off the incoming loud sounds (enemy). “As more loud sounds escape the player and reach the eardrum, the game begins to subtly simulate hearing loss and tinnitus into the over sound track.” This simulation is an engaging activity that people can enjoy while learning the importance of hearing. • Cheers for Ears Charlie is the mascot, shown as a superhero demonstrating headphones as a way to reduce the risk of NIHL. This mascot appears in different settings such as Hearing Awareness Week, school assemblies, and children’s festivals. • Workshops are delivered to schools, and age-appropriate presentations are used. Classroom activities include poster competition, creating a television or radio advertisement and quiz. Contact Information • For more information, email Natalie Leishman natalie.leishman@earscience.org.au 80 Hear 4 Tomorrow Hear 4 Tomorrow is a classroom-based program to educate primary school children about ear health. It was primarily designed for school teachers as a teaching tool with various curricula. The extensive curriculum is composed of four educational modules: understanding hearing loss, the hearing system and noise, how loud is too loud and protecting our hearing. Each module covers different aspects of hearing health, and students learn noise reduction behaviour. The aim of Hear 4 Tomorrow is “to provide teachers with a resource that enables them to teach hearing health in a way that complements their existing teaching programmes.” For more information on Hear 4 Tomorrow, go to https://hear4tomorrow.nal.gov.au/index.html. Resources • For each module, there is a variety of resources that students experience. – Hearing Loss Simulation allows people to have a hands-on experience of hearing loss at different levels. It demonstrates how the audio might sound for a 35-year-old with NIHL or how the audio might sound like for people with NIHL and tinnitus altogether. By providing different cases of diagnosis, the hearing loss simulation helps them understand hearing loss and its challenges. – Students learn to measure the levels of different noises and the relationship between volume and duration of exposure through the flash cards. – Teaching notes are provided. Contact Information • Hear 4 Tomorrow was developed by the National Acoustic Laboratories, the research division of Australian Hearing. You can contact enquiries@nal.gov.au Dangerous Decibels Dangerous Decibels focusses on three ways to prevent noise-induced hearing loss. The programme gives classroom presentation to schools that teach the concepts of noise-induced hearing loss and preventive strategies. Through an interactive workshop, it highlights the importance of protecting the hearing health and suggests to “walk away,” “turn it down,” and “use earplugs.” This school-based workshop has been tested for effectiveness and they haveshown that such presentation is very effective in modifying behavior, knowledge and attitudes among the primary school students. The aim is to “reduce the incidence and prevalence of noise-induced hearing loss (NIHL) and tinnitus (ringing in the ear) by changing knowledge, attitudes, and behaviors of school-aged children.” The programme has created Jolene, a mannequin equipped with a sound level meter, which attracts children and promotes safe listening. 81 Resources • Jolene and the Jolene cookbook: Jolene was constructed using a used fashion mannequin and a sound level meter wired to a silicon ear. Jolene makes appearances at schools and universities, scientific meetings, health fairs, and many other public events. Jolene has also been used as a research tool to study the beliefs and listening practices regarding personal stereo systems. Jolene cookbook is the production by the National Hearing Conservation Association for people to make their own Jolene. • Coloring Sheets is a set of three coloring sheets for the young kids. They make good take-homes. For more resources, please go to http://dangerousdecibels.org/. Noisy Planet Noisy Planet is a public education campaign, developed by the National Institute on Deafness and Other Communication Disorders (NIDCD). Noisy Planet has numerous teaching toolkits for different groups of people (parents, health teacher, school nurses and health professionals). Their aim is to “increase awareness of the causes and prevention of noise-induced hearing loss.” These educational resources include toolkits, advice and tips for safe listening. According to data from two surveys, the Noisy Planet is very effective in reaching target audiences. Additionally, Wise Ear campaign, also launched by the NIDCD, educates primary school students about preventing noise-induced hearing loss. For more information, go to https://www.noisyplanet.nidcd.nih.gov. Resources • The website provides noisy planet presentation, student activity videos and other resources • There are training videos that show the activities in the presentation. Instructions provide in-depth descriptions of each activity, including the required equipment, number of student volunteers needed, and the estimated time for each activity. Contact Information • For general questions, contact NPInfo@nidcd.nih.gov Listen to Your Buds Developed by American Speech and Hearing Association (ASHA), Listen to Your Buds campaign provides various instructions on how to prevent hearing loss through teaching materials. The campaign is delivering an important health message that all parents and kids need to hear. It aims to “make effective communication a human right, accessible and achievable for all.” The campaign educates the public about the risk of hearing loss in children from the unsafe use of personal audio technology, particularly earbuds or headphones. Furthermore, the Listen To Your Buds concert series visit schools, teaching kids about the importance of technology to protect their hearing health. For more information, go to https://www.asha.org/buds/. 82 Resources • Interactive school-based workshops are held in primary schools. Elementary school students learn how to protect their hearing for a lifetime from renowned musicians. Video: https://www.youtube.com/watch?v=cfkPUnWBmiI • Listen to Your Buds Bookmarks • Listen to Your Buds Colouring Book • Turn Down the Volume Song • Radio Disney PSA (educative narrative to protect hearing) • Self-Test for Hearing Loss Contact Information • There is no direct email address but contacting ASHA is possible by filling out information: https://www.asha.org/Forms/Contact-ASHA/

FOR MORE INFORMATION PLEASE CONTACT: Department for Management of NCDs, Disability, Violence and Injury Prevention https://www.who.int/deafness/make-listening-safe/en/ World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland ISBN 978-92-4-151528-3

Make Listening Safe Toolkit for safe listening devices and systems

Make Listening Safe Toolkit for safe listening devices and systems Toolkit for safe listening devices and systems ISBN 978-92-4-151528-3 (WHO) ISBN 978-92-61-28411-4 (ITU) © World Health Organization and International Telecommunication Union, 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO or ITU endorses any specific organization, products or services. The unauthorized use of the WHO or ITU names or logos is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Foreword Acknowledgements Executive summary Background Noise as a risk factor for hearing Impact of hearing loss WHO’s Make Listening Safe initiative Rationale for a standard for safe listening devices WHO-ITU H.870 Global standard on safe listening devices and systems Developing the WHO-ITU Global standard Objective of the toolkit Implementation by goverments Rationale What actions can governments take? Implementation by industry partners Rationale What actions can manufacturers take? Role of civil society Rationale What actions can civil society organizations take References and Bibliography Appendices Appendix 1: Situation assessment tool Appendix 2: Format for stakeholders' consultation Appendix 3: Introductory presentation with key messages Appendix 4: Outline of sensitization workshop Appendix 5: Materials for raising awareness Appendix 6: Summary of WHO–ITU global standard Appendix 7: Example of information flow Appendix 8: Key considerations when developing messages and examples Appendix 9: Resources for school - based workshops on safe listening Contents 8 8 9 10 10 11 11 13 16 16 17 22 22 22 28 28 28 32 36 36 48 49 53 54 62 73 76 79 Foreword Globally, a billion teenagers and young adults are at risk of developing hearing loss due to the practice of listening to music at high volumes for prolonged time over their personal audio devices. Once hearing loss due to loud sounds sets in, it cannot be reversed. Such hearing loss, if unaddressed, can greatly impact one’s ability to communicate, gain education or find and hold suitable employment. However, hearing loss that results from loud sounds can be prevented through raised awareness and appropriate prevented measures. To address this issue the World Health Organization (WHO) and the International Telecommunications Union (ITU) have developed the Toolkit for safe listening devices and systems, which provides the necessary practical guidance for the implementation of the Global standard for safe listening devices (ITU-T H.870). The standard outlines key features to regulate the user’s exposure to sound, limit volume and provide information on safe listening. The implementation of the safe listening features recommended here will be key to protect users from hearing loss caused by loud sounds and ensuring that people can continue enjoying the sounds they like listening to. Governments can act by regulating for the standard and manufacturers can develop and market devices that implement the recommendations of the toolkit. Civil society can advocate for the implementation of the standard and raise awareness on safe listening. ITU and WHO call upon Member States, industry partners and civil society to play their part in promoting safe listening and in addressing this emerging health challenge. The use of this toolkit and implementation of the H.870 global standard will promote the responsible use of technology to enhance health and wellbeing among its users. Ms Doreen Bogdan-Martin, ITU Dr Etienne Krug, WHO Dr. Etienne Krug Director, Department for Management of NCDs’, Disability, Violence and Injury Prevention (NVI), World Health Organization Ms. Doreen Bogdan-Martin Director, Telecommunication Development Bureau (BDT), International Telecommunication Union Acknowledgements The World Health Organization (WHO) and International Telecommunications Union (ITU) gratefully acknowledge the following contributors to this handbook. Content development: Elena Altieri, Young-Se An, Simao Campos-Neto, Shelly Chadha, Alarcos Cieza, Nicola Diviani, Catalina Valencia Mayer, Ericka Lara Ovares, Karen Reyes, Sara Rubinelli, Roxana Widmer-Iliescu. Guidance: Etienne Krug, Tamitza Toroyan. Further contributions: Lidia Best, Avi Blau, Brian Fligor, Mark Laureyns, Richard Neitzel, Michael Santucci. Administrative support: Laure Cartillier, Alina Lashko. Editing: Angela Burton. Layout and Design: 7 Estudio Creativo. Executive summary This toolkit provides practical guidance to support Member States, industry partners and civil society groups in the use and implementation of the WHO-ITU H.870 Global standard on safe listening devices and systems. The WHO-ITU Global standard is the result of a collaboration between the World Health Organization (WHO) and the International Telecommunication Union (ITU), and has been developed in response to the growing prevalence of hearing loss and the threat to hearing posed by unsafe listening. The WHO-ITU Global standard has been deve-lo-ped using an evidence-based and consultative process, with the participation of experts in the field of sound, audiology, acoustics, communication, and smartphone technology. This toolkit outlines the need for hearing loss prevention and describes how WHO and ITU have shaped their response to this. It summarizes the WHO-ITU Global standard in a simplified way and provides a step-wise approach for implementation by three main partners in the field of hearing loss prevention: • Governments • Industry • Civil society A section tailored to each partner outlines the steps necessary for effective implementation of the WHO-ITU Global standard. A variety of tools are included to help with this: a situation assessment tool; an outline of planning workshops; and sample awareness-raising commu-ni-cations and slide presentations. The aim of the toolkit is to make it easy for partners to adopt, implement and monitor the WHO-ITU Global standard. Its overall goal is to ensure that all users of personal audio systems are empowered with information on safe listening and have the option to make safe listening choices in order to protect their hearing. Background 8Background WHO estimates that over a billion young people worldwide are at risk of hearing loss due to unsafe listening practices (1). Action is therefore urgently needed. In recent years, there has been a rapid growth in access to technology and an ever-increasing number of people are using such technology to communicate. In addition, there has been a significant increase in the number of people exposed to loud sounds through use of personal audio systems as well as in entertainment venues, which put them at high risk of damaging their hearing. Overall, the number of people with hearing loss is growing at a rapid pace. It is estimated that there are currently around 466 million people with disabling hearing loss globally (2). Of this total, 432 million (93%) are adults and 34 million (7%) are children. Recent WHO projections suggest that unless action is taken, there will be 630 million people living with disabling hearing loss by 2030. This number is expected to grow to over 900 million by 2050 (2) along with a proportionate rise in the current annual cost of more than US$ 750 billion (in international dollars) globally if hearing loss is not addressed (1,3). Several risk factors affect a person’s hearing throughout life. While some of the risk factors associated with hearing loss are declining in parts of the world (e.g. rubella and meningitis), preventable factors such as noise (which are mainly a consequence of our modern way of life) are on the rise. Noise-induced hearing loss can be caused by a variety of environments and behaviours. For example, 40% of those frequenting such discotheques, clubs, sporting events or music concerts are exposed to potentially damaging sound levels (4). There is evidence that those exposed over the past 20 years to loud sounds in social settings are three times more likely to suffer hearing loss than those unexposed. Noise as a risk factor for hearing Ears are the organs that process sounds, enabling the brain to interpret what the individual is hearing. The ear is divided into three parts – outer ear, middle ear, and inner ear (see Figure 1). Usually sound is perceived by the sensory cells located in the inner ear, and when these cells are exposed frequently to loud sounds they can be permanently damaged, affecting individual’s hearing. Figure 1: Structure of the ear. 9The widespread uptake of personal audio devices such as smartphones and MP3 players has added to this risk. Smartphone use in developing countries has grown from 45% in 2013 to 54% in 2015 (7) and in in developed countries this figure stands at 87%. It is estimated that 50% of those listening to music over their personal audio devices do so at levels that put their hearing at risk (4). This toolkit focusses on hearing loss caused by unsafe listening using personal audio devices. Unsafe listening practices were identified as a major contributor to hearing loss by the Scientific Committee on Emerging and Newly Identified Health Risks in 2008. The committee indicated that 5–10% of listeners are likely to develop hearing loss due to their personal preferences of volume levels and duration of listening. (8) The availability of evidence varied across countries, but one study revealed that more than 40 million adults in the Americas between the ages of 20 and 69 are affected by noise-induced hearing loss due to non-occupational causes (5). Impact of hearing loss Noise-induced hearing loss in young children impairs language acquisition (6,7), learning disabilities, anxiety and attention seeking behaviours are also common in children exposed to loud sounds. (11) Chronic noise exposure in classrooms affects academic performance in areas such as reading ability, comprehension, short and long term memory, and motivation. On average, children who are exposed to noisy learning environments have lower assessment scores on standardized tests, which in the long term might affect their academic and profes-sional development (4, 8). In adults, unaddressed hearing loss can mean loss of earnings and difficulty in finding and retaining jobs. In Europe, for example, people with unaddressed hearing loss are twice as likely to be unemployed compared to their normal hearing peers. When employed they often earn lower wages, for example in the USA, wages are found to be between 50% and 70% lower for adults with unaddressed hearing loss. It affects social relationships and can be a cause for stress in domestic relationships. Noise exposure in young people also contributes to age-related hearing loss that can lead to significant communication difficulties, with the subsequent emotional and cognitive effect this might imply (9). Recent evidence suggests that outcomes such as depression, isolation, frustration, cognitive decline, and decreased personal safety are twice as common among seniors with hearing loss than those without hearing loss (10, 11, 12, 13). While noise-induced hearing loss is irreversible, it can nonetheless be prevented. In the case of hearing loss caused by the unsafe use of personal audio devices, there are simple, effective practices such as keeping the volume within safe listening levels and limiting the time spent engaged in noisy activities that, if followed, can have a protective effect on people’s hearing. 10 Taking preventive action is mostly in the realm of listeners themselves by adopting safe listening behaviours. However, government, health care providers, manufacturers and civil society can create an environment which enables safe listening. WHO’s Make Listening Safe initiative In 2015, responding to this growing public health issue, WHO launched the Make Listening Safe initiative, with the overall vision of ensuring that people of all ages can enjoy listening with full protection of their hearing. The aim of this global initiative is to reduce the risk of hearing loss due to unsafe exposure to sounds in recreational settings through: • regulating exposure to loud sounds through personal audio systems; • undertaking a public awareness campaign to change listening behaviours among the target population; • developing a regulatory framework for safe listening in recreational settings. To achieve the first objective, ITU and WHO collaborated in developing the WHO-ITU Global standard for safe listening devices and systems. Rationale for a standard for safe listening devices Experience from other fields of public health (for example reducing tobacco use or improving road safety) show that policies, regulations and their enforcement can eventually influence people’s behaviours. This is the case for mandatory graphic warnings on cigarette packages, for example, and for fines for ignoring mandatory seatbelt-wearing laws, for example. In line with these experiences (14), it is believed that the design and implementation of specific legislation that regulates the amount of sound energy received through a personal audio system can help prevent hearing loss by ensuring a lower level of sound exposure in people using these devices. Currently, there is one example of regulation that targets sound exposure through personal music players, which is the 2009 directive from the European Commission limiting the output level of personal music players and making it essential to provide a warning to listeners. Legal and regulatory interventions have proved to be an effective strategy for many sentinel public health achievements. An strong example is legislation worldwide on smoking bans that has been effective in reducing the incidence of passive and active smoking as well as the rate of acute coronary syndrome in populations concerned (15). Legislation and its enforcement is shown to be a key intervention for road safety, which can lead to reduction in speeding and drunk driving (16, 17). On the basis of these examples it makes sense to put in place regulations or legislation that address exposure to loud sounds as a public health issue in order to bring about a sustained change in listening habits. 11 WHO-ITU H.870 Global standard on safe listening devices and systems The WHO-ITU Global standard (18) builds on recommendations made by the European Commission (19) and provides evidence-based guidance for promoting safe listening among users of personal audio systems. In principle, the WHO-ITU Global standard proposes ways in which the technology used for listening (personal audio systems) can become a part of the solution of the u nsafe listening challenge. The rapid emergence of sophisticated technology that can track behaviour and health status, and provide personalized feedback, can be implemented to promote safe listening practices, while continuing to provide an enjoyable experience to the listener. Smartphone technology, in which smart mobile devices are connected to powerful computational resources, can thus provide a platform to deliver targeted, customized, safe listening interventions in a timely enough way for maximum effect. Through the use of technology and the creation of targeted protective features, the WHO-ITU Global standard aims to create a safe environment around those who listen to music through personal devices. The protective features recommended by the WHO-ITU Global standard will, among other things, aim at limiting the intensity and duration of users’ exposure to loud music. However, since users can decide to overrule technology (e.g. by deactivating the protective features), the WHO-ITU Global standard also includes recommendations for integrating into the protective features an educational component aimed at helping users to track, interpret and learn from their behaviours. Based on behavioural change theory and models, for users it might be easier to adopt and sustain a safe listening behaviour if they receive information and cues on the types of behaviour that put them at risk, the potential consequences, and what to do about it. Developing the WHO-ITU Global standard The WHO-ITU Global standard is based on current evidence and is the result of collaboration over a period of 2 years with a wide-raging group of experts and stakeholders, including audiologists, academia, sound engineers, professional associations, manufacturers of devices and headsets, regulatory bodies working at global or European level, and members of thetarget age range (12–35 years). Convened alternately by WHO and ITU, this wide-ranging group has provided inputs and feedback to the text of the WHO-ITU Global standard. All background papers and evidence compiled is publicly available. Before entering into force, the WHO-ITU Global standard prepared by the group was posted online for additional comments and inputs from the 193 Member States of the International Telecommunication Union, as well as from its hundreds of sector members. 12 1 Pa2h: pascal squared hours is the unit used to measure sound energy. The WHO-ITU Global standard consists of two integral components: a technical specification and a communication/educational element. The two are closely linked and both must be implemented together in order to be effective. 1. Technical aspects addressed in the WHO-ITU Global standard: It is also recommended that the device allows the user to select their reference exposure as one of two modes: Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h1 per 7 days as the reference exposure (i.e. 80 dBA SPL for 40 hours per week). Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (i.e. 75 dBA SPL for 40 hours per week). The mode choice is given when using the player for the first time (or when the device is reset to factory settings) Mode choice can be changed at any later time, e.g. via a device settings menu. Volume limiting: This is a feature where by a volume-limiting message and option is automatically provided every time the user reaches 100% of their weekly allowance. The message should allow them the option to “continue listening” if they do not wish the device volume to reduce. When the message is not acknowledged, the default action will be to reduce the volume output to a pre-set level. If possible, users should be given the option to customize this level (the level at which they would like their device to limit the volume) according to their preference. The feature may also be used by individual users in order to limit their own sound exposure, if they wish to do so, by fixing the maximum output on their device. Parental control: It is recommended that the device should offer an option whereby maximum sound output can be fixed and locked in the settings, possibly through use of a password. This would allow parents (or other adults) to limit the maximum sound output of the child’s device in a way that cannot be changed by the child. Dosimetry: The WHO-ITU Global standard recommends that each device includes a system that tracks the user’s exposure time and estimates sound level and percentage used of a reference exposure (sound allowance) This acoustic dosimetry must include all media playback through the device (whether stored on the device or streamed) during times when the user is using earphones or headphones. (Voice calls are excluded as they are separately specified by other standards) Dosimetry The calculation and assessment of the amount of sound received by the ear, as compared to the reference exposure (or sound allowance) 13 2. Communication aspects addressed by the WHO-ITU Global standard: The WHO-ITU Global standard intends to provide users with information and guidance to enable them to make safe listening choices by tracking, interpreting and learning from their own behaviours. Such a component includes: – Personal usage information which is based on the tracking system mentioned in technical component. This will help the user to know: • their own listening habits (use of daily and weekly sound allowance); • how to use safe listening features of the specific devices. – Personalized recommendations and cues for actions for safe listening, customized based on each user’s listening profile. – General information on: • safe listening and ways to practice it; • the risk associated with unsafe listening; • the risk of hearing loss due to loud sounds from sources other than the personal audio system. Objective of the toolkit This toolkit aims to provide a practical guide on the implementation and follow-up of the WHO-ITU Global standard that should be used as the basis for regulations or legislation by all Member States, or adopted voluntary by manufacturers in order to protect users from noise-induced hearing loss. The WHO-ITU Global standard is designed to support countries, industries and civil society in approaching noise-induced hearing loss prevention in a strategic, evidence-based and user-friendly way. This toolkit is organised in three sections. Each section is targeted to a group whose action is essential to ensure that the WHO-ITU Global standard is adopted and users protected. This includes: • government, specifically the ministries and departments working in the field of health, technology, commerce, industry, consumer protection and any other department related to disability or accessibility issues; • industry, specifically manufacturers of personal audio systems; • civil society organizations working in the field of hearing or consumer rights. 14 Each section provides the rationale for the stakeholders to take action on safe listening; they list possibilities of how the WHO-ITU Global standard can be implemented or promoted by that particular group; and suggests tools for taking action. The processes, steps and tools are provided for guidance and can be adapted, translated or modified by stakeholders to suit the needs of individual countries and manufacturers. Implementation by governments 16 The section is intended as guidance for (among others): • public officials responsible for drafting policies, advising ministries, setting the priority agenda in the field of health, for example in adolescent health; education; technology; information and communication technology; telecommunication; as well as regulatory or standardization bodies; consumer protection agencies; and managers of hearing programmes or adolescent health within ministries of health; • officials responsible for school health or purchase of equipment within ministries of education; • officials in charge of accessibility issues within government departments. Rationale Hearing loss is increasing in all regions worldwide, posing a public health challenge that carries a significant financial cost. WHO estimates that unaddressed hearing loss costs the world approximately US$ 750 billion each year (in international dollars). Investment in hearing loss prevention can help governments save already-scarce resources. Ministries of education and of technology should advocate for and support hearing loss prevention, in part achieved through implementation of the WHO-ITU Global standard, to fulfil their mandates for protecting technology users in general and in particular children using technologies to learn. The increasing access to technology worldwide and its improper use is posing a huge challenge in this respect. To mitigate the associated risk, it is essential that people learn how to use technology properly so that its harmful impacts can be minimized. The WHO-ITU Global standard makes it possible to use technology interfaces as a platform for prevention of noise-induced hearing loss. Implementation by governments 17 What actions can governments take? Implementation of the WHO-ITU Global standard can be promoted through: 1. Legislation: The WHO-ITU Global standard should be integrated in regulations and legislation related to the manufacturing, importing and selling of personal audio devices. 2. Other policies: 3. Along with legislation and other policies to implement the WHO-ITU Global standard for safe listening devices, governments should launch a public awareness campaign to raise awareness on: • the risks posed by loud sounds, especially those experienced in recreational settings; • safe listening practices that can reduce the risk of hearing loss among listeners. a. Government regulation: The relevant government department (technology, health, consumer protection etc.) should define a mechanism to enforce such policies or regulations that ensure all personal audio devices and systems sold within its jurisdiction comply with the WHO-ITU Global standard and protect users from noise-induced hearing loss. b. Procurement policies: Government departments that regularly procure technologies on a big scale (through tenders and public procurement) should ensure that all devices procured by them are aligned with the WHO-ITU Global standard. In 2003, ITU defined an international standard for video compression (Recommendation ITU-T H.264), which has been widely adopted by industry. France developed a regulation and Brazil issued a presidential decree mandating the use of ITU-T H.264 for over the air broadcast services, resulting in benefits for end users: not only quality of images broadcasted over TV in these countries was significant improved, but also lower cost for the necessary set top box receivers. Where the department of technology has an advisory role and informs decisions made by other departments (concerning relevant devices), they should recommend the alignment of these procurement policies as per the features defined in the WHO-ITU Global standard. Public procurement has been used as a tool to further public policies in many fields and has the potential to deliver on societal goals (20). 18 Engaging partners All stakeholders in the field should be involved, including: • different government departments such as technology, health, education, commerce and industry; environment, youth; • civil society groups including associations of hard of hearing; NGOs, professional societies, • youth organizations; • manufacturers; • consumer electronics associations; • major retail groups; • consumer protection organizations; • others as may be relevant in the context of the country. Proposed steps A step-wise approach, as proposed below, is recommended to ensure the inclusion of the WHO-ITU Global standard in relevant policies and regulations. Step 1: Assessment and policy development a. Conduct a situation assessment: The initiating department should carry out a situation assessment in order to understand: • the safe listening features in the devices currently sold in the country; • current statistics on hearing loss in the country/region, especially hearing loss caused by loud sounds, if available; • existing policies related to hearing loss prevention, noise control and safe listening; who the main stakeholders are, including government departments, civil society groups, youth organizations, manufacturers. A format for conducting a situation assessment can be found in Appendix 1. b. Organize a planning consultation: Following the situation assessment, the initiating department/ministry should organize a meeting to plan for the implementation of the WHO-ITU Global standard and get a buy-in from all relevant stakeholders. This meeting should include all key stakeholders identified in step 1. During this meeting, results of the situation assessment should be presented, the WHO-ITU Global standard outlined, and further steps for its implementation proposed. An outline of stakeholders’ consultation is provided in Appendix 2. c. Develop the policy on safe listening devices: The initiating department should draft the legislation, policy or regulation and discuss it with the relevant ministerial/government departments. It should then be shared with stakeholders to get their feedback, which should be addressed prior to finalization and approval of the policy document. d. Determine ways and means for raising awareness among the target group: Along with development of the policy for safe listening devices, the initiating department should outline a strategy for raising awareness on safe listening and informing users about the new safe listening features proposed in the regulations. This should be done in consultation with relevant health professionals and communication experts. The country can make use of the validated WHO awareness materials that can be adapted and translated for use in the country. Step 2: Launch and communication a. Organize a sensitization workshop: Once the policy or legislation is finalized, a sensitization workshop should be held by the initiating department in collaboration with other departments involved. The purpose of such a workshop is to inform manufacturers and key retail groups of the rationale and intent of the regulations and to gain their support in their implementation. An outline of the workshop is provided as Appendix 4, for guidance. b. Undertake media outreach: A press announcement should be made to launch the new regulations. This should be accompanied by a media campaign through all channels relevant in the context of the country and the target group, e.g. social media, print media, digital media etc. Governments can launch these regulations on the World Hearing Day in order to maximize the advocacy effort. Step 3: Implementation and monitoring a. Monitor policy implementation: Implementation of the policy, regulation or legislation should be monitored by the government through established mechanisms. b. Undertake evaluation and revision: The policy, regulation or legislation and its implementation should be evaluated at regular pre-designated intervals (e.g. every 2 years). This evaluation should further be discussed with the stakeholders and revisions made, depending on the feedback received. 19 Additional actions Wherever possible, the government should make efforts to do the following: a. Monitor epidemiology of hearing loss: The relevant department in the Ministry of Health should regularly assess hearing loss prevalence in the target population through a population-based prevalence study. Such a study should ideally be done at the start of the initiative and repeated every 5 years. b. Carry out research: Relevant departments should assess the occurrence of hearing loss among users of personal audio devices. Tools the following tools are available to guide governments in application of the WHO-ITU Global standard: • Situation assessment/analysis tool (Appendix 1) • Format for stakeholders consultation (Appendix 2) • Introductory presentation with key messages (Appendix 3) • Format for sensitization workshop (Appendix 4) • Materials for raising awareness (Appendix 5) Planning: situation assessment, discussions,policy development, awareness raising Monitoring implementation: monitoring, evaluation, feedback, revision Supporting actions: assessment of hearing loss and listening behaviour outcomes Launching: sensitization workshop, media outreach 20 Implementation by industry partners The section is intended as guidance for: • Manufacturers of personal audio systems including: – Smartphones – MP3 players – Other devices with music playing capability – Headphones/earphones Rationale Investing in the hearing health of their customers makes good business sense for an industry that relies on considerably on its clients’ ability to hear. At present, the increasing use of technology is part of the threat to good hearing. The easy access to such technology without any information or education on safe listening practices is putting at risk the hearing of millions of young people across the world. With the growing penetration of technology, this challenge is likely to grow too, unless concrete steps are taken. At the same time, technology is being used successfully to raise awareness on various health issues and promote healthy lifestyles. This has led to an increasing number of health-related applications made available to users through certain devices. Following this approach, the appropriate use of technology can reduce the risk it poses to hearing. Hence, as part of risk mitigation and in line with principles of responsible business, manufacturers of personal audio devices must share the responsibility of promoting safe listening practices, and to offset any potential harm from the use of their products. This can be done by proper implementation of the WHO-ITU Global standard. Safe listening will reduce the risk posed to hearing and can potentially reduce the occurrence of hearing loss. What actions can manufacturers take? Manufacturers should take the following actions. • Lead the field of safe listening by voluntary implementation of the WHO-ITU Global standard by ensuring that the personal audio devices manufactured by them comply with: – requirements of the WHO-ITU Global standard; – optional features within the WHO-ITU Global standard. 22 Implementation by industry partners • Improve the accuracy of the ‘dose/allowance’ measurement by: – striving to improve the testing algorithm and minimize measurement errors; – ensuring that the algorithms are compatible with a large variety of commonly used headphones/earphones available in the market (including those manufactured by other companies). • Experiment with and create a user interface that is both appealing and informative. The user interface should: – present information on safe listening in an engaging manner that appeals to the user; – provide information on the user’s listening parameters and use of sound allowance in an easily understandable format; – provide access to reliable and validated sources of information on safe listening. Engaging partners All stakeholders in the field should be involved, including: • other manufacturers that have implemented the WHO-ITU Global standard; • retailers that sell devices manufactured by the company; • consumer groups, target group; • government: when applying for any government contracts, the manufacturers can highlight the safe listening features available in their devices; others as may be relevant. A complementary example is the case of digital subscriber line (DSL) technologies that enable broadband Internet access at homes. Amongst others, ITU-developed standard ITU-T G.993.1, which, while it was not mandated by governments, was selected by network operators in their procurement as the technology to enable data rates up 25 Mbit/s between their premises and a user's home. Beyond high speed Internet, this allowed network operators to simplify provisioning of the services and reduce costs. Equipment manufacturers could now bid for a larger number of contracts and offer units to end-users via retail channels. It benefitted users through reduced operation costs and allowing them to choose from a variety of equipment providers (knowing that interoperability was guaranteed). 23 Proposed steps Step 1: Planning a. Carry out an internal assessment: Manufacturers should assess the current state of play relating to safe listening features in the devices they manufacture different parts of the world. b. Download and understand the WHO-ITU Global standard: This can be found at https://itu.int/rec/T-REC-H.870. A summary outline is included in Appendix 6 of this document. Staff working on safety measures and acoustics in the company should read the full WHO-ITU Global standard and applicable references, and understand their implications. c. Discuss implementation: Hold internal discussions regarding the method of including the proposed safe listening features in devices and devise a complete implementation plan. Step 2: Development and testing of safe listening features a. Develop and test a user interface: The WHO-ITU Global standard provides guidance on what sort of information should be conveyed through the device interface. Wherever possible, manufacturers should research this aspect and develop a user-friendly interface for safe listening features, in line with the WHO-ITU Global standard. Where manufacturers cannot or do not wish to undertake such research, they can follow the suggestions provided in Appendix 7 b. Develop and test messages and cues for action: Such messages and instructions have to be included within the user interface. It is important to test these, taking into consideration cultural, linguistic and regional contexts. Where a manufacturer is unable to or does not wish to engage in developing and testing an interface and messages, they could adopt the examples outlined within the tools (see Appendix 7 and Appendix 8) c. Check that your device conforms to the WHO-ITU Global standard: Once the H.870 safe listening specifications are implemented in your company’s products, they should be tested for compliance using a pre-established conformance assessment plan. Step 3: Publicizing and promoting a. Inform and train retailers: Once products that implement the WHO-ITU Global standard are available, retailers should be informed about these features and trained to promote them. b. Popularize the safe listening features of your device: Wherever possible, advertisements and websites should highlight the safe listening features, which will help raise awareness on safe listening and highlight the company’s responsible attitude towards its consumers. 24 Planning: situation assessment, understanding the standards, internal discussions Publicizing and promoting: informing retailers, advertisements, websites Review and revision: feedback, updates, revisions Development and testing: user interface, messages, compliance testing Step 4: Reviewing and revision a. Gather feedback from users: Manufacturers should regularly seek feedback from users regarding the relevance, user friendliness and clarity of safe listening features in their devices. b. Undertake revisions and improvements: The user interface and messaging should be revised periodically based on user feedback. c. Keep up to date with the latest version of the WHO-ITU Global standard: Manufacturers should revise the features as and when the WHO-ITU Global standard is revised. Tools The following tools are available to guide manufacturers in application of the WHO-ITU Global standard: • Summary of the WHO-ITU Global standard (Appendix 6) • Example of information flow (Appendix 7) • Key considerations when developing messages and generic examples (Appendix 8) • List of information sources (Appendix 5) 25 26 Role of civil society The section is intended as guidance for professional associations and civil society organizations and groups working on: • hearing loss prevention; • noise control • consumer rights. Rationale Exposure to loud sounds is a key contributor to preventable hearing loss. It is estimated that 50% of people using personal audio systems do so in a way that puts their hearing at risk. Implementation the WHO-ITU Global standard can promote safe listening behaviours and reduce the risk personal audio systems pose to hearing. Civil society partners should advocate with policy makers for their implementation as a means to prevent hearing loss. What actions can civil society organizations take? Civil society organizations should undertake the following actions: • Advocacy work to persuade governments to develop regulations to implement the WHO-ITU Global standard. • Awareness campaigns to sensitize people regarding hearing loss prevention and safe listening. • Sensitization of manufacturers of devices to motivate them to voluntarily implement the WHO-ITU Global standard in the products they sell. Engaging partners All stakeholders in the field should be involved, including: • Other organizations working in the field of hearing loss prevention, noise control and consumer protection. • Departments of health, education and technology. • Local schools. • Media. • Corporate social responsibility (CSR) departments of manufacturing organizations. • Others that may be considered relevant. 28 Role of civil society Proposed steps Step 1: Plan: a. Identify and brainstorm with other stakeholders to plan actions. b. Determine the target audience they will address e.g. policy makers, manufacturers, schools and universities, the community at large, others. c. Identify the key messages to convey to these audiences and the impact they want to have (e.g. policy development by government; implementation of safe listening features by manufacturers; use of safe listening apps by young people etc.). d. Establish what would be the most effective strategy to convey these messages e.g. through a meeting, media event, awareness sessions etc. Step 2: Prepare a. Review and adapt the WHO advocacy and awareness resources on safe listening to the local context and translate, if required. b. Review other available materials on safe listening. c. Finalize the resources and materials to be used. Step 3: Advocate with the target group identified through available means. This could include: a. Media outreach; b. Social media; c. Websites; d. Webcasts; e. Workshops on safe listening in schools and universities; f. Public events. Step 4: Follow up with the target group and monitor outcomes and impact in terms of: a. Policies established or actions initiated by governments; b. Implementation of safe listening features by manufacturers; c. Use of safe listening applications/features by users of personal audio devices; d. Change in listening habits of users. 29 Tools The following tools are available to guide civil society organizations in promoting the WHO-ITU Global standard: • Awareness-raising materials for policy makers and the general population (Appendix 5) • Social media materials (Appendix 5); • Resources for school-based workshops on safe listening (Appendix 9). Planning: identify stakeholders, brainstorming, determine target audience, identify key messages, strategize Advocate: with the target group Follow up and monitor outcomes Prepare: review and adapt available advocacy materials 30 References and Bibliography References 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva: World Health Organization; 2017 2. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload /noiseprevention.pdf, accessed 21 November 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012;39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008;123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002;65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007;77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018;144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013;173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 2018;Apr 13. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013;No v;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Rev Panam Salud Publica. 2014 Oct;36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recommendation ITU-T H.870. Guidelines for safe listening devices/systems. 2018 (https://itu.int/rec/T-REC-H.870, accessed 15 January 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014;14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017;30. 10.1108/IJPSM-03-2017-0066 32 References 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva: World Health Organization; 2017 2. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload /noiseprevention.pdf, accessed 21 November 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012;39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008;123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002;65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007;77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018;144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013;173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 2018;Apr 13. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013;No v;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Rev Panam Salud Publica. 2014 Oct;36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recommendation ITU-T H.870. Guidelines for safe listening devices/systems. 2018 (https://itu.int/rec/T-REC-H.870, accessed 15 January 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014;14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017;30. 10.1108/IJPSM-03-2017-0066 33 34 Bibliography Arenas J, Suter A. Comparison of occupational noise legislation in the Americas: An overview and analysis. Noise and Health. 2014;16(72), 306–319 Berglund B, Lindvall T, Schwela DH. Guidelines for community noise. Geneva: World Health Organization; 1999. Consumers: EU acts to limit health risks from exposure to noise from personal music players [Press release]. Brussels; European Commission: February 19 2018 (http://europa.eu/rapid/press-release_IP-09-1364_en.htm, accessed 24 August 2018). Gurgel RK, Ward PD, Schwartz S, Norton MC, Foster NL, Tschanz JT. Relationship of hearing loss and dementia: a prospective, population-based study. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2014;35(5):775–781 Joy G, Middendorf P. Noise exposure and hearing conservation in U.S. coal mines – a surveillance report. Journal of Occupational and Environmental Hygiene. 2007;4(1), 26 Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics. 2010;125(6):e1348−55 Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies,http://www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-conti nues-to-climb-in-emerging-economies/2016 Tikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S. Interventions to prevent occupational noise‐induced hearing loss. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD006396. DOI: 10.1002/14651858.CD006396.pub4 Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017;390(10098):934 Appendices 36 Appendix 1 This situation assessment tool has been developed to help governmental departments and ministries gather relevant information to prevent unsafe listening, and to promote and regulate safe listening practices in their country under the WHO-ITU H.870 Global standard on safe listening devices and systems. Information to complete this assessment can be obtained from existing peerreviewed literature, World Health Organization (WHO) statistics, national statistics, and Ministry of Health documents. Technical assistance in conducting a situation assessment or using the results is available from WHO. [Country name] National data profile compiled by: National Data Coordinator Name of the person in charge of this Situation assessment Designation and qualification Institution Address Email Telephone numbers Respondent’s details (this form can be duplicated for each person interviewed) Name Position/Title Institution Email Telephone numbers Fax Situation assessment tool 37 Population profile Name of the area (state, region, province, district) (if relevant) for which this situation assesment is being undertaken Total number of mobile device users in the country/area Total number of mobile device users between the ages of 12 and 35 years Total number of smartphone users in the country/area Total number of smartphone users between the ages of 12 and 35 years Sex distribution of mobile device users (%) Male: % Female:% % Rural-urban distribution of mobile device users (%) Rural:% Urban:% Literacy rate among mobile device users (as a % of total population) Any other population-related factor that needs to be considered in mobile device services Area: State: (optional) Region: (optional) Province: (optional) District: (optional) Section A. General country information Mobile device usage Languages used by mobile device users Total number of personal audio devices sold in the country/area: Number of smartphones sold: Number of MP3 players: Number of other related devices (personal audio players) % of population/area reached by internet services:% Number of companies that sell personal audio devices in the country/area Name of mobile device brands sold in your country [] Samsung [] Motorola [] Apple [] Alcatel [] Sony [] Nokia [] Huawei [] Google [] LG [] Other (please specify): Names of leading retailers that sell mobile devices in the country/area What is the percentage of people with disabling hearing loss due to noise-induced hearing loss and other relevant causes? Overall:% Age group 12 to 35 years:% Any other age group (as reported in literature):% Names Names of leading mobile phone service providers that operate in the country/area Names Hearing loss Prevalence of disabling hearing loss: Overall:% Age group 12 to 35 years:% Any other age group (as reported in literature): % If information on disabling hearing loss is not available, indicate the definition used in estimation of prevalence: 38 39 Lead agency profile Coordination Legislation Other (please specify) Monitoring and evaluation Is there a government agency or department that takes responsibility for overseeing and/or coordinating hearing care activities/plans (i.e. a lead agency) in your country? Where is this agency located within the government structure (please tick one)? The agency is a single government ministry/department, or situated within one government ministry/department (please specify ministry and department, if relevant) [] Stand-alone entity [] Other (please specify) [] Don’t know For which of the following functions is the lead agency responsible? (please tick all that apply) [] Yes [] No [] Don’t know Is funding allocated in the government’s budget for the lead agency to carry out the functions listed above? [] Yes (please name this agency) [] No (please skip to Section B) [] Don't know (please skip to Section B) [] Coordination of intergovernmental working processes at central government level [] Coordination of hearing care decision-making across central government [] Coordination across different levels of government (e.g. central, regional, local) [] Coordination of national mass media initiatives [] Establishing and supporting data systems that are used to monitor safe listening devices [] Compilation and dissemination of national statistics [] Periodic review of legislation, rules and standards against best practice, and recommendations for improvement [] Development and/or revision of legislation Section B. Leadership and governance 40 Section C. Strategy and targets National strategy profile Is there a national strategy for deafness and hearing loss prevention in your country? If yes, does this strategy include prevention of recreational noise-induced hearing loss? Is there a regulation regarding safe listening features in personal audio devices? If answer to any of the above is yes, do any strategies that exist include volume regulations on personal audio devices such as mobile phones, mp3 players, tablets, etc? Is there an awareness programme regarding noise control in environmental/recreational settings? If yes, does the awareness programme include a focus on safe listening? Are funds available to implement part or all of any strategies that exist? If a national strategy exists, does it set measurable targets to increase the number of personal music players with safe listening features? [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please submit relevant source documents) [] No [] Don't know [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please submit relevant source documents) [] No [] Don't know [] Yes (please submit relevant source documents) [] No [] Don’t know [] Yes (please provide details/source documents as annex) [] No [] Don't know [] Yes [] No [] Don’t know If yes, please provide the targets and their timeframes: • Device targeted increase: • Time period relating to device target (please specify start and end years that these targets relate to, e.g. (2002–2012) (2016-2020) [] Yes, fully funded [] Partially funded [] Not funded [] Don’t know Does the national strategy include recommendations for any of the following: Reducing volume level [] Yes [] No [] Don’t know Allowing users to keep track of their sound usage [] Yes [] No [] Don't know Showing messages to the user when reaching unsafe volume levels [] Yes [] No [] Don’t know Showing messages about safe listening practices [] Yes [] No [] Don't know Encouraging the use of earplugs in loud environments such as bars, sporting events and concerts [] Yes [] No [] Don't know 41 42 Please mention all potential and existing stakeholders in your country that are or could be involved in ear and hearing care services. Identify the lead or responsible position or person, where possible, and give contact details. Stakeholder profile Government departments List in order of perceived priority for collaboration in developing and implementing a safe listening strategy Name of Department Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Section D. Stakeholder analysis 43 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Professionals and academics List in order of experience and interest in the development and implementation of the safe listening strategy Name of Institute or association 44 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Name of Institute or association Civil society groups, including disabled persons’ organizations List in order of perceived priority for collaboration in developing and implementing the safe listening strategy 45 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Name of agency UN agencies 46 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Industry partners List in order of perceived priority, based on need for collaboration and possible interest of the stakeholder, in developing and implementing the Safe Listening strategy Name of Company 47 Level of influence (1–10) Level of interest (1–10) Contact detailsLead/contact person (name and designation) Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: Address: Telephone no: Email: 1. 2. 3. 4. 5. Any others (can include any other groups that are interested in hearing loss prevention, noise control, audiology, acoustics or consumer rights) 48 Appendix 2 Outline of stakeholders planning meeting for regulations on safe listening The following stakeholder groups should be invited to the meeting: • Relevant government departments: technology, health, education, commerce and industry, environment, youth • Civil society groups including associations of hard of hearing; ngos, professional societies • Youth organizations • All manufacturers • Consumer electronics associations • Major retail groups • Consumer protection organizations • WHO and ITU representatives Purpose: • To inform stakeholders about the global standards and the country’s intention to implement them • To gain buy-in from relevant stakeholders in this respect • To discuss the way forward regarding adoption of standards and their implementation • To agree on timelines • To discuss customization and adaptation of the awareness materials The following outline is suggested: • Introductions • Need for safe listening • Current status in the country regarding regulations on safe listening • Global standards for safe listening • Perspectives required to implement safe listening strategies and regulations: – Government (Technology, health, any other) – Users (one representative to present user view) – Industry (umbrella organization or a company with leadership in this field to speak on behalf of industry) – Hearing care profession (one member from a professional, hearing-related organization to speak) – Civil society view (one speaker from a relevant civil society group to speak) • Possibilities regarding adoption and implementation of the Standard in the country (including timelines): discussion • Need for raising awareness and available tools • Determining the next steps for: – developing a regulation/legislation; – developing an awareness campaign and adapting awareness materials. WHO estimates that 1.1 billion young people worldwide could be at risk of hearing loss as a result of unsafe listening practices. Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD, Finucane M. Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries. Eur J Public Health 2013; 23: 146-52 (http://dx.doi.org/10.1093/eurpub/ckr176, accessed 19 January 2019). Hearing loss is on the rise! Overarching messages • Rise and ageing of the global population • 466 million people globally are currently living with disabling hearing loss • 630 million people estimated to be living with disabling hearing loss by 2030 • Over 900 million estimated to be living with disabling hearing loss by 2050 How do we hear? Appendix 3 Make listening safe initiative: Introductory presentation 49 Recreational noise, unsafe listening practices and the impact of hearing loss • Those exposed to loud sounds in social settings over the past 20 years are over three times more at risk of hearing loss compared to those unexposed. • 50% of people listening to music over their personal audio devices do so at levels which put their hearing at risk. • 5–10% of listeners are likely to develop hearing loss due to their personal volume preferences and duration of listening. • Depression, isolation, frustration, cognitive decline and decreased personal safety are twice as common among seniors with hearing loss than those without hearing loss. Noise-induced hearing loss is irreversible Photos from top to bottom by Thibault Trillet, Kevin Grieve, Simon Matzinger, Adobe PhotoStock. 50 Make listening safe initiative Smartphone technology can  provide a platform to  deliver targeted, customized safe listening interventions while continuing to provide an enjoyable experience to the listener. Technical aspects Acoustic dosimetry • Tracking users’ exposure time to sound • Estimating sound level • Estimating % used of a reference exposure, or sound allowance • Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h1 per 7 days as the reference exposure (i.e. 80 dBA SPL for 40 hours per week). • Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (i.e. 75 dBA SPL for 40 hours per week). Prevention This means creating an environment that enables the exercise of safe listening practices, including through: • Regulating exposure to loud sounds through personal audio systems.  • Undertaking public awareness campaigns to change listening behaviours among people aged 12 to 35 years. • Developing a regulatory framework for safe listening in recreational settings.  WHO-ITU H.870 Global standards for safe listening devices and systems 51 Volume limiting • Volume limiting message • "Continue listening" option • Default action: to reduce the volume output to a predetermined level • Customizing option Parental control  • Maximum sound output can be fixed and locked in the device’s settings Make listening safe toolkit Practical guide for implementation and follow-up of global safe listening standards in recreational settings to be adopted by all countries worldwide • Designed to support countries, industries and civil society in approaching noise-induced hearing loss prevention in a strategic, evidence-based and user-friendly way. • Targets three key stakeholders that can be instrumental in implementing the standards • Government: ministries/departments working in the field of health or technology • Industry: manufacturers of personal audio devices and systems • Civil society organizations: field of hearing or consumer rights The processes, steps and tools are provided for guidance and can be adapted, translated or modified by stakeholders to suit the needs of individual countries and manufacturers.   Personal usage information • Listening habits, including sound allowance • How to use safe listening features  Personalized recommendations and cues • Actions for safe listening • Customized advice based on user's listening profile General information • Safe listening and ways to practice it   • Risk associated with unsafe listening • Risk of hearing loss due to loud sounds from sources other than personal audio devices and systems Communication aspects 52 53 Appendix 4 Outline of sensitization workshop for regulations on safe listening The following groups should be invited to participate in the workshop: • Relevant government departments: technology, health, education, commerce and industry, environment, youth • All manufacturers • Consumer electronics associations • Major retail groups Purpose: To sensitize manufacturers and retailers regarding regulations on safe listening devices and to to guide them regarding implementation, timelines and reporting. The following outline is suggested: • Introductions • Rationale for safe listening standards • Outline of national regulations on standards: essential and optional components • Timelines for implementation • Monitoring/reporting mechanism on implementation • Manufacturers’ issues and concerns • Awareness materials that can be used for by manufacturers for distribution, social media and websites 54 Appendix 5 Advocacy materials Goal These awareness materials are designed to inform people about the risk of hearing loss due to unsafe listening; the concept of safe listening; and available tools to promote its practice. Who are these materials for? These evidence-based advocacy materials are intended to provide key stakeholders (government, industry and civil society organizations) with tools to raise awareness among policymakers and the public about safe listening. Advocacy materials WHO’s resources to promote safe listening are available at: www.who.int/deafness/make-listening-safe/advocacy-materials/en/ Communication objectives • Raise awareness and engage the public on the importance of safe listening practices. • Create a conversation on the risk of hearing loss due to loud sounds from sources such as personal audio systems and mobile devices. • Raise awareness about the risks of unsafe listening practices among teenagers and young adults. • Build an understanding of the importance of multisectoral engagement and action for implementing the WHO-ITU H.870 Global standard for safe listening devices and systems. • Promote examples of good multisectoral engagement leading to successful interventions that have addressed the issue of exposure to loud sounds in recreational settings. Overarching messages • Noise-induced hearing loss is irreversible! • Prevention is one of the most effective strategies to reduce the occurrence of noise-induced hearing loss. • Keeping the volume within safe levels and limiting the time spent engaged in noisy activities can reduce the risk of hearing loss. • Smartphone technology can be used as a means to promote and practice safe listening.  • The design and implementation of specific legislation can lead to a lower level of sound exposure 55 Infographic Share information and materials on social media Our social media channels • Follow us on Twitter, Facebook and Instagram @WHO and tag us in your posts Twitter official hashtag • #SafeListening Twitter official hashtag • #WHO • #HearingCare • #HearTheFuture • #WorldHearingDay 56 Poster 57 Brochure Tips for safe listening 58 Press release Related document 59 Videos Facebook posts Instagram posts 60 Tweets 61 FAQs 1. Introduction 2. How is loudness measured? What is dB? 3. What is safe listening? 4. How do loud sounds affect my ears? 5. How can I tell if my hearing has been affected? 6. Once I have lost my hearing can I get it back? 7. Is there a way to use a mobile phone to monitor my listening levels? 8. How can I monitor sound exposure or daily allowance for music that is not stored on my device? 9. What can I do to make my listening safe? 10. What can I do as a parent to ensure safe listening? 11. What can I do as a teacher to ensure safe listening? 12. What can I do as a physician to ensure safe listening? 13. What can I do as a manager of an entertainment venue to ensure safe listening? 14. What can I do as a manufacturer of personal audio devices to ensure safe listening? 15. What can governments do to ensure safe listening? Relevant websites • World Health Organization (WHO) http://www.who.int/deafness/make-listening-safe/en/ • Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/hearingloss/default.html • Action on Hearing Loss https://www.actiononhearingloss.org.uk/ • European Union of the Deaf https://www.eud.eu/ • Hear The World Foundation https://www.hear-the-world.com/en • American Speech Language Hearing Association – Listen To Your Buds campaign https://www.asha.org/buds/ • Dangerous Decibels http://dangerousdecibels.org/ Media interest If you are a journalist interested in covering issues related to the Make Listening Safe initiative please email us at whopbd@who.int 62 2 The full text of the H.870 Guidelines for safe listening devices/systems is available at https://www.itu.int/rec/T- REC-H.870-201808-I/en Appendix 6 Summary of WHO–ITU global standard H.870 for safe listening devices and systems Safe listening refers to listening behaviour that does not put a person’s hearing at risk. The risk of hearing loss depends on the level (loudness), duration (time period) and frequency of exposure to loud sounds. Such exposure may be through personal audio devices, in entertainment venues, or outside (for example in traffic), in the workplace, or at home. The WHO–ITU H.870 standard describes requirements for personal and portable audio systems, especially those for playing music, with the aim of protecting people from developing hearing loss as a result of their use. It provides a glossary for common terms to help understanding, as well as background information on sound, hearing and hearing loss. The Standard recommends criteria for avoiding unsafe listening: one for adults and the other for children, both based on the equal energy principle. Importantly, the Standard provides guidelines on health communication for safe-listening so that appropriate warning messages can be delivered effectively when necessary. Examples of such messages can be found in the Standard’s Appendix VII. Finally, the Standard also provides information about implementation of dosimetry and related issues. The key aspects of the WHO–ITU H.870 standard for safe listening devices/systems are summarized below. 63 1. Scope of the standard This document describes requirements for personal/portable audio systems, especially those used for playing music, in order to reduce the risk of hearing loss posed to the users of these devices. Figure 6.1: Architecture of a personal audio system In such devices, “source” can be either stored or retrieved remotely, e.g., streaming from a local server or the Internet (see Figure 6.1) A PAS is intended for use by an ordinary person and; • is designed to allow the user to listen to audio or audiovisual content / material; and • uses a listening device, such as headphones or earphones that can be worn in or on or around the ears; and • has a player that can be body worn (of a size suitable to be carried in a clothing pocket) and is intended for the user to walk around with while in continuous use (for example, on a street, in a subway, at an airport, etc.) Examples are portable CD players, MP3 audio players, mobile phones with MP3 type features, PDAs or similar equipment. For the purposes of this Standard, the following types of devices are excluded: • Communication devices (walkie-talkies, etc.) • Rehabilitative and medical devices (e.g. hearing aids, FM systems, and other assistive listening devices (ALD) approved as part of hearing aids and cochlear implants systems, etc.) • Personal sound amplification devices • Professional audio equipment and devices • Portable game consoles Personal Audio Device Personal Audio System Listening Device Effect Effect Volume ControlSource DAC Transducer 64 2. Equal energy principle The recommendations of this Standard are based on the equal energy principle. This is the assumption that the total effect of sound on ear and hearing is proportional to the total amount of sound energy received by the ear, irrespective of the distribution of that energy in time. According to this principle, equal amounts of sound energy is expected to cause equal amounts of sound induced permanent threshold shift regardless of the distribution of the energy across time. In practical terms this implies that listening to lower volumes for long periods of time can have the same impact as listening to very loud volumes for a short duration e.g. listening to a 100 dB sound for 16 minutes will have the same impact as listening to an 80 dB sound for 40 hours. Based on this principle, “dose” of sound energy is defined as the squared A-weighted sound pressure, , integrated over the exposure time Mathematically, this is expressed as: Where is the A-weighted and diffuse-field corrected sound pressure. The unit of this value is Pascal squared hours, or Pa2 h. 3. Reference exposure/sound allowance, operational modes It is recommended that each device includes a system that tracks the user’s exposure time and loudness level, and estimates the percentage used of a reference exposure (also referred to as sound allowance) This must take account of all media played through the device (i.e. whether it is stored on the device itself, or streamed) during times when the user is using ear/headphones. Voice calls may be excluded as they are separately specified by other standards. It is also recommended that the device allow the user to select their reference exposure as one of two operational modes: Mode 1: (WHO) standard level for adults. This will apply 1.6 Pa2h per 7 days as the reference exposure (derived from 80dBA for 40 hours a week) Mode 2: (WHO) standard level for sensitive users (e.g. children). This will apply 0.51 Pa2h per 7 days as the reference exposure (derived from 75dB for 40 hours a week) The user should be allowed to select either of the two modes when using the player for the first time (or when the device is reset to factory settings). It should be possible for the user to change the mode choice at a later time, e.g. via a device settings menu. 65 Sound allowance Refers to a dose estimate of sound exposure over a certain rolling period of time (e.g., daily or weekly), commonly expressed as a percentage of the reference exposure. A 100% weekly sound allowance is equivalent to the weekly reference exposure, based on the mode selected. Examples of weekly listening time duration based on sound allowance for the modes described earlier can be found in Table 1 and Table 2. Table 1: Example of weekly listening Table 2: Example of weekly listening dB(A) SPL Weekly (0.51 Pa h )2 107 104 101 98 95 92 89 86 83 80 24 minutes 12 minutes 6 minutes 3 minutes 1.5 minutes 48 minutes 6 hours 24 minutes 3 hours 15 minutes 1 hours 36 minutes 12 hours 30 minutes 77 25 hours 75 40 hours time for Mode 1 time for Mode 2 dB(A) SPL Weekly (1.6 Pa h )2 107 4.5 minutes 104 9.5 minutes 101 18.75 minutes 98 37.5 minutes 95 75 minutes 92 2.5 hours 89 5 hours 86 10 hours 83 20 hours 80 40 hours 66 4. Measurement methods/acoustic dosimetry Standard H.870 defines dose in the context of acoustic dosimetry. Under mode 1, 1.6 Pa2h constitutes 100% weekly sound allowance, corresponding to 100% calculated sound dose (CSD) as defined in [EN 50332-3]. For mode 2, 0.51 Pa2h is the total weekly sound allowance or reference exposure. Standard H.870 also refers to other related standards that describe a dose measurement system in a portable music player (PMP). [IEC 61252] describes acoustic dosimeters to be worn on the body including [EN 50332-1], [EN 50332-2] and [EN 50332-3]. Appendix II of H.870 gives an example of how a dosimeter can be implemented in a personal audio system when measuring the digital media signal and considering known or assumed properties of headphones. It is based on the equal energy principle in hearing loss risk assessment, where the squared A-weighted sound pressure, integrated over the exposure time, constitutes the dose. The dosimeter functionality is tested by playing the programme simulation sound according to [EN 50332-1] and [IEC 60268-1] and measuring the time until the dose estimate reaches 100% CSD, using interpolation and tolerances as described in [EN 50332-3]. Such testing may be performed in the acoustic domain (when a certain headset is used) or in the electrical domain using a 32 Ω resistive load (when the headset characteristics are unknown). See measurement setup information in [ITU-T P.381]. Uncertainties: In estimating sound dose there are a number of sources for uncertainties and margin of error can be very high. It is therefore suggested to refrain from signalling “safe” and “green” to the user based on dose readings below a certain limit. The dose estimation is however relevant in accounting for the general trends: • Higher signal level means higher risk • Longer exposure means higher risk • The spectral content of the music is accounted for 67 Refers to the hardware components (such as screen) that allows a human being to interact with an electronic device. 5. Health communication A key aspect of the Standard is to provide user with a tool that will allow them to monitor their own personal sound exposure. Such a tool should give users the choice of safe listening, and empower them to make informed choices for listening through greater awareness. This section of the Standard summary outlines its health communication aspects that should be applied for complete implementation of standards for safe listening devices. Specifically, it presents evidence-based recommendations on how to communicate the risks of unsafe listening and support users in adopting appropriate behaviour in this respect. Purpose of including health communication as part of the standards for safe listening personal audio systems The intent is to provide users with information and guidance to enable them to make safe listening choices. These include providing: • Personal usage information, in order for the user to know: – their own listening habits (use of daily and weekly sound allowance); – how to use safe listening features of the specific devices. • Personalized recommendations and cues for actions for safe listening, customized based on each user’s listening profile. • General information on: – safe listening and ways to practice it; – the risk associated with unsafe listening; – the risk of hearing loss due to loud sounds from sources other than the personal audio system. This information and guidance must be shared by default with users via their mobile devices in order to reduce the risk of hearing loss. Key recommendations for communication as part of safe listening devices Information and messages on safe listening must be provided through: • the device interface3 (wherever an appropriate visual interface is available); • instruction manuals; • when possible, information about the safe listening features of the device should be included on or in the packaging. 68 6.1 Information delivered through device interface Personal usage information Information regarding various listening parameters defining the users’ listening habits should be accessible to users in order to allow them to keep track of their exposure to sound through the device. For devices with a screen, this could be through an icon on the screen. Through the icon, the user should be able to see their use of daily/weekly sound allowance in an easy to understand presentation, e.g. the person may be able to view how much of the weekly sound allowance has been used and to see how their listening behaviour has been over the past seven days. In devices without screen, the information should be made available through alternate means, such as audio cues. The device (when capable) should display: • the average sound level for the day and week; • the time for which the user has listened in hours and minutes over the day and the week. Figure 6.2 gives a non-normative example of information provided on a smartphone visual interface for safe listening Figure 6.2: Examples of information provided on a smartphone visual interface for safe listening Today’s sound allowance Sound track #5 Disclosure 51.6% Time left: 01:14:17 Today’ Listening time: 37 min Average dB level (leg) : 93.3 dB 90 80 70 60 50 40 30 20 10 0 52% Today’s sound allowance 52% Today’s sound allowance Sound track #5 Disclosure 119.5% Time left: 00:00:00 Today’ Listening time: 1.80 h Average dB level (leg) : 93.5 dB 90 80 70 60 50 40 30 20 10 0 120% Today’s sound allowance 120% 69 Personalized recommendations and cues for actions and messages: a.The device should give relevant warnings and cues for actions when the user exceeds 100% of the weekly allowance. • The user will receive first a “warning” expressed through text and visuals informing that a threshold has been reached and that from this point on, further listening at the same volume will pose a hearing risk. • The warning will be followed by a “cue for action” in which the user is offered the choice to either accept the risk of continued listening or protect their hearing. The “cue for action” should be linked to active options on the device, such as: – automatic safe volume option, by which the device automatically changes the volume to a safe volume level; – direct access to volume settings; – set up of default volume limits; – “remind me later” option; – “ignore and continue” option. • If the user fails to take any action, the volume will automatically be reduced to below the standard level (80 or 75 dBA as selected). b.The device should provide relevant messages when the sound allowance usage reaches certain pre-determined levels. Refer to Appendix 8 for the suggested levels at which warnings/cues can be given and sample content. Such warnings depend on the device’s capability and should be multimodal, e.g. a mix of visual, vibratory or audible warnings, in order to ensure that the user’s attention can be directed towards these.Figure 6.3 gives non-normative examples of messaging displayed in a smart watch. Figure 6.3: Example of messaging displayed in a smart watch 50% of daily allowance: you have spent 50% of your safe listening allowance for the day. keep the volume low to listen longer. SAFELISTEN Hey! Your last sound dose was 60%. Well done! Keep listening safely. SAFELISTEN Daily messages: the device should provide a daily summary message based on the user’s listening behaviour in recent days, encouraging safe listening habits and discouraging or warning against unsafe listening habits. Examples of such messages are provided in Appendix 8 General information: when the device has a screen, information on what is safe listening and its benefits – as well as the risks posed by unsafe listening – should be displayed on the screen. It is recommended that the availability of this information be indicated on the user interface (home screen) through a distinct and recognizable icon. Figure 6.4 gives a non-normative example of a safe listening icon displayed on a smartphone screen. How does loud music affect my ears? What is safe listening? How can I make listening safe on my device? No, thanks. Play my music Safe listen What are first signs of hearing damage? What does hearing loss sound like? Hearing damage may not be noticeable initially. At first you may only have trouble hearing high-pitched sounds like bells or experience persistent tinnitus. Find out here. Centres for disease control and prevention Hear the word Information What is safe listening? OK, thanks. Play my music Figure 6.5: Examples of screens linking to information on safe listening and external links Figure 6.4: Safe listening icon displayed on a smartphone screen There should be a tutorial informing users about safe listening; the risks of unsafe listening; and the device’s safe listening features and how to use them. The screens should also include links to relevant webpages where the user can find more information. Figure 6.5 gives non-normative examples of screens linking to information on safe listening and external links. 70 71 6.2 Information delivered by means other than the device itself User manual The user manual should clearly state that unsafe listening practices using the device pose the risk of permanent hearing loss. It should also give details of the volume-limiting functions and cues for action. The user manual should also clearly outline how the allowance-assessment system works and refer to its uncertainty. It should indicate that information on the device does not take into account additional sources of sound exposures either from other audio devices or environmental sound exposure. The manual could also provide information regarding hearing protections from loud environmental sounds in order to minimize the risk of hearing loss. Packaging Wherever possible, a clear, concise message or warning should included on the external packaging of the device. It is recommended that such a warning/message be: • concise, simple and clear; • accompanied by a relevant illustration; • positioned on a plain background. Website and advertising Information on safe listening should be included on the manufacturer’s website. Such information should be aligned to the specifications in Standard H.870. A link to WHO website and other relevant, reputable websites could be included. Wherever possible, advertising of products could also provide relevant information. Such information can refer to both the potential harm to hearing through improper use of their device and the advantages of listening safely in order to maintain healthy hearing while enjoying a good listening experience. 7. Volume control Volume limiting: as per Standard H.870, the device should provide the user with a suitable method for volume-limiting. This refers to a feature where a message will be given before or when the user reaches 100% of the weekly allowance, offering them the option to “continue listening”, if they do not wish the device volume to reduce. When the message is not acknowledged, the default action will be to reduce the volume output to the predetermined level. If possible, users should be given the option to customize this level (the level at which they would like their device to limit the volume) according to their preference. Parental control: it is recommended that the device should have the option whereby the maximum sound output can be fixed and locked in the settings, possibly through use of a password. The purpose of this feature is to allow parents (or other adults) to limit the maximum sound output of the child’s device, in a way that cannot be changed by the child. The feature can also be used by individual users in order to limit their own sound exposure, by fixing the maximum output on their device. 72 73 Packaging •A clear, concise message/warning should be included on the external packaging of the devices, wherever possible. •Messages should appear on a plain background and be short, simple, and clear, with a relevant illustration. •The manual should clearly state that unsafe listening via the device may pose the risk of permanent hearing loss. •It should indicate that the device is equipped with safety features to help users protect their hearing. •This message should align with information provided through the device interface. It should contain similar text regarding the risks of hearing loss from unsafe listening and the recommendations for safe listening. •It should also detail the safe listening features within the device. •A visible icon on the device screen will direct users to the general information on safe listening. •This icon will also lead the user to a display (in devices with screens) which provides information regarding individuals' listening parameters and (daily and weekly) usage statistics. •The first use of ear/headphones with the device should direct the user to a tutorial with information on safe listening, how to practice it, and their personal listening profile (same information as available through the icon). •It will describe the standard levels for adults and children and allow the user to select a level. •Users will be given the option to set up how often and at what levels of usage they wish to receive the notifications. • The information on the daily/weekly sound allowance consumption is available to users at any time through the distinctive icon above mentioned. • Calculation should include all sounds played through the music players or online, as long as ear/headphones are used. • The displayed information should include: weekly allowance used and remaining; listening time (for the day/week), and indicate how the user's listening has been for the past 7 days, including current day, where possible. •Warnings and cues for action shall be delivered every time the user reaches 100% of the allowance exposure levels and also as per settings customized by the user. •These should be visual (where possible) and audible/vibratory to ensure that the user's attention be directed towards these. •The notifications should include information on the level of audio usage and the corresponding recommendations for safe listening. •The first time a user connects to an ear/headphones or starts playing music on a given day, the device could give a welcome message based on the usage on the previous days/week. User manual Device interface 1st use Personal Usage Notications Daily alerts Appendix 7 This section and the figure below contains suggested steps for explaining how the communication aspects of the standard can be implemented within devices Figure 7.1: Flow of information as part of standards for safe listening devices Example of information flow Example of how the information on listening parameters can be conveyed to users Through a clearly recognisable icon, users should be able to access a “dedicated space” (screen) on the device where information on the user’s listening habits is stored, visualized and interpreted. In this space, the user should be able to access a graphic representation of his/her overall listening habits or patterns and learn if (and what type of) unsafe listening practices have occurred. The visualization of the user’s listening habits will include: • graphic display of the use of weekly sound allowance; • graphic display of daily sound exposure through a colour-coded display; • duration of listening, over each day and the past 7 days in hours and minutes. 1. Information on use of weekly allowance Use of weekly allowance can be graphically conveyed as illustrated in Figure 7.2 Figure 7.2 – Illustration of how to graphically convey the use of a weekly allowance 2. Information on how the user has used the allowance on any day For the purpose of this display, the maximum daily allowance will be equal to weekly allowance divided by 7 (approximately 15% of the weekly allowance). Usage for the last 7 days (including the present day) would be indicated by a range of colours depicting different levels of usage, e.g. red for over 100% use and green when use is below 50%. For the purpose of this communication, each day would be considered as a separate unit and colour coding for the day would not take the previous days’ exposure into account. Hence, the user would start with green icon each day, regardless of past days’ usage. Used Remaining 60% 40% Listening time (for last 7 days): 4 hours 20 minutes 74 75 3. Listening time Information on the overall time the user spent listening to audio content through the device each day will also be displayed (as shown in Figure 7.3.) Figure 7.3 – Information on the overall daily time the user spent listening to audio content 4. Warnings and cues for actions Warnings accompanied by cues for action should be provided to the user regularly: • When reaching 80% and 100% of the weekly allowance. • Upon reaching 100% of weekly allowance, the device should automatically reduce the volume to the reference level unless the user choses to continue listening at high volume despite the risk communicated. • Each message should be accompanied by a cue for action that will facilitate the listener to reduce the volume or stop listening. • Every day, the user should be provided with a notification informing them of how their listening has been over the last day and suggesting action to be taken that day. This may be an encouraging or warning type of message. Examples of such messages and cues for action are included in annex 8. Date-6 Date-5 Date-4 Date-3 Date-2 Date-1 Date (Today) Time 1h 5m 1h 20m 2h 1m 1h 50m 2h 5m 3h 2m 2h 50m safe unsafe 76 Appendix 8 Key considerations when developing messages and examples Given below are some evidence-based considerations for manufacturers develop messages as part of the safe listening features for their devices. As far as possible, manufacturers should try to develop messages which are appropriate for the cultural and linguistic context of the country. • The aim of such messages is to gain attention, build interest and encourage users to practice safe listening. • They should share actionable information, provide viable alternative behaviours and facilitate safe listening practices. Points to consider while developing such messages/cues are: • They should clearly convey the benefits of safe listening and the risks of not doing so. • There should be 3–4 variations of each message that can convey the information in a non- repetitive manner, designed to address a wide audience. • Text should be simple, clear and jargon-free in order that they can be understood by the majority of users. • Some messages should be positively and others negatively worded. • Written information should be complemented by pictorial information for ease of understanding. • Messages should be based on recommendations from a credible source. • Wherever possible, messages should be pre-tested by the manufacturer before use. The following are some examples of warnings and cues for action for the safe listening features. Examples of warnings and cues based on weekly use Information when user reaches: a. 80% of weekly allowance: friendly warning message: You have already spent 80% of your allowance. Turn down the volume to protect your hearing Reduce volume/Stop listening/Ignore warning/Go to personal usage information. OR Hello! It looks like you have been playing a lot of loud music lately. Why don't you take a short break to protect your hearing? Reduce volume/Stop listening/Ignore warning/Go to personal usage information. 77 b. 100% of weekly allowance: warning message (with an option to pause listening immediately): You are now OVER 100% of your safe listening allowance. Unsafe listening poses a risk to your hearing. Reduce volume/Stop listening/Ignore warning/Go to personal usage information OR Hey! You have played too much loud music recently. Take a break and protect your hearing. Reduce volume/Stop listening/Ignore warning/Go to personal usage information Unless the user agrees to “ignore warning: or to “pause listening”, the default will reduce the volume to below an average of 80 or 75 dB Examples of messages based on daily use Daily message (when opening the app or at player page) which should be based on the user’s use of sound allowance over the last few days: a. Mostly in green (where the user stays below 50% weekly usage most days, not exceeding the allowance on any day): encouraging messages Good job. This is the way to listen well Good job! Keep playing music safely for endless fun Well done. Keep listening safely and have endless fun b. Mostly green or yellow/orange (where the user stays below 80% on most days, not exceeding the allowance on any day): Be careful and listen safely. Hey! It seems that sometimes you enjoy high volume! Be careful and protect your hearing for endless fun! You can listen safely for longer by lowering the volume 78 c. Mostly yellow/orange with occasional red (where the user is not exceeding the allowance on any day): Be careful! Keep the volume down to listen safely for longer Hey! It seems that sometimes you enjoy loud music! Be careful and protect your hearing for endless fun! Hey! You should watch how you listen. d. Mostly red (exceeding the allowance on most days): You are putting your hearing at risk. Keep the volume low to listen safely Hey! You need to watch how you listen. Turn it down. Hey! It seems that you enjoy really loud music! Don't put your hearing at risk and have endless fun. Examples of messages with positive versus negative frame; and emotional versus rational appeal Positive frame: You exceeded your daily allowance for safe listening. Keeping the volume low lets you listen safely for longer without risk to hearing. Turn it down. Negative frame: You exceeded your daily allowance for safe listening. If you keep listening this way, you risk damaging you hearing forever. Turn it down Rational appeal: The evidence says that if you listen to music above the 80 dBA SPL, for 8 hours or its equivalent, you might damage your hearing forever. Turn down the volume. Emotional appeal: Once you lose your hearing, it will not come back. Listen safely. Turn down the volume. 79 Appendix 9 Resources for school-based workshops for safe listening Cheers for Ears Developed by the Ear Science Institute Australia, Cheers for Ears educates school students aged 10 to 12 years old about the dangers of hearing loss and its prevention. The programs use various multimedia materials and provide interactive sessions in schools. Aside from the programs, the team has created a number of activities including: Safe Hearing Suzie, Epic Ear Defence and Cheers for Ears Charlie, the mascot. These activities have been successful in encouraging safe listening among 21,300 children at 226 schools over last three years. There are three aims of the project: “to develop a health promotion program to educate primary school-aged children in the dangers of exposure to dangerous levels of noise and music,” “to develop an application to monitor and track noise exposure from personal music players,” and “to develop an Internet resource as a central information site for all matters related to NIHL and exposure to entertainment-related sounds.” For more information on Cheers for Ears, go to http://www.hearingservices.gov.au/wps/wcm/connect/8c6fc19a-4f10-4307-93f3-d350f50fbe5b/che ers-for-ears.pdf?MOD=AJPERES Resources • Safe Hearing Suzie is a mannequin head with a built-in sound level meter and hearing loss simulator. Suzie shows the decibel level of the sound as well as information on whether the sound is a safe listening volume or not. Therefore, Suzie teaches students about the truths and risks of NIHL. • Epic Ear Defence is an online game that students can actively engage in learning the importance of protecting ears. During the game, players have to use defensive techniques to fight off the incoming loud sounds (enemy). “As more loud sounds escape the player and reach the eardrum, the game begins to subtly simulate hearing loss and tinnitus into the over sound track.” This simulation is an engaging activity that people can enjoy while learning the importance of hearing. • Cheers for Ears Charlie is the mascot, shown as a superhero demonstrating headphones as a way to reduce the risk of NIHL. This mascot appears in different settings such as Hearing Awareness Week, school assemblies, and children’s festivals. • Workshops are delivered to schools, and age-appropriate presentations are used. Classroom activities include poster competition, creating a television or radio advertisement and quiz. Contact Information • For more information, email Natalie Leishman natalie.leishman@earscience.org.au 80 Hear 4 Tomorrow Hear 4 Tomorrow is a classroom-based program to educate primary school children about ear health. It was primarily designed for school teachers as a teaching tool with various curricula. The extensive curriculum is composed of four educational modules: understanding hearing loss, the hearing system and noise, how loud is too loud and protecting our hearing. Each module covers different aspects of hearing health, and students learn noise reduction behaviour. The aim of Hear 4 Tomorrow is “to provide teachers with a resource that enables them to teach hearing health in a way that complements their existing teaching programmes.” For more information on Hear 4 Tomorrow, go to https://hear4tomorrow.nal.gov.au/index.html. Resources • For each module, there is a variety of resources that students experience. – Hearing Loss Simulation allows people to have a hands-on experience of hearing loss at different levels. It demonstrates how the audio might sound for a 35-year-old with NIHL or how the audio might sound like for people with NIHL and tinnitus altogether. By providing different cases of diagnosis, the hearing loss simulation helps them understand hearing loss and its challenges. – Students learn to measure the levels of different noises and the relationship between volume and duration of exposure through the flash cards. – Teaching notes are provided. Contact Information • Hear 4 Tomorrow was developed by the National Acoustic Laboratories, the research division of Australian Hearing. You can contact enquiries@nal.gov.au Dangerous Decibels Dangerous Decibels focusses on three ways to prevent noise-induced hearing loss. The programme gives classroom presentation to schools that teach the concepts of noise-induced hearing loss and preventive strategies. Through an interactive workshop, it highlights the importance of protecting the hearing health and suggests to “walk away,” “turn it down,” and “use earplugs.” This school-based workshop has been tested for effectiveness and they haveshown that such presentation is very effective in modifying behavior, knowledge and attitudes among the primary school students. The aim is to “reduce the incidence and prevalence of noise-induced hearing loss (NIHL) and tinnitus (ringing in the ear) by changing knowledge, attitudes, and behaviors of school-aged children.” The programme has created Jolene, a mannequin equipped with a sound level meter, which attracts children and promotes safe listening. 81 Resources • Jolene and the Jolene cookbook: Jolene was constructed using a used fashion mannequin and a sound level meter wired to a silicon ear. Jolene makes appearances at schools and universities, scientific meetings, health fairs, and many other public events. Jolene has also been used as a research tool to study the beliefs and listening practices regarding personal stereo systems. Jolene cookbook is the production by the National Hearing Conservation Association for people to make their own Jolene. • Coloring Sheets is a set of three coloring sheets for the young kids. They make good take-homes. For more resources, please go to http://dangerousdecibels.org/. Noisy Planet Noisy Planet is a public education campaign, developed by the National Institute on Deafness and Other Communication Disorders (NIDCD). Noisy Planet has numerous teaching toolkits for different groups of people (parents, health teacher, school nurses and health professionals). Their aim is to “increase awareness of the causes and prevention of noise-induced hearing loss.” These educational resources include toolkits, advice and tips for safe listening. According to data from two surveys, the Noisy Planet is very effective in reaching target audiences. Additionally, Wise Ear campaign, also launched by the NIDCD, educates primary school students about preventing noise-induced hearing loss. For more information, go to https://www.noisyplanet.nidcd.nih.gov. Resources • The website provides noisy planet presentation, student activity videos and other resources • There are training videos that show the activities in the presentation. Instructions provide in-depth descriptions of each activity, including the required equipment, number of student volunteers needed, and the estimated time for each activity. Contact Information • For general questions, contact NPInfo@nidcd.nih.gov Listen to Your Buds Developed by American Speech and Hearing Association (ASHA), Listen to Your Buds campaign provides various instructions on how to prevent hearing loss through teaching materials. The campaign is delivering an important health message that all parents and kids need to hear. It aims to “make effective communication a human right, accessible and achievable for all.” The campaign educates the public about the risk of hearing loss in children from the unsafe use of personal audio technology, particularly earbuds or headphones. Furthermore, the Listen To Your Buds concert series visit schools, teaching kids about the importance of technology to protect their hearing health. For more information, go to https://www.asha.org/buds/. 82 Resources • Interactive school-based workshops are held in primary schools. Elementary school students learn how to protect their hearing for a lifetime from renowned musicians. Video: https://www.youtube.com/watch?v=cfkPUnWBmiI • Listen to Your Buds Bookmarks • Listen to Your Buds Colouring Book • Turn Down the Volume Song • Radio Disney PSA (educative narrative to protect hearing) • Self-Test for Hearing Loss Contact Information • There is no direct email address but contacting ASHA is possible by filling out information: https://www.asha.org/Forms/Contact-ASHA/

FOR MORE INFORMATION PLEASE CONTACT: Department for Management of NCDs, Disability, Violence and Injury Prevention https://www.who.int/deafness/make-listening-safe/en/ World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland ISBN 978-92-4-151528-3

安全收听设备与系统 工具包 让听力安全

安全收听设备与系统 工具包 让听力安全 安全收听设备与系统工具包 [Toolkit for safe listening devices and systems] ISBN 978-92-4-000169-5（网络版） ISBN 978-92-4-000170-1（印刷版） © 世界卫生组织和国际电信联盟 2020年 部分版权保留︒本作品可在知识共享署名——非商业性使用——相同方式共享3.0政府间组织 (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo) 许可协议下使用︒ 根据该许可协议条款，可为非商业目的复制︑重新分发和改写本作品，但须按以下说明妥善引用︒在 对本作品进行任何使用时，均不得暗示世卫组织或国际电联认可任何特定组织︑产品或服务︒不允许 使用世卫组织或国际电联的标识︒如果改写本作品，则必须根据相同或同等的知识共享许可协议对改 写后的作品发放许可︒如果对本作品进行翻译，则应与建议的引用格式一道添加下述免责声明：“本 译文不由世界卫生组织（世卫组织）或/ 和国际电信联盟（国际电联）翻译，世卫组织或儿基会均不 对此译文的内容或准确性负责︒原始英文版本为应遵守的正本︒” 与许可协议下出现的争端有关的任何调解应根据世界知识产权组织调解规则进行︒ 建议的引用格式︒安全收听设备与系统工具包 [Toolkit for safe listening devices and systems]︒日内瓦： 世界卫生组织和国际电信联盟︔ 2020年︒ 许可协议：CC BY-NC-SA 3.0 IGO︒ 在版编目（CIP）数据︒在版编目数据可查阅http://apps.who.int/iris︒ 销售︑版权和许可︒购买世卫组织出版物，参见http://apps.who.int/bookorders︒国际电联出版物可从 国际电联书店获得http://www.itu.int/fr/publications︒提交商业使用请求和查询版权及许可情况，参 见http://www.who.int/about/licensing︒ 第三方材料︒如果希望重新使用本作品中属于第三方的材料，如表格︑图形或图像等，应自行决定这 种重新使用是否需要获得许可，并相应从版权所有方获取这一许可︒因侵犯本作品中任何属于第三方 所有的内容而导致的索赔风险完全由使用者承担︒ 一般免责声明︒本出版物采用的名称和陈述的材料并不代表世卫组织或国际电联对任何国家︑领地︑ 城市或地区或其当局的合法地位，或关于边界或分界线的规定有任何意见︒地图上的虚线表示可能尚 未完全达成一致的大致边界线︒ 凡提及某些公司或某些制造商的产品时，并不意味着它们已为世卫组织或国际电联所认可或推荐，或比 其它未提及的同类公司或产品更好︒除差错和疏忽外，凡专利产品名称均冠以大写字母，以示区别︒ 世卫组织或国际电联已采取一切合理的预防措施来核实本出版物中包含的信息︒但是，已出版材料的 分发无任何明确或含蓄的保证︒解释和使用材料的责任取决于读者︒世卫组织或国际电联对于因使用 这些材料造成的损失不承担责任︒ 瑞士印刷. 前言 致谢 摘要 背景 噪音是影响听力的一个风险因素 听力损失带来的影响 世界卫生组织的“保护听力”举措 安全收听设备标准的基本原理 WHO-ITU H.870安全收听设备与系统的全球标准 制定WHO-ITU全球标准 工具包的目标 政府的实施方案 基本原理 政府可采取哪些行动︖ 业界合作伙伴的实施方案 基本原理 制造商可采取哪些行动︖ 民间团体的作用 基本原理 民间社会组织可采取哪些行动︖ 参考文献与参考书目 附录 附录1:状况评估工具 附录2:利益攸关方磋商的格式 附录3:关键信息的介绍性说明 附录4:宣传讲习班的大纲 附录5:宣传材料 附录6:WHO-ITU全球标准的概述 附录7:信息流的示例 附录8:开发消息和示例时的主要考虑事项 A附录9:关于安全收听的学校讲习班的资源 目录 8 8 9 10 10 11 11 13 16 16 17 22 22 22 28 28 28 32 36 36 48 49 53 54 62 73 76 79 在全球范围内,有十亿青少年和年轻人面临因长时间,大音量用其个人音频设备听音乐而导致听力损失 的风险.一旦因听大音量声音而导致听力损失,它将无法逆转.如果没有得到解决,这种听力损失会极大地 影响一个人的沟通,接受教育或者找到并保持适当工作的能力.不过,通过宣传和适当的预防措施,是可以 避免因大音量而引起的听力损失的. 为了解决这个问题,世界卫生组织(WHO)和国际电信联盟(ITU)开发了安全收听设备与系统工具包,它为 实施安全收听设备全球标准(ITU-T H.870)提供了必要的实用指导.该标准概述了调节用户暴露于声音,限 制音量和提供有关安全收听信息的关键特征.此处推荐之关于安全收听特征的实施方案,将是保护用户 免受因大音量而造成听力损失并确保人们可继续享用其所喜欢之声音的关键. 政府可以通过规范标准来采取行动,制造商可以开发和销售实施工具包各建议的设备.民间团体可以倡 导实施标准和提高安全收听意识. 国际电联和世界卫生组织呼吁各成员国,业界合作伙伴和民间团体在促进安全收听并应对这一新的健康 挑战中发挥积极作用. 使用该工具包和实施H.870全球标准将有助于负责任地使用技术来增强其用户的健康和福祉. 国际电联,多琳•伯格丹-马丁 (Doreen Bogdan-Martin)女士 世界卫生组织,Etienne Krug博士 Etienne Krug 博士 世界卫生组织非传染性疾 病(NCD),残疾,暴力和伤害 预防(NVI)管理局主任 Doreen Bogdan-Martin女士 国际电信联盟电信发展局 (BDT)主任 前言 致谢 世界卫生组织(WHO)和国际电信联盟(ITU)非常感谢本手册的以下贡献者. 内容开发:Elena Altieri,Young-Se An,Simao Campos-Neto,Shelly Chadha,Alarcos Cieza,Nicola Diviani,Catalina Valencia Mayer,Ericka Lara Ovares,Karen Reyes,Sara Rubinelli, Roxana Widmer-Iliescu. 指导意见:Etienne Krug,TamitzaToroyan. 进一步的贡献:Lidia Best,Avi Blau,Brian Fligor,Mark Laureyns,Richard Neitzel,Michael Santucci. 行政支持:Laure Cartillier,Alina Lashko. 编辑:Angela Burton. 布局和设计:Estudio Creativo. 摘要 该工具包提供实用指导,以支持成员国,业界合作伙伴和民间团体使用和实施WHO-ITU H.870安全收听 设备与系统全球标准.WHO-ITU全球标准是世界卫生组织(WHO)与国际电信联盟(ITU)之间合作的成果, 它为应对日益普遍的,因不安全的收听而造成的听力损失和听力威胁而制定.WHO-ITU全球标准采用基 于证据的和咨询的程序而制定,并有声音,听力学,声学,传播和智能手机技术领域的专家参与. 该工具包概述了预防听力损失的必要性,并描述了世界卫生组织和国际电联如何应对这一挑战.它以简 化的方式总结了WHO-ITU全球标准,并为听力损失预防领域的三个主要合作伙伴提供了逐步实施的方 法: • 政府 • 业界 • 民间团体 为每个合作伙伴量身定制的部分概述了有效实施WHO-ITU全球标准所需的步骤.包括各种各样的工具, 以帮助解决这一问题:状况评估工具;规划讲习班的大纲;以及宣传沟通和幻灯片演示样本. 该工具包的目的是使合作伙伴能够轻松采用,实施和监督WHO-ITU全球标准.其总体目标是确保所有个 人音频系统的用户均能获得有关安全收听的信息,并可选择安全的收听方式,从而保护好其听力. 背景 8背景 世界卫生组织估计,由于不安全的收听行为,全世界有超过10亿的年轻人存在听力损失的风险(1).因此迫 切需要采取行动.近年来,技术的获取迅速增长,并且有越来越多的人正在使用这种技术来进行通信.此 外,通过使用个人音频系统以及娱乐场所中暴露于高声下的人数显著增加,这使他们处于听力损害的高 风险中. 总体而言,听力损失的人数正在快速增长.据估计,目前全球约有4.66亿人患有听力损失(2).其中,4.32亿 (93%)是成年人,3400万(7%)是儿童.世界卫生组织最近的预测表明,除非采取行动,否则到2030年将有6.3 亿人患有听力损失.如果不解决听力损失问题,到2050年,这一数字预计将增加到9亿以上(2),而目前全球 超过7500亿美元(以国际美元计)的年度费用也将相应增加(1,3). 注:Pa2h:帕斯卡平方小时是用于度量声 能的单位. 若干风险因素会影响人一生中的听力. 虽然世界部分地区与听力损失有关的 某些风险因素正在下降(例如风疹和脑 膜炎),但噪音等可预防的因素(主要是 我们现代生活方式造成的结果)正在上 升. 噪音是影响听力的一个风险因素 耳朵是处理声音的器官,它使大脑能够 解释个体听到的内容.耳朵分为三个部 分 — 外耳,中耳和内耳(见图1).通常声 音被位于内耳中的感觉细胞感知,并且 当这些细胞经常暴露于响亮的声音时, 它们可被永久性损坏,从而影响个体的 听力. 图1:耳朵的结构 弹性软骨 肌肉 头骨 锤骨 砧骨 半规管 镫骨 前庭神经 耳蜗神经 耳蜗 到鼻咽 咽鼓管 卵圆窗 耳廓 耳道 鼓膜 前庭 圆窗 内耳 中耳外耳 (深至镫骨) 噪音引起的听力损失可能因各种环境和行为而引起.例如,在经常出现在迪斯科舞厅,俱乐部,体育赛事 或音乐会的人中,有40%将暴露于潜在的破坏性声级下(4).有证据表明,在过去20年中暴露于社交环境中 高声下的人,其遭受听觉损失的可能性是未暴露者的三倍. 9智能手机和MP3播放器等个人音频设备的广泛应用增加了这种风险.发展中国家的智能手机使用率已从 2013年的45%增长到了2015年的54%(7),而在发达国家,智能手机的使用率高达87%. 据估计,50%通过个人音频设备收听音乐的人,是在存在听力风险的音量上进行收听的(4). 本工具包专注于因使用个人音频设备进行不安全收听而造成的听力损失.不安全的听力行为于2008年被 关于新兴和新确定的健康风险科学委员会认定为造成听力损失的一个主要原因.该委员会指出,5-10%的 听众可能因其个人喜好的音量水平和收听持续时间而导致听力损失.(8)不同国家的证据来源各不相同, 但有一项研究显示,美国有超过4000万20至69岁的成年人因非职业原因而受到由噪音引起之听力损失的 影响(5). 听力损失带来的影响 幼儿因噪音而造成听力损失将有损其语言获得(6,7),儿童因暴露于高声而造成学习障碍,产生焦虑和注意 力分散也很常见(11).教室里长期的噪音暴露会影响学习成绩,体现在以下方面,如阅读能力,理解能力,短 期和长期记忆以及学习的积极性,主动性等.平均而言,暴露于嘈杂学习环境中的儿童,在标准化考试中的 评估分数会较低,从长远来看,这可能会影响他们的学术和专业发展(4,8). 在成人中,未能有效恢复的听力损失可意味着收入的损失以及难以找到和留住工作.例如,在欧洲,相比听 力正常的人,听力损失未能有效恢复的人其失业的可能性要高两倍.在就业时,他们获得的工资通常会更 低,例如,在美国,对于听力损失未能有效恢复的成年人,其工资要低50%至70%.未能有效恢复的听力损失 会影响社会关系,并可成为造成家庭关系紧张的一个原因. 年轻人中的噪音暴露也会导致年龄相关的听力损失,它可造成重大的沟通困难,这可能意味着对随后的 情绪和认知造成影响(9).最近的证据表明,相比没有听力损失的老年人,在有听力损失的老年人中,抑郁,孤 僻,挫败,认知能力下降和人身安全下降等现象要高两倍(10,11,12,13). 虽然因噪音而导致的听力损失是不可逆转的,但仍可以预防.在因不安全使用个人音频设备而导致的听 力损失的情况下,有简单,有效的预防措施,例如,将音量保持在安全的听力水平内,并限制从事嘈杂活动的 时间,如果遵循这些做法,则对人们的听力可以起到保护作用. 10 采取安全的收听行为,采取预防措施,主要在听众自身.不过,政府,医疗保健提供者,制造商和民间团体可以 创造一个能使收听安全的环境. 世界卫生组织的“保护听力”举措 2015年,为了应对这一日益严重的公共卫生问题,世界卫生组织提出了“保护听力”举措,其总体愿景是确保 所有年龄段的人都能在听力得到充分保护的情况下享受收听. 该全球倡议的目的是通过以下方式降低因娱乐场所不安全的声音暴露而导致的听力损失风险: • 通过个人音频系统来调节对高声的暴露; • 开展公众宣传活动,改变目标人群的收听行为; • 制定娱乐场所安全收听的监管框架. 为实现第一个目标,国际电联和世界卫生组织合作制定了关于安全收听设备与系统的WHO-ITU全球标 准. 安全收听设备标准的基本原理 其他公共卫生领域的经验(例如,减少烟草使用或改善道路安全)表明:政策,法规及其执法最终可影响人们 的行为.例如,卷烟包装上的强制性图形告警就是这种情况;再如,忽视强制性安全带佩戴法规将受到罚款 就是这种情况.根据这些经验(14),相信设计和实施特定的立法,要求能够通过个人音频系统来调节接收的 声音能量,确保使用这些设备的人能够较少地暴露于声音下,将有助于防止听力损失. 目前,有一个监管示例,针对的是经个人音乐播放器暴露于声音下的情况,这是欧盟委员会2009年的指令, 用于限制个人音乐播放器的输出音量水平,并强调对收听者提供告警的重要性.事实证明,法律和监管干 预措施是取得诸多守卫公共卫生成就的一项有效策略.一个强有力的例子是世界范围内关于禁烟的立法 ,该措施有效地降低了被动和主动吸烟的发生率以及相关人群中急性冠状动脉综合征的发病率(15). 立法及其执法被证明是道路安全的关键干预措施,这可以减少超速行驶和酒驾(16,17).从这些例子可以看 出,制定法规或法律以解决作为公共卫生问题之一的高音量暴露问题是有意义的,以便使不良的收听习 惯得到持续改变. 11 WHO-ITU H.870安全收听设备与系统的全球标准 WHO-ITU全球标准(18)以欧盟委员会(19)提出的建议为基础,并提供了基于证据的导则,以促进个人音频 系统用户的安全收听. 原则上,WHO-ITU全球标准提出了适当方法,以便将收听(个人音频系统)技术转变为应对不安全收听挑 战解决方案的一部分.能够跟踪行为和健康状况并提供个性化反馈意见的复杂技术的迅猛发展,可推动 安全收听行为,同时继续为收听者提供愉快的体验. 利用智能手机技术可将智能移动设备连接到强大的计算资源,从而提供一个平台,来以足够及时的方式 提供有针对性的,定制的,安全的收听干预措施,并获得最佳效果. 通过使用技术和创建有针对性的保护功能,WHO-ITU全球标准旨在为那些通过个人设备收听音乐的人 创造一个安全的环境.除其他外,WHO-ITU全球标准推荐的保护功能旨在限制用户暴露于高声下的强度 和持续时间.不过,由于用户可以决定否决技术(例如,通过停用保护功能),WHO-ITU全球标准还包括以下 建议,即在保护功能中集成进一个教育组件,以帮助用户跟踪,解释和学习其行为. 基于行为改变理论和模型,对用户而言,如果他们能接收到有关使之处于危险的行为类型,潜在后果以及 如何应对的信息和线索,则可能更容易采用和保持安全的收听行为. 制定WHO-ITU全球标准 WHO-ITU全球标准基于现有证据,是两年来与众多专家和利益攸关方合作的结果,包括听力学家,学术界, 音响工程师,专业协会,设备和耳机制造商,工作于全球或欧洲层面的监管机构,以及目标年龄范围(12-35 岁)的成员.在世界卫生组织和国际电联交替召集下,该涉及面广泛的小组,为WHO-ITU全球标准的案文 提供了输入和反馈意见.所有编制的背景文件和证据都是公开的.在生效之前,该小组编制的WHO-ITU全 球标准已在网上公布,以向国际电信联盟193个成员国及其数百个部门成员征求意见和建议. 12 WHO-ITU全球标准由两个有机部分组成:技术规范和传播/教育要素.二者密切相关,必须一起实施方有 效. 1. WHO-ITU全球标准中涉及的技术方面问题: 还建议设备允许用户选择其参考暴露量作为以下两种模式之一: 模式1 :(WHO)成人的标准水平.它将每7天1.6 Pa2h作为参考暴露量(即每周40小时的80 dBA SPL). 模式2:(WHO)敏感用户(例如儿童)的标准水平.它将每7天0.51Pa2h作为参考暴露量(即每周40小时的 75dBA SPL). 当第一次使用播放器时(或者当设备重置为出厂设置时)给出模式选择.模式选择可以在以后的任何时候 予以改变,例如,通过设备设置菜单. 音量限制:这是一种功能,当每次用户达到其每周限额的100%时,会自动提供音量限制消息和选项.如果用 户不希望设备音量减小,则该消息应允许用户选择“续收听”.当消息未得到确认时,默认操作将是把音量 输出降低到某个预设水平.如果可能,应该根据用户的偏好,为用户提供自定义该音量水平(用户希望其设 备限制的音量水平)的选项. 如果用户希望这么做,通过固定其设备上的最大输出,个人用户也可以使用该功能来限制他们自己的声 音暴露情况. 家长控制:建议设备应提供一个选项,可能是通过密码的使用,可以在设置中固定和锁定最大声音输出.这 将允许父母(或其他成年人)以儿童无法改变的方式来限制儿童设备的最大声音输出. 剂量测定:WHO-ITU全球标准建议每个设备都包括一个用于跟踪用户 暴露时间并使用参考暴露量(声音限额)估算声级和百分比的系统. 该声学剂量测定必须包括在用户使用耳机期间通过设备播放的所有 媒体(无论是存储在设备上的还是流式传输的).(语音通话被排除在外, 因为它们是由其他标准单独规定的). 剂量测定 比照参考暴露量(或声 音限额),计算和评估耳 朵接收的声音量. 13 2. WHO-ITU全球标准解决的传播方面问题: WHO-ITU全球标准旨在为用户提供信息和指导,使之能够通过跟踪,解释和学习自己的行为,来做出安全 的收听选择.这样的组件包括: – 个人使用信息,基于技术组件中提到的跟踪系统.这将有助于用户了解: • 他们自己的收听习惯(每日和每周声音限额的使用情况); • 如何使用特定设备的安全收听功能. – 个性化建议以及根据每个用户收听状况而定制的安全收听行动提示. – 关于以下诸点的一般信息: • 安全收听和实践方法; • 与不安全收听有关的风险; • 因来自个人音频系统以外之声源的高声而导致的听力损失风险. 工具包的目标 该工具包旨在为WHO-ITU全球标准的实施和后续行动提供实用指南,它应作为所有成员国的法规或立 法的基础,或者由制造商自愿采用,以保护用户免受因噪音而引起的听力损失.WHO-ITU全球标准旨在支 持各个国家,各行各业和民间团体以策略性的,基于证据的和用户友好的方式来应对和预防因噪音而引 起的听力损失. 该工具包分为三个部分.每个部分都针对一个小组,其行动对于确保采用WHO-ITU全球标准和用户受到 保护至关重要.这包括: • 政府,特别是工作于卫生,技术,商业,工业,消费者保护领域以及与残疾或无障碍问题有关的任何其 他部门的部委和部门; • 业界,特别是个人音频系统的制造商; • 工作于收听或消费者权利领域的民间社会组织. 14 每个部分都为利益攸关方提供了关于采取安全收听行动的理由;它们列出了该特定群体如何实施或 促进WHO-ITU全球标准的可能性;并对采取行动的工具提出了建议. 提供了过程,步骤和工具,以供指导,并且可以由利益攸关方来做调整,转换或修改,从而满足各个国家和 制造商的不同需求. 政府的实施方案 16 本节旨在作为以下诸项(及其他项)的导则: • 负责起草政策,为各部委提供咨询意见,在卫生领域确定优先议程(例如,在青少年健康方面),教育, 技术,信息通信技术,电信,以及监管或标准化机构,消费者保护机构和卫生部委内负责听力计划或 青少年健康的管理人员; • 负责学校健康或教育部门内设备采购的官员; • 负责政府部门内无障碍问题的官员. 基本原理 全球所有地区的听力损失都在增加,这构成了公共卫生挑战,带来巨大的经济成本.世界卫生组织估计,未 能有效恢复的听力损失每年花费全世界大约7500亿美元(以国际美元计). 对听力损失预防的投资可以帮助政府节省已经稀缺的资源.教育部门和技术部门应倡导并支持对听力损 失的预防,部分通过实施WHO-ITU全球标准来实现,以完成其保护一般技术用户,特别是使用技术进行学 习的儿童的任务.全球范围内技术用得越来越多,其不当使用在这方面构成了巨大挑战.为了降低相关风 险,人们必须学会如何正确使用技术,以便最大限度地减少其有害影响.WHO-ITU全球标准使之可以使用 技术接口作为预防噪音引起听力损失的一个平台. 政府的实施方案 17 政府可采取哪些行动︖ 可通过以下方式来推动实施WHO-ITU全球标准: 1. 立法:WHO-ITU全球标准应纳入与个人音频设备的制造,进口和销售有关的法规和立法中. 2. 其他政策: a. 政府监管:相关政府部门(技术,卫生,消费 者保护等)应确定一项机制来执行此类政 策或规定,以确保其管辖范围内销售的所 有个人音频设备与系统均符合WHO-ITU 全球标准,并保护用户免受噪音引起的听 力损失. b. 采购政策:定期大宗采购技术的政府部 门(通过招标和公共采购)应确保其采购的 所有设备均符合 2003年,国际电联制定了一项有关视频 压缩的国际标准(ITU-T H.264建议书), 该标准已被业界广泛采用.法国制定了 一项法规,巴西颁布了一项总统令,要求 将ITU-T H.264用于无线广播业务,该标 准可为最终用户带来以下益处:不仅在 这些国家中通过电视广播的图像质量 得到了显著改善,而且可以降低所需机 顶盒接收机的成本. WHO-ITU全球标准.如果技术部门扮演咨询角色并通报其他 部门(涉及相关设备)做出的决定,则应建议根据WHO-ITU全球 标准中定义的功能来调整这些采购政策. 公共采购已被用作是一种 深化诸多领域中公共政策 的工具,并有可能助力实现 社会目标(20). 3. 除了实施WHO-ITU关于安全收听设备的全球标准的法律和其他政策外,政府还应开展旨在提高公众 意识的活动,以提高对以下方面问题的认识: • 高声带来的风险,特别是那些在娱乐场所经历的高声; • 可降低收听者听力损失风险的安全收听行为. 18 吸引合作伙伴 该领域的所有利益攸关方都应参与其中,包括: • 不同的政府部门,如技术,卫生,教育,商业和工业;环境,青年; • 民间团体,包括听力障碍协会;非政府组织,专业社团; • 青年组织; • 制造商; • 消费电子协会; • 大的零售集团; • 消费者保护组织; • 在国家背景下可能相关的其他方. 提议的步骤 建议采用下面提议的逐步方法,来确保将WHO-ITU全球标准纳入相关的政策和法规中. 第1步:评估和政策制定 a. 开展状况评估:发起部门应开展状况评估,以了解: • 目前在该国销售的设备的安全收听功能; • 目前有关该国家/地区听力损失的统计数据,特别是有关因高声而引起的听力损失的统计数据(如 果有的话); • 与听力损失预防,噪音控制和安全收听有关的现行政策; • 主要利益攸关方是谁,包括政府部门,民间团体,青年组织,制造商. 开展状况评估的格式见附录1. b. 组织规划咨询:在状况评估后,发起部门/部委应组织召开一次会议,以规划实施WHO-ITU全球标 准,并获得所有相关利益攸关方的认可.该会议应包括步骤1中确定的所有主要的利益攸关方.在该 会议期间,应提交状况评估结果,概述WHO-ITU全球标准,并提出进一步实施的步骤. 利益攸关方咨询大纲见附录2. c. 制定关于安全收听设备的政策:发起部门应起草法律,政策或法规,并与相关的部长/政府部门进 行讨论.然后应与利益攸关方共享,以获得其反馈意见,这应该在最终确定和批准政策文件之前得 到解决. d. 确定提高目标群体意识的方式和方法:随着安全收听设备政策的制定,发起部门应制定提高安全 收听意识的策略,并告知用户有关法规中提出的新的安全收听功能.这应该与相关的卫生专业人员 和沟通专家协商完成.国家可以利用经过验证的,世界卫生组织的宣传材料,这些材料可以根据使 用国的情况与需要进行调整和翻译. 第2步:启动和沟通 a. 组织宣传讲习班:一旦政策或法律最终确定,则发起部门应与其他相关部门合作举办宣传讲习班. 这样一个讲习班的目的是向制造商和主要的零售团体通报法规的基本原理和意图,并在实施过程 中获得其支持. 讲习班大纲见附录4,以供指导. b. 开展媒体宣传:应该发布新闻公告以启动新的规定.这应该伴随着通过与国家和目标群体相关的 所有渠道进行的媒体宣传活动,例如,社交媒体,平面媒体,数字媒体等.政府可以在“世界听力日”启 动这些规定,以便最大限度地宣传倡议. 第3步:实施和监督 a. 监督政策实施:政府应通过既定机制来监督政策,法规或法律的实施情况. b. 开展评估和修订:对政策,法规或法律及其实施情况,应按照预先指定(例如,每2年一次)的间隔进 行评估.应与利益攸关方就评估工作和结果做进一步讨论,并根据收到的反馈意见做好修订. 19 其他行动 政府应尽可能努力做到以下几点: a. 监测听力损失的流行病学:卫生部的相关部门应通过基于人群的患病率研究来定期评估目标人 群中的听力损失患病率.理想情况下,这样一项研究工作应在倡议之初即进行,并每5年重复一次. b. 开展研究:有关部门应评估个人音频设备用户听力损失的发生率. 工具 以下工具可用于指导政府应用WHO-ITU全球标准: • 状况评估/分析工具(附录1) • 利益攸关方磋商的格式(附录2) • 关键信息的介绍性说明(附录3) • 宣传讲习班的大纲(附录4) • 宣传材料(附录5) 规划: 状况评估,讨论,政策制定,认识提高 启动: 宣传讲习班,媒体宣传 监控实施: 监控,评估,反馈,修订 支持行动: 评估听力损失和收听行为结果 20 业界合作伙伴的实施方案 本节旨在作为以下诸项的导则: • 个人音频系统的制造商包括: – 智能手机 – MP3播放器 – 其他具有音乐播放功能的设备 – 头戴式耳机/塞式耳机 基本原理 投资于客户的听力健康对依赖客户听力的行业而言具有良好的商业意义.目前,越来越多的技术使用已 成为良好听力威胁的一部分.在没有任何关于安全收听行为的信息或教育的情况下可轻易获得此类技术 ,将使全世界数百万年轻人的听力面临风险.随着技术的日益普及,除非采取具体的防范步骤,否则这一挑 战也可能会增长. 与此同时,技术正在成功地用于提高对各种健康问题的认识并促进健康的生活方式.这导致越来越多的, 与健康有关的应用可通过某些设备提供给用户.采用这种方法后,适当使用技术可以降低其对听力构成 的风险. 因此,作为风险缓解的一部分,并依据负责任的商业原则,个人音频设备的制造商必须分担有关推动安全 收听行为的责任,并抵消因使用其产品而可能造成的任何伤害. 这可以通过适当实施WHO-ITU全球标准来实现.安全收听将降低对听力有影响的风险,并可能减少听力 损失的发生. 制造商可采取哪些行动︖ 制造商应采取以下行动 • 通过自愿实施WHO-ITU全球标准,确保其制造的个人音频设备符合以下要求,来引领安全收听领 域: – WHO-ITU全球标准的要求; – WHO-ITU全球标准中的可选功能. 22 业界合作伙伴的实施方案 • 通过以下方式提高“剂量/容量”测量的精度: – 努力改进测试算法,尽量减少测量误差; – 确保算法与市场上可获得的各种各样常用耳机(包括其他公司制造的耳机)相兼容. • 试验并创建一个既吸引人又信息丰富的用户界面.用户界面应: – 以吸引用户的方式提供有关安全收听的信息; – 以易于理解的格式提供有关用户收听参数以及声音限额使用情况的信息; – 提供有关安全收听的,可靠且经过验证的信息来源. 一个互补的例子是数字用户线(DSL)技术,它可以在家中实现宽带互联网接入.其中包括国际电联制 定的ITU-T G.993.1标准,虽然它没有得到政府的授权,但网络运营商在其采购中选择了这些标准,作 为使其场所与用户家庭之间的数据率提高至25 Mbit/s的技术.除了高速互联网之外,这使网络运营 商能够简化服务提供并降低成本.设备制造商现在可以竞标更多的合同,并通过零售渠道向最终用 户提供设备.它通过降低运营成本并允许用户从各种各样的设备提供商中进行选择(知道互操作性 可得到保证)而使用户受益. 23 吸引合作伙伴 该领域的所有利益攸关方都应参与其中,包括: • 已实施WHO-ITU全球标准的其他制造商; • 销售公司制造之设备的零售商; • 消费群体,目标群体; • 政府:在申请任何政府合同时,制造商都可以突出其设备中可用的安全收听功能;以及其他可能相 关的功能. 建议的步骤 第1步:规划 a. 进行内部评估:制造商应评估与其在世界不同地区制造的设备中安全收听功能有关的当前状态. b. 下载并了解WHO-ITU全球标准:可在以下网址找到:https://itu.int/rec/T-REC-H.870.摘要大纲包 含在本文件的附录6中.公司中从事安全措施和声学研究工作的人员应阅读完整的WHO-ITU全球 标准及适用的参考文献,并了解其含义. c. 讨论实施方案:举行内部讨论,讨论在设备中纳入建议之安全收听功能的方法,并制定完整的实施 计划. 第2步:开发和测试安全收听功能 a. 开发和测试用户界面:WHO-ITU全球标准提供了关于应通过设备界面传达何种信息的指南.在 可能的情况下,制造商应根据WHO-ITU全球标准来研究这方面的问题并开发用户友好的,有关安 全收听功能的界面.如果制造商不能或不希望进行此类研究,则可遵循附录7中提供的建议. b. 开发和测试有关行动的消息与提示:此类消息和指令必须包含在用户界面中.考虑到文化,语言和 地区背景,做好对这些的测试至关重要.如果制造商无法或不希望参与开发和测试界面与消息,则 可采用工具中列出的示例(参见附录7和附录8). c. 检查您的设备是否符合WHO-ITU全球标准:一旦在贵公司的产品中实施H.870安全收听规范,则 应使用预先确立的一致性评估计划来对其进行合规性测试. 第3步:宣传和推广 a. 通知和培训零售商:一旦获得实施WHO-ITU全球标准的产品,零售商应了解这些功能并接受培 训,以推动这些功能得到实施. b. 推广您的设备的安全收听功能:广告和网站应尽可能突出安全收听功能,这有助于提高安全收听 意识,突出公司对其消费者的负责任态度. 24 第4步:审核和修订 a. 收集用户的反馈意见:制造商应定期向用户征询有关其设备中安全收听功能相关性,用户友好性 和清晰度的反馈意见. b. 进行修订和改进:应根据用户的反馈意见定期修改用户界面和消息. c. 及时了解最新版本的WHO-ITU全球标准:制造商应在修订WHO-ITU全球标准时修改功能. 工具 以下工具可用于指导制造商如何应用WHO-ITU全球标准: • WHO-ITU全球标准的概述(附录6) • 信息流的示例(附录7) • 开发消息和一般示例时的主要考虑事项(附录8) • 信息来源的清单(附录5) 规划: 状况评估,了解标准,内部讨论 开发和测试: 用户界面,消息,合规性测试 宣传和推广: 通报零售商,广告,网站 审核和修订: 反馈,更新,修订 25 26 民间团体的作用 本节旨在作为从事以下工作的专业协会和民间社会组织与团体的导则: • 听力损失预防; • 噪音控制; • 消费者权益保护. 基本原理 暴露于高声下是可预防的听力损失的一个关键因素.据估计,使用个人音频系统的人群中有50%的人暴露 于大音量下,这使其听力处于危险之中.实施WHO-ITU全球标准有助于推动安全的收听行为,并降低个人 音频系统对听力构成的风险.民间团体合作伙伴应与政策制定者一起来宣传,倡导其实施方案,作为一种 手段,来防止听力损失. 民间社会组织可采取哪些行动︖ 民间社会组织应采取以下行动: • 宣传工作,说服政府制定实施WHO-ITU全球标准的法规; • 宣传活动,使人们了解关于听力损失预防和安全收听的信息; • 宣传设备制造商,激励他们自愿地在其销售的产品中实施WHO-ITU全球标准. 吸引合作伙伴 该领域的所有利益攸关方都应参与其中,包括: • 从事于听力损失预防,噪音控制和消费者保护领域的其他组织; • 卫生,教育和技术部门; • 当地学校; • 媒体; • 制造组织的企业社会责任(CSR)部门; • 其他可能被认为是相关的组织或部门. 28 民间团体的作用 建议的步骤 第1步:规划: a. 确定并与其他利益攸关方开展讨论,以规划行动; b. 确定其将涉及的目标受众,例如,政策制定者,制造商,学校和大学,整个社区及其他; c. 确定向这些受众传达的关键信息及其想要产生的影响(例如,政府制定政策,制造商实施安全收听 功能,年轻人使用安全收听APP等). d. 确定传达这些消息的最有效策略,例如,通过会议,媒体活动,宣传会议等. 第2步:准备 a. 审查并根据当地情况调整世界卫生组织关于安全收听的宣传及资源,并在必要时进行翻译; b. 审查有关安全收听的其他可用材料; c. 最终确定要使用的资源和材料. 第3步:通过可用的方式来和目标群体一起进行宣传. 这可包括: a. 媒体宣传; b. 社交媒体; c. 网站; d. 网络广播; e. 关于学校和大学安全收听的讲习班; f. 公共活动. 第4步:和目标群体一起跟进并监控以下诸项的结果与影响 a. 政府制定的政策或发起的行动; b. 制造商实施安全收听功能; c. 个人音频设备的用户使用安全收听应用/功能; d. 改变用户的收听习惯. 29 工具 以下工具可用于指导民间社会组织推广WHO-ITU全球标准: • 提高政策制定者和一般民众认识的材料(附录5); • 社交媒体材料(附录5); 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Smartphone ownership and internet usage continues to climb in emerging economies, http: //www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-continues-to-climb-in-emergi ng-economies/2016 Tikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S. Interventions to prevent occupational noise‐induced hearing loss. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD006396. DOI: 10.1002/14651858.CD006396.pub4 Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017; 390(10098): 934 附录 36 附录1 状况评估工具 开发该状况评估工具旨在帮助政府部门和部委收集相关信息,以防止不安全的收听行为,并根据 WHO-ITU H.870关于安全收听设备与系统的全球标准,来推动和规范本国的安全收听行为.完成该评估 的信息可以从现有的同行评审文献,世界卫生组织(WHO)统计数据,国家统计数据和卫生部文件中获得. 世界卫生组织可提供状况评估或结果使用所需的技术援助. [国家的名字] 国家数据概况汇编者: 国家数据协调者 该状况评估负责人的姓名 指定和资格 机构 地址 电子邮件 电话号码 �答者的��信息 (每个受�者都可以复制�表格) 姓名 职位/职务 机构 电子邮件 电话号码 传真 37 人口概况 正在进行该状况评估的地区(州,区 域,省,区)(如果相关的话)的名称 该国家/地区的移动设备用户总数 年龄介于12至35岁之间的移动设备 用户总数 该国家/地区的智能手机用户总数 年龄介于12至35岁之间的智能手机 用户总数 移动设备用户的性别分布(%) 男: % 女: % % 移动设备用户的城乡分布(%) 农村: % 城市: % 移动设备用户的识字率(占总人口 的百分比) 移动设备服务中需要考虑的任何其 他与人口相关的因素 地区: 州:(可选的) 区域:(可选的) 省(可选的) 区:(可选的) A 部分. 国家一般信息 移动设备使用情况 移动设备用户使用的语言 在该国家/地区销售的个人音频设备总数: 销售的智能手机数量: MP3播放器数量: 其他相关设备(个人音频播放器)的数量 互联网服务达到的人口/面积百分比:% 在该国家/地区销售个人音频设备的公司数量 在贵国销售的移动设备品牌名称 [ ]三星[]摩托罗拉 [ ]苹果[]阿尔卡特 [ ]索尼[]诺基亚 [ ]华为[]谷歌 [ ]LG[]其他(请注明): 在该国/地区销售移动设备的 主要的零售商的名称 因噪音和其他相关原因而引起的失能性听力损失者的百分比是多少︖ 总体:% 12至35岁年龄组:% 任何其他年龄组(如文献中所报道):% 名称 在该国/地区经营的 主要的移动电话服务提供商的名称 名称 听力损失 失能性听力丧失的患病率: 总体:% 12至35岁年龄组:% 任何其他年龄组(如文献中所报道):% 如果没有关于失能性听力损失的信息,则请说明用于估计患病率的定义: 38 39 牵头机构概况 协调 立法 其他(请注明) 监控和评估 是否有一政府机构或部门来负责监督 和/或协调贵国的听力保健活动/计划 (即牵头机构)︖ 该机构位于政府架构内的哪个位置上 (请勾选一个)︖ 该机构是一个政府部委/部门,或者位于一个政府部委/部门内( 如果相关,请注明部委和部门). [] 独立实体 [] 其他(请注明) [] 不知道 牵头机构负责以下哪项职能︖(请勾 选所有适用的选项) [] 是 [] 否 [] 不知道 在政府的预算中是否为牵头机构分配 了资金,以履行上述职能︖ []是(请指出该机构的名称) []否(请跳至B部分) [] 不知道(请跳至B部分) []协调中央政府一级的政府间工作程序 []协调中央政府的听力保健决策 []各级政府之间的协调(例如,中央,区域,本地) []协调国家大众媒体倡议 []建立和支持用于监控安全收听设备的数据系统 []汇编和分发国家统计数据 []定期审查有背最佳做法的法律,规则和标准,以及提出改进建 议 []制定和/或修订法律 B部分.领导和治理 40 C部分.策略和目标 国家战略概况 贵国是否有关于预防耳聋和听力损失 的国家战略︖ 如果是,该战略是否包括预防因娱乐 性噪音而导致的听力损失︖ 是否有关于个人音频设备安全收听功 能的规定︖ 如果对以上任何一个问题的回答为是 ,那么现有的任何策略是否包括有关 个人音频设备(例如,移动电话,MP3播 放器,平板电脑等)如手机)的音量规定 ︖ 在环境/娱乐场所中是否有关于噪音 控制的宣传计划︖ 如果是,宣传计划中是否重点指出了 安全收听问题︖ 是否有资金来实施现有的部分或全部 战略︖ 如果存在一项国家战略,是否制定了 可度量的目标来增加具有安全收听功 能的个人音乐播放器的数量︖ [] 是(请提交相关的源文件) [] 否 [] 不知道 [] 是(请提交相关的源文件) [] 否 [] 不知道 [] 是(请提交相关的源文件) [] 否 [] 不知道 [] 是(请提交相关的源文件) [] 否 [] 不知道 [] 是(请提交相关的源文件) [] 否 [] 不知道 [] 是(请以附件形式提供细节/相关的源文件) [] 否 [] 不知道 [] 是 [] 否 [] 不知道 如果是,请提供目标及其时间框架: • 目标设备增长: • 与目标设备相关的时间段(请注明这些目标相关的开 始和结束年份,例如,(2002-2012年)(2016-2020年) [] 是,全部资助 [] 部分资助 [] 不资助 [] 不知道 国家战略是否包括以下任何建议: 降低音量 允许用户跟踪其声音使用情况 [] 是 [] 否 [] 不知道 [] 是 [] 否 [] 不知道 [] 是 [] 否 [] 不知道 [] 是 [] 否 [] 不知道 [] 是 [] 否 [] 不知道 当达到不安全的音量水平时向用户显 示消息 显示关于安全收听行为的消息 鼓励在诸如酒吧,体育赛事和音乐会 等嘈杂环境中使用耳塞 41 42 请提及您所在国家/地区的所有潜在和现有利益攸关方,这些利益攸关方可能参与耳朵和听力保健业务. 在可能的情况下,确定牵头或负责职位或人员,并提供联系方式. 利益攸关方概况 政府部门 按照在制定和实施安全收听策略过程中可感知的合作优先顺序列出 部门名称 影响程度 (1-10) 兴趣程度 (1-10) 联络信息负责/联络人员 (姓名和职务名称) 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 1. 2. 3. 4. 5. D部分.利益攸关方分析 43 影响程度 (1-10) 兴趣程度 (1-10) 联络信息负责/联络人员 (姓名和职务名称) 1. 2. 3. 4. 5. 专业人士和学者 按照在制定和实施安全收听政策过程中的经验和兴趣顺序列出 协会或学会名称 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 44 影响程度 (1-10) 兴趣程度 (1-10) 联络信息负责/联络人员 (姓名和职务名称) 1. 2. 3. 4. 5. 协会或学会名称 民间团体,包括残疾人组织 按照在制定和实施安全收听策略过程中可感知的合作优先顺序列出 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 45 影响程度 (1-10) 兴趣程度 (1-10) 联络信息负责/联络人员 (姓名和职务名称) 1. 2. 3. 4. 5. 机构名称 联合国机构 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 46 影响程度 (1-10) 兴趣程度 (1-10) 联络信息负责/联络人员 (姓名和职务名称) 1. 2. 3. 4. 5. 业界合作伙伴 按照在制定和实施安全收听策略中可感知的优先顺序,基于利益攸关方合作需求和可能兴趣列出 公司名称 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 47 影响程度 (1-10) 兴趣程度 (1-10) 联络信息负责/联络人员 (姓名和职务名称) 1. 2. 3. 4. 5. 任何其他团体(可以包括对听力损失预防,噪音控制,听力学,声学或消费者权益保护感兴趣的任何其他 团体) 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 地址: 电话号码: 电子邮件: 48 附录2 利益攸关方关于安全收听规则规划会议的大纲 应邀请以下利益攸关方团体参加会议: • 相关政府部门:技术,卫生,教育,商业和工业,环境,青年; • 民间团体(包括听力障碍协会),非政府组织(NGO),专业协会; • 青年组织; • 所有的制造商; • 消费电子协会; • 大的零售集团; • 消费者权益保护组织; • 世界卫生组织和国际电联的代表. 目的: • 向利益攸关方通报全球标准以及该国实施这些标准的意图; • 在这方面获得相关利益攸关方的支持; • 讨论有关采用标准及其实施方案的推进方向; • 商定时间表; • 讨论如何定制和改编宣传材料. 大纲建议如下: • 引言; • 安全收听的需求; • 该国有关安全收听规定的现状; • 有关安全收听的全球标准; • 实施安全收听策略和规定所需的观点: – 政府(技术,卫生和任何其他部门); – 用户(由一位代表来提出用户观点); – 业界(伞形组织或者该领域的一个牵头公司来代表业界做发言); – 听力保健专业人士(来自专业,听力相关组织的一个成员来发言); – 民间团体的观点(来自相关民间团体的一个发言者来发言); • 关于在该国采用和实施该标准的可能性(包括时间表):讨论; • 宣传需求以及可用的工具; • 确定以下步骤: – 制定法规/法律; – 开展宣传活动并调整宣传材料. 据世界卫生组织估计,由于不安全的收听行为,全世界有11亿年轻人可能面临听力损失的风险. Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD, Finucane M. Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries. Eur J Public Health 2013; 23: 146-52 (http://dx.doi.org/10.1093/eurpub/ckr176, 2019年1月19日访问.) 听力损失正在上升！ 总体消息 • 全球人口的增加和老龄化; • 目前全球有4.66亿人存在失能性听力损失问题; • 据估计,到2030年,将有6.3亿人存在失能性听力损失问题; • 到2050年,估计有超过9亿人存在失能性听力损失问题. 我们是怎么听的︖ 附录3 保护听力举措:介绍性演示 49 健康的毛细胞 神经纤维 受损的毛细胞 耳蜗 466 millones de personas 630 millones de personas 900 millones de personas 466 百万人 百万人 百万人 娱乐性噪音,不安全收听行为和听力损失的影响 • 相比未暴露于高声下的人,在过去20年中,暴露于社交场合高声下的人面临的听力损失风险要高3 倍多; • 有50%的人通过其个人音频设备收听音乐的音量会使其听力处于危险中; • 因其个人音量偏好和收听持续时间,有5%-10%的收听者可能会出现听力损失; • 相比没有听力损失的普通老人,有听力损失的老人出现抑郁,孤僻,挫折,认知能力下降和人身安全 下降等现象的概率要高2倍. 因噪音而引起的听力损失是不可逆转的 从上到下的照片由Thibault Trillet,Kevin Grieve,Simon Matzinger,Adobe PhotoStock提供 50 保护听力举措 WHO-ITU H.870关于安全收听设备与系统的全球标准 智能手机技术可以提供一个平台,来提供有针对性的,定制的安全收听干预措施,同时继续为听众提供愉 快的体验. 技术方面的问题 声学剂量测定 • 跟踪用户暴露于声音下的时间; • 估计声音水平; • 估算参考暴露量或声音限额的使用百分比: • 模式1 :(WHO)成人的标准水平.它将每7天1.6 Pa2h作为参考暴露量(即每周40小时的 80 dBA SPL). • 模式2:(WHO)敏感用户(例如儿童)的标准水平.它将每7天0.51 Pa2h作为参考暴露量 (即每周40小时的75 dBA SPL). 预防 这意味着创建一个环境,可以用来练习安全的收听行为,包括: • 通过个人音频系统调节对高声的暴露; • 开展公众宣传活动,以改变12至35岁人群的收听行为; • 制定有关娱乐场所安全收听的监管框架. 51 音量限制 • 音量限制消息; • “继续收听”选项; • 默认操作:将音量输出降低到预定水平; • 自定义选项. 家长控制 • 最大声音输出可以固定并锁定在设备的设置中. 沟通方面问题 个人使用信息 • 收听习惯,包括声音限额; • 如何使用安全收听功能. 个性化的建议和提示 • 有关安全收听的行动; • 根据用户的收听状况来定制建议. 一般信息 • 安全收听及其实践方法; • 与不安全收听行为相关的风险; • 由个人音频设备与系统以外的其他来源发出的高声而导致的听力损失风险. 使收听安全的工具包 全球所有国家采用的,有关娱乐场所中安全收听全球标准实施和跟进的实用指南: • 旨在支持国家,业界和民间团体以策略性,基于证据和用户友好的方式,来推进有关因噪音而引起的 听力损失预防工作; • 针对可能有助于标准实施的三个关键利益攸关方; • 政府:从事卫生或技术领域工作的部委/部门; • 业界:个人音频设备与系统的制造商; • 民间社会组织:听力或消费者权益保护领域. 提供过程,步骤和工具以供指导,并可由利益攸关方进行调整,翻译或修改,以满足各个国家和制造商的需求 . 52 53 附录4 关于安全收听规定的宣传讲习班大纲 应邀请以下团体参加讲习班: • 相关政府部门:技术,卫生,教育,商业和工业,环境,青年; • 所有的制造商; • 消费电子协会; • 大的零售集团. 目的: 提高制造商和零售商对安全收听设备有关规定的认识,并就规定的实施, 时间表和报告等为之提供指导. 建议大纲如下: • 引言; • 安全收听标准的基本原理; • 国家标准法规的大纲:必要的部分和可选的部分; • 实施时间表; • 有关实施情况监测/报告的机制; • 制造商的问题和关注; • 制造商可用于分发,社交媒体和网站的宣传材料. 54 附录5 宣传材料 目标 这些宣传材料旨在告知人们关于因不安全收听而导致的听力损失风险;安全收听的概念;以及可用的,促 进安全收听的工具. 这些材料是针对谁的︖ 这些以证据为基础的宣传材料旨在为关键利益攸关方(政府,业界和民间社会组织)提供工具,以提高政策 制定者和公众对安全收听的认识. 传播目标 • 提高公众意识并让公众了解安全收听行为的重要性; • 展开关于因个人音频系统与移动设备等声源的高声而导致的听力损失风险的对话; • 提高青少年和年轻人对不安全收听行为风险的认识; • 了解多部门参与并就WHO-ITU H.870安全收听设备与系统全球标准实施采取行动的重要性; • 做好有关良好的多部门参与带来成功干预并解决娱乐场所高声暴露问题的示范工作. 总体消息 • 因噪音而引起的听力损失是不可逆转的！ • 预防是减少因噪音而引起的听力损失发生率的最有效策略之一; • 将音量保持在安全水平内并限制花费在从事嘈杂活动上的时间可以降低听力损失的风险; • 智能手机技术可以用作促进和实践安全收听的手段; • 具体立法的设计和实施可以降低声音暴露水平. 宣传材料 世界卫生组织促进安全收听的资源可在以下网站获得: www.who.int/deafness/make-listening-safe/advocacy-materials/en/ 55 信息图 在社交媒体上分享信息和材料. 我们的社交媒体渠道 • 在Twitter,Facebook和Instagram @WHO上关注我们,并在您的帖子中标记我们. Twitter官方标签 • #SafeListening Twitter官方标签 • #WHO • #HearingCare • #HearTheFuture • #WorldHearingDay 56 海报 57 小册子 有关安全收听的提示 58 新闻稿 相关文件 59 视频 Facebook帖子 Instagram帖子 60 Tweets 61 常见问题解答 1. 引言 2. 如何度量响度︖什么是dB︖ 3. 什么是安全收听︖ 4. 高声如何影响我的耳朵︖ 5. 如何判断我的听力是否受到了影响︖ 6. 一旦我失去了听力,我可以恢复吗︖ 7. 有没有办法用手机监测我的听力水平︖ 8. 如何对未存储在我设备上的音乐的声音暴露量或每日限额实施监测︖ 9. 我该怎么做才能使我的收听安全︖ 10. 作为家长,我可以做些什么来确保安全收听︖ 11. 作为老师,我可以做些什么来确保安全收听︖ 12. 作为医生,我可以做些什么来确保安全收听︖ 13. 作为娱乐场所的经理,我可以做些什么来确保安全收听︖ 14. 作为个人音频设备制造商,我可以做些什么来确保安全收听︖ 15. 政府可以做些什么来确保安全收听︖ 相关网站 • 世界卫生组织(WHO):http://www.who.int/deafness/make-listening-safe/en/ • 疾病控制和预防中心(CDC):https://www.cdc.gov/hearingloss/default.html • 关于听力损失的行动:https://www.actiononhearingloss.org.uk/ • 欧洲聋人联盟:https://www.eud.eu/ • 听力世界基金会:https://www.hear-the-world.com/en • 美国语言听力协会 - “聆听您的耳机”(Listen to Your Buds)活动:https://www.asha.org/buds/ • 危险的分贝(Dangerous Decibels):http://dangerousdecibels.org/ 媒体兴趣 如果您是一位有兴趣报道与“保护听力”举措有关问题的记者,请发送电子邮件至whopbd@who.int. 62 注:有关安全收听设备/系统的H.870指南的全文可在以下网站获得:https://www.itu.int/rec/T-REC-H.870-201808-I/en. 附录6 用于安全收听设备与系统的WHO–ITU H.870全球标准的概述 安全收听指的是不会使人的听力面临风险的收听行为.听力损失的风险取决于音量水平(响度),收听持续 时间(时间周期)和暴露于高声下的频率.这种暴露可能是通过个人音频设备,在娱乐场所或外部(例如,在 交通中),在工作场所或在家中. WHO–ITU H.870标准描述了个人和便携式音频系统的要求,特别是用于播放音乐的系统,目的是保护人 们免于因使用这些系统而导致听力损失.它提供了常用术语表,以帮助理解,以及有关声音,听力和听力损 失的背景信息. 该标准就避免不安全的收听行为提出了建议:一个针对成人,另一个针对儿童,两者均基于相等能量原理. 重要的是,该标准提供了有关安全收听的健康传播指南,以便在必要时有效地发出适当的告警消息.此类 消息的示例可在标准的附录VII中找到. 最后,标准还提供了有关实施剂量测定和相关问题的信息.下面概述了有关安全收听设备/系统的 WHO–ITU H.870标准的关键问题. 63 1. 标准范围 本文档描述了个人/便携式音频系统的要求,特别是用于播放音乐的系统,以便降低这些设备用户的听力 损失风险. 在这样的设备中,可以远程存储或检索“声源”,例如,从本地服务器或互联网流式传输(见图6.1) 个人音频系统(PAS)旨在供普通人使用; • 允许用户收听音频或音视频内容/材料;以及 • 使用某种收听设备,例如,可以佩戴在耳朵内或耳朵周围的头戴式耳机或耳塞式耳机等;以及 • 拥有某种穿戴式播放器(尺寸适于放在衣服口袋里),旨在使用户能边走边听,连续使用(例如,在街 道,在地铁,在机场). 例如,便携式CD播放器,MP3音频播放器,具有MP3类型功能的移动电话,PDA或类似设备.就本标准而言, 不包括以下类型的设备: • 通信设备(对讲机等); • 康复和医疗设备(例如,助听器,FM系统,以及被批准作为助听器和人工耳蜗植入系统一部分的其他 辅助听力设备(ALD)等); • 个人声音放大设备; • 专业的音响装置和设备; • 便携式游戏机. 个人音频设备 个人音频系统 收听设备 音量控制 声源 DAC 换能器 图6.1:个人音频系统的架构 效果 效果 64 2. 相等能量原理 本标准的建议基于相等能量原则.假设声音对耳朵和听觉的总的影响与耳朵接收的声能总量成正比,而 不管该能量在时间上的分布如何. Conforme a ese principio, cantidades iguales de energía acústica causarán los mismos 根据该原理,无论能量 在时间上的分布如何,等量的声能有望造成因等量的声音而引起的永久阈值偏移. 实际上,这意味着长时间收听较低音量可产生与短时间收听非常大音量相同的影响,例如,收听16分钟100 dB的声音将产生与收听40小时80 dB的声音相同的影响. 基于该原理,声能的“剂量”被定义为在曝光时间 T = t2 - t1.内积分的平方A加权声压 pA. 在数学上,这表示为 式中, pA 为A加权和扩散场校正的声压. 该值的单位为帕斯卡平方小时,或Pa2h. 3. 参考暴露量/声音限额,操作模式 建议每个设备都包含一个用于跟踪用户暴露时间和响度水平的系统,并估算参考暴露量的使用百分比( 也称为声音限额). 这必须考虑在用户使用耳机期间通过设备播放的所有媒体(即不论它是存储在设备本身上,还是通过流 式传输).可以排除语音呼叫,因为它们通过其他标准来单独规定. 还建议设备允许用户选择其参考暴露量作为以下两种操作模式之一: 模式1:(WHO)成人的标准水平.它将每7天1.6 Pa2h作为参考暴露量(得自每周40小时的80 dBA). 模式2:(WHO)敏感用户(例如儿童)的标准水平.它将每7天0.51 Pa2h作为参考暴露量(得自每周40小时 的75 dBA). 首次使用播放器时(或当设备重置为出厂设置时),应允许用户选择两种模式中的任何一种.用户应该可以 在之后更改模式选择,例如,通过设备设置菜单. dose = (pA (t))2dt t2 t1 ʃ 65 声音限额 指在特定滚动时间段(例如,每天或每周)内对声音暴露剂量的估计,通常表示为参考暴露量的一个百分比. 根据所选模式,每周100%的声音限额相当于每周的参考暴露量. 基于前面所述模式的声音限额的每周收听持续时间示例可以在表1和表2中找到. 表1:模式1下每周收听时间示例 表2:模式2下每周收听时间示例 dB(A) SPL 107 104 101 98 95 92 89 86 83 80 24 分钟 12 分钟 6 分钟 3 分钟 1.5 分钟 48 分钟 6 小时 24 分钟 3 小时 15 分钟 1 小时 36 分钟 12 小时 30 分钟 77 25 小时 75 40 小时 dB(A) SPL 每周(1.6 Pa2h) 107 4.5 分钟 104 9.5 分钟 101 18.75 分钟 98 37.5 分钟 95 75 分钟 92 2.5 小时 89 5 小时 86 10 小时 83 20 小时 80 40 小时 每周(0.51 Pa2h) 66 4. 测量方法/声学剂量测定 标准H.870定义了声学剂量测定中的剂量.在模式1下,1.6 Pa2h构成100%的每周声音限额,对应于[EN 50332-3]中定义的100%的计算声音剂量(CSD).对于模式2,0.51 Pa2h是每周总的声音限额或参考暴露量. 标准H.870还涉及描述便携式音乐播放器(PMP)中剂量测定系统的其他相关标准.[IEC 61252]描述了穿戴 式声学剂量计,包括[EN 50332-1],[EN 50332-2]和[EN 50332-3]. H.870的附录II提供了一个在测量数字媒体信号以及考虑耳机已知或假定属性时如何在个人音频系统中 使用剂量计的示例.它基于听力损失风险评估中的相等能量原理,其中在曝光时间上进行积分的平方A加 权声压构成剂量. 通过依据[EN 50332-1]和[IEC 60268-1]播放程序模拟声音,并使用[EN 50332-3]中所述的插值和容差度量剂 量估值达到100% CSD的时间,来对剂量计功能进行测试.这种测试可以在声领域(当使用某个耳机时)或电 领域中使用32 Ω电阻负载(当耳机特性未知时)来执行.见[ITU-T P.381]中的测量设置信息. 不确定性:在估算声音剂量时,存在许多不确定性来源,误差幅度可能会非常高.因此建议基于低于某个限 度的剂量读数来避免向用户发出“安全”和“绿色”信号.不过,剂量估算与对总的趋势的考虑有关: • 信号电平越高意味着风险越高; • 暴露时间越长意味着风险越高; • 要考虑音乐的频谱内容. 67 3Se refiere a los componentes del hardware (como la pantalla), que permiten al usuario interactuar con el dispositivo electrónico. 5. 健康传播 该标准的一个关键问题是为用户提供一种工具,使之能够监控自身的个人声音暴露量.这样一个工具应 该为用户提供安全收听选择,并使之能够通过提高认识来做出明智的选择. 标准摘要部分概述了其应该用于完整实施安全收听设备标准的健康传播方面的问题.具体而言,它提出 了基于证据的建议,说明如何传达不安全收听的风险,并支持用户在这方面采取适当的行为. 将健康传播作为安全收听个人音频系统标准一部分的目的 目的是为用户提供信息和指导,使之能够做出安全收听的选择.这包括提供: • 个人使用情况信息,以便用户了解: – 他们自己的收听习惯(每日和每周声音限额的使用情况); – 如何使用特定设备的安全收听功能. • 根据每个用户的收听状况而定制的,有关安全收听的个性化建议和行为提示. • 关于以下内容的一般信息: – 安全收听和实践方法; – 与不安全收听有关的风险; – 因来自个人音频系统以外的声源的高声而导致的听力损失风险. 默认情况下,用户必须通过其移动设备共享该信息和指南,以降低听力损失的风险. 作为安全收听设备一部分的,关于传播的主要建议: 必须通过以下方式来提供有关安全收听的信息和消息: • 设备界面(只要有合适的可视界面); 注:设备界面指的是使人能与电子设备实现交互的硬件部件(例如屏幕). • 说明书; • 如果可能,有关设备安全收听功能的信息应包含在包装上或包装内. 68 6.1 通过设备界面提供的信息 个人使用情况信息 关于定义用户收听习惯的各种收听参数的信息，对用户应该是可访问的，以便允许用户通过设备来跟 踪其暴露于声音的情况︒对于带有屏幕的设备，这可以通过屏幕上的图标来实现︒ 通过图标，用户应该能够以易于理解的呈现方式来看到其对每日/每周声音限额的使用情况，例如， 一个人可以查看已使用了多少每周声音限额，并了解其在过去七天中的收听行为︒在不带屏幕的设备 中，应通过其他方式来提供信息，例如，音频提示︒ 设备（有这方面功能时）应显示： • 白天和星期的平均声音水平︔ • 用户在一天和一周内以小时和分钟计的收听时间︒ 图6.2给出了一个在智能手机的可视界面上提供的︑有关安全收听的信息的非规范示例︒ 图6.2：智能手机的可视界面上提供的︑有关安全收听的信息的示例 今天的声音限额 音轨5 暴露 51.6% 剩余时间: 01:14:17 今天的收听时间:37分钟 平均dB水平(leg):93.3 dB 90 80 70 60 50 40 30 20 10 0 52% 今天的声音限额 51.6% 今天的声音限额 音轨5 暴露 119.5% 剩余时间:00:00:00 今天的收听时间:1.8小时 平均dB水平(leg):93.5 dB 90 80 70 60 50 40 30 20 10 0 今天的声音限额 120% 120% 69 行动和消息的个性化建议与提示: a. 当用户超过每周限额的100%时,设备应提供相关的告警和提示. • 用户将首先接收通过文本和视频表达的“告警”,告知已达到某个阈值,并且从此时开始,在相同音 量上做进一步收听将带来听力风险. • 告警之后将是“行动提示”,对此用户可以选择接受继续收听的风险或者保护其听力.“行动提示”应 与设备上的活动选项相关联,例如: – 自动安全音量选项,通过该选项,设备将自动地把音量更改为某个安全的音量水平; – 引向音量设置; – 设置默认音量限值; – “稍后提醒我”选项; – “忽略并继续”选项. • 如果用户未采取任何行动,则音量将自动降至标准水平以下(所选的80 dBA或75 dBA). b. 当声音限额使用情况达到某个预定水平时,设备应提供相关消息.关于建议的,可提供告警/提示的声音 水平和示例内容,请参阅附录8. 此类告警取决于设备的能力,并应是多模式的,例如,视频,振动或音频告警的某种混合,以便确保用户的注 意力可指向这些告警.图6.3给出了智能手表中显示的非规范消息提示示例 图6.3:智能手表中显示的消息提示示例 每日限额的50%:您 当天已花费了50% 的安全收听限额. 保持低音量可以听 得更久. 安全收听 嘿! 您最后的声音 剂量为60%.做得好 ！请保持安全收听 . 安全收听 每日消息 设备应根据最近几天中用户的收听行为来提供一条每日摘要消息,鼓励安全的收听习惯,以及劝阻或告 警不安全的收听习惯.附录8提供了有关此类消息的示例. 一般信息 当设备带有屏幕时,应在屏幕上显示有关安全收听行为及其益处和不安全收听行为风险的信息.建议通 过独特且可识别的图标来在用户界面(主屏幕)上指明该信息的可用性.图6.4给出了一个有关智能手机屏 幕上显示的安全收听图标的非规范示例. 噢,谢谢,播放音乐. 安全收听 什么是听力损伤的最初迹象︖ 听力损失听起来像什么︖ 答案在这里. 疾病控制和预防中心,请听！ 信息 什么是安全收听︖ 噢,谢谢,播放音乐. 图6.5:链接到安全收听和外部链接信息的屏幕示例 图6.4:智能手机屏幕上显示的安全收听图标 应该有一个教程告知用户安全收听行为;不安 全收听行为存在的风险;以及设备的安全收听 功能和如何使用它们.屏幕还应该包括指向相 关网页的链接,用户可在其中找到更多的信息. 图6.5给出了链接到关于安全收听和外部链接 之信息的非规范屏幕显示示例. 70 大音量音乐如何影响我的耳朵︖ 什么是安全收听︖ 在我的设备上我该如何使收听安全︖ 听力损伤最初可能并不明显.起初,您可能只 能听到像铃声那样高亢的声音或经历持续 的耳鸣. 71 6.2 通过设备本身以外的方式提供的信息 用户手册 用户手册应明确指出使用该设备的不安全收听行为会带来永久性听力损失的风险.它还应该提供关于音 量限制功能和行动提示的详细信息. 用户手册还应清楚地概述限额评估系统的工作原理并指出其不确定性.它应指明设备上的信息未考虑来 自其他音频设备或环境声音暴露的其他声音暴露源. 该手册还可以提供有关高音量环境声音下听力保护的信息,以尽量减少听力损失的风险. 包装 只要有可能,设备的外包装上应包含清晰,简明的消息或告警.建议这样的告警/消息应: • 简洁,简单,清晰; • 附有相关的插图; • 位于纯背景上. 网站和广告 有关安全收听的信息应包含在制造商的网站上.此类信息应与标准H.870中的规范相一致.可以包括与世 界卫生组织网站和其他相关的,信誉良好的网站的链接. 产品广告也可尽可能提供相关信息.这些信息既可以指通过不恰当使用其设备而对听力可能造成的危害 ,也可以指安全收听的优势,以便在享受良好收听体验的同时保持健康的听力. 7. 音量控制 音量限制:根据标准H.870,设备应为用户提供一种合适的音量限制方法.这指的是在用户达到每周限额的 100%之前或之时提示一条消息的功能,如果他们不希望设备音量降低,则为其提供“继续收听”的选项.当 消息未被确认时,默认动作将是把音量输出降低到预定水平上.如果可能,应该根据用户的偏好,为用户提 供自定义该水平(他们希望其设备限制在一个什么样的音量水平上)的选项. 家长控制:建议设备应具有可通过使用密码在设置中固定和锁定最大声音输出的选项.该功能的目的是 允许父母(或其他成年人)以儿童无法改变的方式,来限制儿童设备的最大声音输出.个人用户也可以使用 该功能,通过固定其设备上的最大输出,来限制他们自己的声音暴露. 72 73 包装 用户手册 设备界面 通知 •只要有可能,应在设备的外包装上包含清晰明了的消息/告警. •消息应显示在纯背景上,简短,清晰,并附有相关插图. •手册应明确指出通过设备进行不安全收听可带来永久性听力损失的风险. •它应指明该设备配备了安全功能,以帮助用户保护其听力. •该消息应与通过设备界面提供的信息相一致.它应包含类似不安全收听可带来 听力损失风险和安全收听建议这样的文本. •还应详细说明设备中的安全收听功能. •设备屏幕上的可见图标将引导用户获取有关安全收听的一般信息. •该图标还将引导用户至显示器(在带屏幕的设备中),它将提供有关个人收听参 数和(每日与每周)使用情况的统计信息. •第一次使用耳机时,应将用户引导至教程,其中包含有关安全收听,如何练习 之以及个人收听概况的信息(与图标中提供的信息相同). •它将描述成人和儿童的标准水平,并允许用户选择某个水平. •用户可以选择设置其希望收到通知的频率以及在什么样的使用情况下才 接收通知. •用户可以通过上述独特的图标随时获取有关每日/每周之声音限额消耗 情况的信息. •只要使用耳机,计算就应包括通过音乐播放器或在线播放的所有声音. •显示的信息应包括:已用和剩余的每周限额;(每日/每周的)收听时间,可能 的话,还要指出用户在过去7天(包括当天)中的收听情况. •每次当用户达到限额暴露水平的100%以及由用户定制的设置时,都应提供告警 和行动提示. •这些都应是可视的(如果可能的话)以及可听的/振动的,以确保能将用户的注意 力引导到这些上来. •通知应包括有关音频使用水平的信息以及相应的安全收听建议. •用户在某个特定日期第一次连接耳机或开始播放音乐时,设备可根据前几天/ 前一周的使用情况发出欢迎消息. 个人使 用情况 每日提醒 第一次 使用 附录7 图7.1:作为安全收听设备标准一部分的信息流 信息流的示例 本节和下图包含建议的步骤,用于说明如何在设备中实现对标准的传播问题. 如何将有关收听参数的信息传达给用户的示例. 通过清晰,可识别的图标,用户应该能够访问设备上的“专用空间”(屏幕),其中存储,可视化和解释关于用户 收听习惯的信息.在该空间中,用户应该能够访问他/她整体收听习惯或样式的图形表示,并了解是否发生 了不安全的收听行为(以及是哪种类型的不安全收听行为).用户收听习惯的可视化将包括: • 每周声音限额使用情况的图形显示; • 通过彩色编码显示器显示每天的声音暴露量的图形显示; • 收听持续时间,每天和过去7天中的小时和分钟. 1. 关于每周限额使用情况的信息 如图7.2所示,可以图形化地传达每周限额的使用情况. 图7.2:如何以图形方式表达每周限额的使用情况的说明 2. 关于用户如何在任何一天使用限额的信息 出于该显示的目的,每日最高限额将等于每周限额除以7(约为每周限额的15%). 过去7天(包括当天)的使用情况将由描绘不同使用水平的一系列颜色来表示,例如,红色表示超过100%的 使用限额,绿色表示小于50%的使用限额. 出于该传播的目的,每一天都将被视为一个单独的单元,当天的颜色编码不会将前一天的暴露量考虑在 内.因此,无论过去几天的使用情况如何,用户每天都会以绿色图标开始. 已用 剩余 60% 40% (最近7天的)收听 时间 4小时20分钟 74 75 3. 收听时间 此外,还将显示有关用户每天通过设备收听音频内容的总时间的信息(如图7.3所示). 图7.3:用户每天用于收听音频内容的总的时间的信息 4. 行动的告警和提示 应定期向用户提供伴随行动提示的告警: • 当达到每周限额的80%和100%时; • 一旦达到每周限额的100%,则设备应自动将音量降低至参考水平,除非用户选择继续在大音量下 收听,尽管传达了存在风险的消息; • 每条消息都应附有一个动作提示,以便推动听众降低音量或停止收听; • 每天都应向用户提供通知,告知其在过去一天中的收听情况,并建议当天应采取的行动.这可以是 一种鼓励或告警消息. 此类消息和行动提示的示例见附件8. 日期-6 日期-5 日期-4 日期-3 日期-2 日期-1 日期 (今天) 时间 1h 5m 1h 20m 2h 1m 1h 50m 2h 5m 3h 2m 2h 50m 安全 不安全 76 附录8 开发消息和示例时的主要考虑事项 下面给出了制造商开发消息作为其设备安全收听功能一部分的一些基于证据的考虑因素.制造商应尽 可能尝试开发适合该国文化和语言背景的消息. • 这些消息的目的是获得关注,建立兴趣并鼓励用户实施安全的收听行为; • 它们应该分享可操作的信息,提供可行的替代行为并促进实施安全的收听行为. 开发此类消息/提示时要考虑的要点是: • 它们应该清楚地传达安全收听的益处以及不这样做的风险; • 每条消息应该有3至4种变体,可以以非重复的方式来传达信息,以满足广大受众的需要; • 文本应该简单,清晰且没有专业术语,以便大多数用户能够理解它们; • 一些消息应是正向的,另一些则是负向的; • 为便于理解,书面信息应辅以图片信息; • 消息应基于可靠来源的建议; • 在可能的情况下,消息应在使用前由制造商进行预先测试. 以下是有关安全收听功能的告警和提示的一些示例. 基于每周使用情况的告警和提示的示例 用户到达一定限额时的提示信息: a. 每周限额的80%:友好告警信息: 您已经花费80%的限额.调低音量以保护您的听力. 降低音量/停止收听/忽略告警/转到个人使用情况信息. 或者 嘿！看起来您最近一直在大声地播放很多音乐.为什么不短暂休息一下以保护您的听力呢︖ 降低音量/停止收听/忽略告警/转到个人使用情况信息. 77 b. 每周限额的100%:告警信息(可选择立即暂停收听): 您现在已超过100%的安全收听限额.不安全的收听会给您的听力带来风险: 降低音量/停止收听/忽略告警/转到个人使用情况信息. 或者 嘿！您最近播放了太多大声的音乐.休息一下,保护听力. 降低音量/停止收听/忽略告警/转到个人使用情况信息. 除非用户同意“忽略告警”或“暂停收听”,否则默认情况下会将音量降低到平均值80 dB或 75 dB以下. 基于每日使用情况的消息示例 每日消息(当打开应用程序或播放器页面时)应基于用户过去几天中声音限额的使用情况: a. 主要是绿色(用户在大多数日子里每周使用率低于50%,不超过任何一天的限额):鼓励消息. 做得好！这是很好的收听方式. 做得好！保持安全收听音乐,享受无穷收听乐趣. 做得好！保持安全收听,享受无穷乐趣. b. 主要是绿色或黄色/橙色(用户在大多数日子里保持在80%以下,不超过任何一天的限额): 小心,请安全收听. 嘿！看起来有时您喜欢大音量！小心并保护您的听力,以便享受无穷乐趣！ 通过降低音量,您可以更长时间地安全收听. 78 c. 主要是黄色/橙色,偶尔为红色(用户在任何一天都不超过限额): 小心！保持低音量,以便更长时间地安全收听. 嘿！看起来有时您喜欢大音量！小心并保护您的听力,以便享受无穷乐趣！ 嘿！您应该注意一下您的收听行为了. d. 主要是红色(在大多数日子里超过限额): 您的听力正面临风险.保持低音量,请安全收听！嘿！您需要注意一下您的收听行为了.请调低音量. 嘿！看起来您真的很喜欢大音量！请勿将您的听力置于危险中,以便享受无穷乐趣. 正向说和反向说的消息示例;以及感性和理性的呼吁 正向说: 您超出了有关安全收听的每日限额.保持低音量可让您更长时间地安全收听,而无听力损失的风险.请调 低音量. 反向说: 您超出了有关安全收听的每日限额.如果您继续这么听,那么您将面临听力永久损伤的风险.请调低音量. 理性呼吁: 有证据表明,如果您在80 dBA SPL以上收听音乐,持续8小时或等效时间,那么您可能永远损伤您的听力.请 调低音量. 感性呼吁: 一旦您失去听力,它就不会再回来.安全收听,调低音量. 79 附录9 用于安全收听的学校讲习班的资源 由澳大利亚耳科学研究所开发的“为耳朵欢呼”(Cheer for Ears)旨在传授10至12岁的学生有关听力损失的 危险性及其预防的知识.这些计划使用各种各样的多媒体材料,并在学校提供互动课程.除了这些计划外, 团队还创建了许多活动,包括:“安全收听苏茜”(Safe Hearing Suzie),“史诗般的耳朵防御战”(Epic Ear Defence)和吉祥物“为耳朵欢呼查理”(Cheers for Ears Charlie).这些活动在过去三年中成功地鼓励了226所 学校中的21,300名儿童养成安全收听行为.该项目有三个目标:“制定一个健康促进计划,告知学龄儿童暴 露于危险水平的噪音和音乐下存在危害”“开发一个用于监控和跟踪个人音乐播放器噪音暴露情况的应 用程序”“开发一个互联网资源,作为与NIHL和暴露于娱乐声响下相关的所有事项的中心信息站点”.有关 “为耳朵欢呼”(Cheer for Ears)的更多信息,请访问 http://www.hearingservices.gov.au/wps/wcm/connect/8c6fc19a-4f10-4307-93f3-d350f50fbe5b/cheers-for-e ars.pdf?MOD=AJPERES 资源 • “安全收听苏茜”(Safe Hearing Suzie)是一个人体模型头,内置声级计和听力损失模拟器.苏茜显示 声音的分贝级别以及声音是否是安全收听音量的信息.因此,苏茜告知学生们NIHL的真相和风险. • “史诗般的耳朵防御战”(Epic Ear Defence)是一款在线游戏,学生可以积极参与,学习保护耳朵的重 要性.在游戏期间,玩家必须使用防御技术来对抗传入的大音量声音(敌人).“随着更多大音量声音逃 离播放器并到达鼓膜,游戏开始巧妙地模拟听力损失和耳鸣进入过高音轨”.这种模拟是一种引人入 胜的活动,人们可在学习关于听力重要性知识的同时获得享受. • “为耳朵欢呼查理”(Cheers for Ears Charlie)是一个吉祥物,显示为一个超级英雄,展示头戴式耳机作 为降低NIHL风险的一种方法.该吉祥物出现在不同的场合中,如收听宣传周,学校集会和儿童节日. • 在学校举办讲习班,并使用适合年龄的演讲. 联系信息 • 欲了解更多信息,请发邮件至Natalie Leishman natalie.leishman@earscience.org.au. 为耳朵欢呼 80 为了明天的听力 “为了明天的听力”(Hear 4 Tomorrow)是一个以课堂为基础的计划,旨在传授小学生们关于耳朵健康的知 识.它主要是为学校教师而设计的,是一个具有各种课程的教学工具.广泛的课程由四个教学模块组成:了 解什么是听力损失,听觉系统与噪音,多大的声音为太大了,保护我们的听力.每个模块涵盖有关听力健康 的不同方面,学生学习降噪行为.“为了明天的听力”(Hear 4 Tomorrow)目的是“为教师提供一种资源,使其 能够以与现有教学计划相辅相成的方式来传授听力健康知识”.有关“为了明天的听力”(Hear 4 Tomorrow)的更多信息,请访问:https://hear4tomorrow.nal.gov.au/index.html. 资源 • 对每个模块,学生都可有各种各样的资源. –“听力损失模拟”允许人们在不同级别上获得有关听力损失的实践经验.它演示了对一个患 有NIHL的35岁的人来说音频听起来是怎样的,或者对患有NIHL和耳鸣的人来说音频听起来 是怎样的.通过提供不同的诊断病例,“听力损失模拟”模块可以帮助他们了解什么是听力损失 及其面临的挑战. –学生学习如何测量不同噪音的水平以及音量与通过闪存卡的暴露量和持续时间之间的关 系. –提供教学笔记. 联系信息 • “为了明天的听力”(Hear 4 Tomorrow)是由澳大利亚听力研究部门国家声学实验室开发的.您可 联系:enquiries@nal.gov.au. “危险的分贝”(Dangerous Decibels)专注于三种方法,以预防因噪音而引起的听力损失.该计划向学校提供 课堂演示,传授有关因噪音而引起的听力损失和预防策略的概念.通过互动式讲习班,它强调了保护听力 健康的重要性,并建议“离开”“调低”和“使用耳塞”.这个以学校为基础的讲习班已经经过有效性测试,证明 了这样的演示在改变小学生行为,知识和态度等方面非常有效. 其目的是“通过改变学龄儿童的知识,态度和行为来降低因噪音而引起的听力损失(NIHL)和耳鸣(耳中有 铃声)的发生率和流行程度”.该计划创造了Jolene,一个配备了声级计的人体模型,以吸引儿童并促进安全 收听. 危险的分贝 81 资源 • Jolene和Jolene的“食谱”:Jolene是用使用过的时装模型和一个连接到硅耳的声级计构建的.Jolene 出现在学校和大学,科学会议,健康博览会和许多其他公共活动中.Jolene也被用作研究个人立体声 系统的理念和收听行为的研究工具.Jolene的“食谱”是由国家听力保护协会为人们可制作自己的 Jolene而设计的. • 着色表是为年幼的孩子们而设置的三张着色纸,可很好地带回家. 欲了解更多资源,请访问:http://dangerousdecibels.org/. “嘈杂的星球”(Noisy Planet)是一项公共教育活动,由国家耳聋和其他交流障碍研究所(NIDCD)开发.“嘈杂 的星球”(Noisy Planet)为不同的人群(父母,健康教师,学校护士和健康专业人士)提供了诸多教学工具包. 其目的是“提高对因噪音而引起的听力损失之原因和预防的认识”.这些教育资源包括工具包,建议和安全 收听提示.根据两项调查的数据,“嘈杂的星球”(Noisy Planet)在触达目标受众方面非常有效.此外,也是由 NIDCD发起的“聪明的耳朵”(Wise Ear)活动旨在教育小学生预防因噪音而引起的听力损失.欲了解更多 信息,请访问:https://www.noisyplanet.nidcd.nih.gov. 资源 • 该网站提供有关“嘈杂的星球”(Noisy Planet)的演示材料,学生活动视频和其他资源. • 有培训视频,以显示演示材料中的活动.说明提供了有关每项活动的深入描述,包括所需设备,所需 学生志愿者人数以及每项活动的预计时间. 联系信息 • 一般问题,请联系NPInfo@nidcd.nih.gov. 由美国语言和听力协会(ASHA)开发,“聆听您的耳机”(Listen to Your Buds)活动提供了有关如何通过 教学材料预防听力损失的各种各样指令.该活动正在传递一个重要的健康信息,对之,所有的家长和 孩子都需要听到.其目的是“使有效的沟通成为一种人权,让所有人都可获得和实现”.该活动教育公 众了解儿童因不安全使用个人音频技术(尤其是耳塞或耳机)而导致听力损失的风险.此外,“聆听您 的耳机”(Listen to Your Buds)系列音乐会到访学校,让孩子们了解技术的重要性,以保护其听力健康. 欲了解更多信息,请访问:https://www.asha.org/buds/. 嘈杂的星球 聆听您的耳机 82 资源 • 在小学举办互动学校讲习班.小学生向著名音乐家学习如何终生保护好其听力. 视频:https://www.youtube.com/watch?v=cfkPUnWBmiI • “聆听您的耳机”书签 • “聆听您的耳机”着色书籍 • 调低音乐音量 • 迪士尼广播电台PSA(保护听力的教育叙事) • 听力损失的自我测试 联系信息 • 没有直接的电子邮件地址,但通过填写信息可联系ASHA https://www.asha.org/Forms/Contact-ASHA/.

欲了解更多信息 请联系: 非传染性疾病,残疾,暴力和伤害预防管理部 https://www.who.int/deafness/make-listening-safe/en/ 世界卫生组织 Avenue Appia 20 CH-1211 Geneva 27 瑞士 ISBN 978-92-4-000169-5

Комплект материалов по безопасным устройствам и системам прослушивания Сделать прослушивание безопасным

Комплект материалов по безопасным устройствам и системам прослушивания Сделать прослушивание безопасным Комплект материалов по безопасным устройствам и системам прослушивания ISBN 978-92-4-151528-3 (ВОЗ) ISBN 978-92-61-28411-4 (МСЭ) © Всемирная организация здравоохранения и Международный союз электросвязи, 2019 год Некоторые права защищены. Данная работа распространяется на условиях лицензии Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). По условиям данной лицензии разрешается копирование, распространение и адаптация работы в некоммерческих целях при условии надлежащего цитирования по указанному ниже образцу. В случае какого-либо использования этой работы не должно подразумеваться, что ВОЗ или МСЭ одобряют какую-либо организацию, товар или услугу. Несанкционированное использование названий или эмблем ВОЗ или МСЭ не допускается. Результат адаптации работы должен распространяться на условиях такой же или аналогичной лицензии Creative Commons. Переводы настоящего материала на другие языки должны сопровождаться следующим предупреждением и библиографической ссылкой: "Данный перевод не был выполнен Всемирной организацией здравоохранения (ВОЗ) или Международным союзом электросвязи (МСЭ). Ни ВОЗ, ни МСЭ не несут ответственности за его содержание или точность. Аутентичным и подлинным изданием является оригинальное издание на английском языке". Любое урегулирование споров, возникающих в связи с указанной лицензией, проводится в соответствии с согласительным регламентом Всемирной организации интеллектуальной собственности (http://www.wipo.int/amc/en/mediation/rules). Пример оформления библиографической ссылки для цитирования. Комплект материалов по безопасным устройствам и системам прослушивания [Toolkit for safe listening devices and systems]. Женева: Всемирная организация здравоохранения и Международный союз электросвязи, 2019. Лицензия: CC BY-NC-SA 3.0 IGO. Данные каталогизации перед публикацией (CIP). Данные CIP доступны по ссылке: http://apps.who.int/iris. Приобретение, вопросы авторских прав и лицензирование. Для приобретения публикаций ВОЗ перейдите по ссылке http://apps.who.int/bookorders. Публикации МСЭ можно приобрести в книжном магазине МСЭ по адресу http://www.itu.int/en/publications. Чтобы направить запрос для получения разрешения на коммерческое использование или задать вопрос об авторских правах и лицензировании, перейдите по ссылке http://www.who.int/about/licensing. Материалы третьих лиц. Если вы хотите использовать содержащиеся в данной работе материалы, правообладателем которых является третье лицо, вам надлежит самостоятельно выяснить, требуется ли для этого разрешение правообладателя, и при необходимости получить у него такое разрешение. Риски возникновения претензий вследствие нарушения авторских прав третьих лиц, чьи материалы содержатся в настоящей работе, несет исключительно пользователь. Общие оговорки об ограничении ответственности. Обозначения, используемые в настоящей публикации, и приводимые в ней материалы не отражают какого-либо мнения ВОЗ или МСЭ относительно юридического статуса какой-либо страны, территории, города или района или их органов власти либо относительно делимитации их границ. Пунктирные линии на географических картах обозначают приблизительные границы, в отношении которых пока еще может быть не достигнуто полное согласие. Упоминание конкретных компаний или продукции отдельных изготовителей, патентованной или нет, не означает, что ВОЗ или МСЭ поддерживают или рекомендуют их, отдавая им предпочтение по сравнению с другими компаниями или продуктами аналогичного характера, не упомянутыми в тексте. За исключением случаев, когда имеют место ошибки и пропуски, названия патентованных продуктов выделяются начальными прописными буквами. ВОЗ и МСЭ приняли все разумные меры предосторожности для проверки информации, содержащейся в настоящей публикации. Тем не менее опубликованные материалы распространяются без какой-либо явно выраженной или подразумеваемой гарантии их правильности. Ответственность за интерпретацию и использование материалов ложится на пользователей. ВОЗ и МСЭ ни в коем случае не несут ответственности за ущерб, возникший в результате использования этих материалов. Отпечатано в Швейцарии. Предисловие Выражение признательности Резюме Общая информация Шум как фактор риска для слуха Воздействие потери слуха Инициатива ВОЗ "Сделать прослушивание безопасным" Обоснование стандарта для безопасных устройств прослушивания Глобальный стандарт ВОЗ–МСЭ H.870 для безопасных устройств и систем прослушивания Разработка Глобального стандарта ВОЗ–МСЭ Задачи настоящего комплекта материалов Реализация правительствами Обоснование Какие действия могут предпринять правительства? Реализация отраслевыми партнерами Обоснование Какие действия могут предпринять производители? Роль гражданского общества Обоснование Какие действия могут предпринять организации гражданского общества? Справочная литература Библиография Библиография Дополнение 1. Инструмент оценки ситуации Дополнение 2. Формат консультаций с заинтересованными сторонами Дополнение 3. Вводная презентация, содержащая основные идеи Дополнение 4. План ознакомительного семинара-практикума Дополнение 5. Материалы для повышения осведомленности Дополнение 6. Резюме глобального стандарта ВОЗ–МСЭ Дополнение 7. Пример информационного потока Дополнение 8. Основные факторы, которые необходимо учитывать при составлении сообщений, и примеры Дополнение 9. Ресурсы для проведения на базе школ семинаров-практикумов, посвященных вопросам безопасного слушания Содержание 8 8 9 9 10 10 11 12 15 15 15 20 20 20 26 26 26 30 31 33 45 46 50 51 59 70 73 76 Предисловие Миллиард подростков и молодых взрослых людей во всем мире находятся под угрозой развития потери слуха вследствие практики прослушивания музыки на персональных аудиоустройствах с высоким уровнем громкости в течение продолжительного времени. Когда потеря слуха вследствие воздействия громких звуков уже началась, ее нельзя обратить вспять. Такая потеря слуха, если ей не уделяется должного внимания, может оказать существенное влияние на способность человека общаться, получать образование, а также находить и сохранять подходящую работу. Тем не менее потерю слуха, обусловленную громкими звуками, можно предотвратить путем повышения осведомленности и принятия соответствующих профилактических мер. В целях решения этой проблемы Всемирная организация здравоохранения (ВОЗ) и Международный союз электросвязи (МСЭ) разработали Комплект материалов по безопасным устройствам и системам прослушивания, который содержит необходимые практические руководящие принципы внедрения Глобального стандарта по безопасным устройствам прослушивания (МСЭ-T H.870). В этом стандарте дается краткое описание основных характеристик регулирования воздействия звука на пользователя, ограничения громкости и предоставления информации о безопасном прослушивании. Реализация рекомендуемых в нем характеристик безопасного прослушивания будет играть важнейшую роль в защите пользователей от потери слуха, вызванной громкими звуками, и обеспечении людям возможности продолжать наслаждаться звуками, которые им нравится слушать. Правительства могут осуществлять регулирование в соответствии со стандартом, а производители могут разрабатывать и выпускать на рынок устройства, соответствующие рекомендациям, содержащимся в настоящем комплекте материалов. Гражданское общество может выступать в поддержку внедрения стандарта и повышать информированность населения о безопасном прослушивании. МСЭ и ВОЗ призывают Государства-Члены, партнеров из отрасли и гражданское общество внести свой вклад в содействие распространению безопасного прослушивания и в решение этой новой проблемы в области здравоохранения. Использование настоящего комплекта материалов и внедрение Глобального стандарта H.870 будет способствовать ответственному использованию технологий в целях укрепления здоровья и повышения благосостояния пользователей. Г-жа Дорин Богдан-Мартин, МСЭ Д-р Этьен Круг, ВОЗ Д-р Этьен Круг Директор Департамента по неинфекционным заболеваниям, инвалидности и предупреждению насилия и травматизма, Всемирная организация здравоохранения Г-жа Дорин Богдан-Мартин Директор Бюро развития электросвязи (БРЭ), Международный союз электросвязи Выражение признательности Всемирная организация здравоохранения (ВОЗ) и Международный союз электросвязи (МСЭ) выражают глубокую признательность следующим авторам настоящего справочника. Разработка содержания: Елена Алтьери, Ён-Се Ан, Симан Кампус-Нету, Шелли Чадха, Аларкос Сьеса, Никола Дивиани, Каталина Валенсия Майер, Эрика Лара Оварес, Карен Рейес, Сара Рубинелли, Роксана Видмер-Илиеску. Руководство: Этьен Круг, Тамица Тороян. Дополнительные вклады: Лидия Бест, Ави Блау, Брайан Флигор, Марк Лорейнс, Ричард Нейцель, Майкл Сантуччи. Административная поддержка: Лор Картилье, Алина Лашко. Редактирование: Анджела Бертон. Макет и дизайн: 7 Estudio Creativo. Резюме Настоящий комплект материалов содержит практическое руководство для содействия Государствам-Членам, партнерам из отрасли и группам гражданского общества в использовании и внедрении Глобального стандарта ВОЗ–МСЭ H.870 по безопасным устройствам и системам прослушивания. Глобальный стандарт ВОЗ–МСЭ – результат сотрудничества между Всемирной организацией здравоохранения (ВОЗ) и Международным союзом электросвязи (МСЭ) – был разработан в ответ на все более широкое распространение потери слуха и на угрозы для слуха, создаваемые небезопасным прослушиванием. Глобальный стандарт ВОЗ–МСЭ был разработан с использованием основанного на фактических данных консультативного процесса с участием экспертов в области звука, аудиологии, акустики, коммуникации, а также технологий смартфонов. В настоящем комплекте материалов акцент делается на необходимости профилактики потери слуха и содержится характеристика ответных мер, разработанных ВОЗ и МСЭ в связи с этим. В нем в упрощенном виде содержится краткое изложение глобального стандарта ВОЗ–МСЭ и представлен поэтапный подход к его внедрению силами трех основных партнеров в области профилактики потери слуха: • правительств; • отрасли; • гражданского общества. В каждом из разделов, посвященных определенному партнеру, описываются шаги, которые необходимо предпринять для эффективного внедрения Глобального стандарта ВОЗ–МСЭ. Для этого предусмотрено множество инструментов: инструмент оценки ситуации; краткий обзор семинаров-практикумов по планированию; а также образцы информационно-просветительских сообщений и слайдовых презентаций. Цель настоящего комплекта материалов – облегчить для партнеров принятие, внедрение и контроль за выполнением Глобального стандарта ВОЗ–МСЭ. Его общая задача заключается в том, чтобы все пользователи персональных аудиосистем имели возможность получить информацию о безопасном прослушивании и выбирать безопасные варианты прослушивания в целях защиты своего слуха. Общая информация 8Общая информация По оценкам ВОЗ, более миллиарда молодых людей во всем мире подвергаются риску потери слуха вследствие практики небезопасного прослушивания [1]. В связи с этим необходимо принять безотлагательные меры. В последние годы наблюдается стремительный рост доступа к технологиям, и все больше людей используют такие технологии для общения. Кроме того, значительно увеличилось число людей, испытывающих воздействие громких звуков при использовании персональных аудиосистем, а также в развлекательных заведениях, что подвергает их высокому риску возникновения нарушений слуха. В целом число людей с потерей слуха растет быстрыми темпами. Согласно оценкам, в настоящее время в мире насчитывается около 466 миллионов человек с инвалидизирующей потерей слуха [2], в том числе 432 миллиона (93%) взрослых и 34 миллиона (7%) детей. Согласно последним прогнозам ВОЗ, если не принимать никаких мер, к 2030 году в мире будет уже 630 миллионов человек с инвалидизирующей потерей слуха. И если не решать проблему потери слуха, то ожидается, что к 2050 году их число превысит 900 миллионов человек [2], что будет сопровождаться пропорциональным увеличением общемирового объема текущих ежегодных расходов более чем на 750 миллиардов долларов США (в международных долларах) [1, 3]. На протяжении всей жизни человека его слух оказывается под воздействием целого ряда факторов риска. И если некоторые факторы риска, связанные с потерей слуха, в отдельных частях мира сокращаются (например, краснуха и менингит), то такие предотвратимые факторы, как шум (который в основном является следствием нашего современного образа жизни), получают все более широкое распространение. Шум как фактор риска для слухаz Ухо – это орган, который обрабатывает звуки, обеспечивая мозгу возможность распознать то, что слышит человек. Ухо подразделяется на три части: наружное ухо, среднее ухо и внутреннее ухо (см. рисунок 1). Обычно звук воспринимается сенсорными клетками, расположенными во внутреннем ухе, и в тех случаях, когда эти клетки часто подвергаются воздействию громких звуков, они могут быть необратимо повреждены, что оказывает негативное воздействие на слух человека. Вызванная шумом потеря слуха может развиваться из-за воздействия различных факторов среды и особенностей поведения. Например, 40% людей, часто посещающих шумные дискотеки, клубы, спортивные мероприятия или музыкальные концерты, подвергаются воздействию потенциально травмирующих уровней звука [4]. Есть данные, свидетельствующие о том, что люди, которые на протяжении последних 20 лет подвергались воздействию громких звуков в общественных местах, в три раза чаще страдают потерей слуха, чем те, кто не подвергался такому воздействию. Рисунок 1. Структура уха Ушная раковина Мышца Эластичный хрящ Молоточек Черепная кость Наковальня Полукружный канал Преддверный нерв Внутреннее ухо Улитковый нерв Улитка Наружный слуховой проход Барабанная перепонка Преддверие Круглое окошко Евстакиева труба К носоглотке Стремечко Овальное окошко (под стремечком) Среднее ухоНаружное ухо 9Этот риск возрастает в связи с широким распространением персональных аудиоустройств, таких как смартфоны и MP3-плееры. Использование смартфонов в развивающихся странах выросло с 45% в 2013 году до 54% в 2015 году [7], а в развитых странах этот показатель составляет 87%. По оценкам, 50% людей, слушающих музыку с помощью персональных аудиоустройств, устанавливают уровень громкости, подвергающий их слух риску [4]. Настоящий комплект материалов посвящен проблеме потери слуха, вызванной небезопасным прослушиванием с использованием персональных аудиоустройств. В 2008 году Научный комитет по возникающим и вновь выявленным рискам для здоровья определил небезопасное прослушивание в качестве основной причины потери слуха. Комитет отметил, что у 5–10% слушателей может развиться потеря слуха вследствие их личных предпочтений в отношении уровня громкости и продолжительности прослушивания [8]. Объем имеющихся фактических данных в разных странах различен, но, как показало одно исследование, в странах Северной и Южной Америки более 40 миллионов взрослых людей в возрасте от 20 до 69 лет страдают от потери слуха, вызванной шумом, не связанным с профессиональной деятельностью [5]. Воздействие потери слуха У детей раннего возраста вызванная шумом потеря слуха затрудняет усвоение языка [6, 7]. Кроме того, у детей, подверженных воздействию громких звуков, часто встречаются пониженная обучаемость, тревожность и поведение, свидетельствующее о потребности в повышенном внимании [11]. Постоянное воздействие шума в классных комнатах отрицательным образом сказывается на таких аспектах успеваемости, как чтение, понимание, кратковременная и долговременная память и мотивация. В среднем дети, вынужденные учиться в шумной обстановке, получают более низкие оценки при прохождении стандартизированных тестов, что в долгосрочной перспективе может негативно отразиться на их образовательном и профессиональном развитии [4, 8]. У взрослых неустраненная проблема потери слуха может приводить к потере заработка и трудности с нахождением и сохранением работы. Например, в Европе у людей с неустраненной проблемой потери слуха вероятность стать безработными в два выше, чем у их ровесников с нормальным слухом. И даже если люди со сниженным слухом имеют работу, они часто получают более низкую заработную плату. Например, было установлено, что в США заработная плата у взрослых с неустраненной проблемой потери слуха на 50–70% ниже. Это оказывает негативное воздействие на социальные отношения и может стать причиной напряженности в семье. Воздействие шума в молодом возрасте также способствует развитию возрастной потери слуха, которая может приводить к значительным трудностям в общении и соответствующим негативным последствиям в эмоциональной и когнитивной сфере [9]. Последние данные свидетельствуют о том, что у пожилых людей с потерей слуха такие последствия, как депрессия, изоляция, фрустрация, снижение когнитивных способностей и снижение личной безопасности, встречаются в два раза чаще, чем у пожилых людей без потери слуха [10, 11, 12, 13]. Хотя вызванная шумом потеря слуха необратима, ее тем не менее можно предотвратить. Что касается потери слуха, вызванной небезопасным использованием персональных аудиоустройств, то существуют простые и эффективные методы ее профилактики, такие как поддержание безопасного уровня громкости и ограничение времени участия в шумных занятиях. Применение этих методов может оказывать защитное воздействие на слух людей. 10 Профилактические меры должны приниматься в первую очередь самими слушателями, которым следует соблюдать правила безопасного поведения при прослушивании. Вместе с тем правительство, поставщики медицинских услуг, производители и гражданское общество могут создать среду, обеспечивающую возможности для безопасного прослушивания. Инициатива ВОЗ "Сделать прослушивание безопасным" В качестве ответной меры на эту проблему общественного здравоохранения, приобретающую все более широкие масштабы, ВОЗ в 2015 году выступила с инициативой "Сделать прослушивание безопасным", общая концепция которой заключается в обеспечении для людей всех возрастов возможности получать удовольствие от прослушивания при полной защите слуха. Целью этой глобальной инициативы является снижение риска потери слуха вследствие небезопасного воздействия звуков в местах развлечения посредством: •регулирования воздействия громких звуков в персональных аудиосистемах; •проведения кампании по информированию общественности в целях изменения моделей поведения целевых групп населения при прослушивании; •разработки нормативной базы, касающейся безопасного прослушивания в местах развлечения. Для решения первой из поставленных задач МСЭ и ВОЗ совместно разработали Глобальный стандарт ВОЗ–МСЭ для безопасных устройств и систем прослушивания. Обоснование стандарта для безопасных устройств прослушивания Как показывает опыт в других областях общественного здравоохранения (таких как сокращение потребления табака или повышение безопасности дорожного движения), меры политики, нормативно-правовые акты и обеспечение их соблюдения в конечном итоге способны повлиять на поведение людей. Это верно, например, в отношении обязательных графических предупреждений на упаковках сигарет и штрафов за несоблюдение законов об обязательном использовании ремней безопасности. В соответствии с этим опытом [14] представляется, что разработка и выполнение специальных законодательных положений, регулирующих количество звуковой энергии, поступающей через персональную аудиосистему, может способствовать предупреждению потери слуха, обеспечивая более низкий уровень звукового воздействия на людей, использующих эти устройства. В настоящее время существует лишь один пример нормативных положений, касающихся воздействия звука через персональные музыкальные проигрыватели, – это директива Европейской комиссии 2009 года, ограничивающая уровень выходного сигнала персональных музыкальных проигрывателей и предписывающая обязательное предупреждение слушателей. Правовые и регуляторные меры оказались эффективной стратегией обеспечения многих достижений дозорного общественного здравоохранения. Ярким примером являются принятые во всем мире законодательные положения о запрете курения, которые стали эффективным средством сокращения масштабов пассивного и активного курения, а также снижения частоты случаев острого коронарного синдрома в соответствующих группах населения [15]. Как показала практика, законодательство и его применение являются важнейшим инструментом обеспечения безопасности дорожного движения, который способен привести к сокращению случаев превышения скорости и вождения в состоянии алкогольного опьянения [16, 17]. С учетом этих примеров для обеспечения устойчивого изменения привычек, связанных с прослушиванием, имеет смысл принять нормативные акты или законодательные положения, направленные на борьбу с воздействием громких звуков как проблемой общественного здравоохранения. 11 Глобальный стандарт ВОЗ–МСЭ H.870 для безопасных устройств и систем прослушивания Глобальный стандарт ВОЗ–МСЭ [18] опирается на рекомендации Европейской комиссии [19] и содержит основанные на фактических данных руководящие принципы содействия применению пользователями персональных аудиосистем практики безопасного прослушивания. По сути Глобальный стандарт ВОЗ–МСЭ предлагает способы сделать технологии, используемые для прослушивания (персональные аудиосистемы), одним из компонентов решения проблемы небезопасного прослушивания. Стремительное развитие сложных технологий, способных отслеживать поведение и состояние здоровья и обеспечивать персонализированную обратную связь, может быть использовано для содействия привитию навыков безопасного прослушивания, при котором слушатель продолжает получать приятные впечатления. Таким образом технология смартфонов с "умными" мобильными устройствами, подключенными к мощным вычислительным ресурсам, может обеспечить платформу для принятия адресных индивидуальных мер по обеспечению безопасного прослушивания настолько своевременно, насколько это необходимо для достижения максимального эффекта. Цель Глобального стандарта ВОЗ–МСЭ заключается в создании безопасной среды для тех, кто слушает музыку на персональных устройствах, с помощью использования технологий и создания адресных защитных функций. Защитные функции, рекомендуемые в Глобальном стандарте ВОЗ–МСЭ, будут, помимо прочего, обеспечивать ограничение интенсивности и продолжительности воздействия громкой музыки на пользователей. Тем не менее, поскольку пользователи могут принять решение об отказе от этой технологии (например, отключив защитные функции), Глобальный стандарт ВОЗ–МСЭ также содержит рекомендации по включению в защитные функции информационно-просветительского компонента, помогающего пользователям отслеживать и анализировать свое поведение и делать соответствующие выводы. Как следует из теории и моделей изменения поведения, пользователям, возможно, будет легче принять принципы безопасного поведения при прослушивании и постоянно следовать им в том случае, если они будут получать информацию и указания о тех видах поведения, из-за которых они подвергаются риску, о потенциальных последствиях и о том, что надо делать в связи с этим. Разработка Глобального стандарта ВОЗ–МСЭ Глобальный стандарт ВОЗ–МСЭ основан на современных данных и является результатом двухлетнего сотрудничества с широким кругом экспертов и заинтересованных сторон, в том числе с аудиологами, представителями научного сообщества, инженерами звукозаписи, профессиональными ассоциациями, производителями устройств и гарнитур, регуляторными органами, действующими на глобальном или европейском уровне, и представителями целевой возрастной группы (от 12 до 35 лет). Члены этой группы широкого состава, которая созывалась попеременно ВОЗ и МСЭ, представили свои идеи и замечания по поводу текста Глобального стандарта ВОЗ–МСЭ. Все справочные документы и собранные фактические данные являются общедоступными. До вступления в силу Глобальный стандарт ВОЗ–МСЭ, подготовленный группой, был размещен в интернете для получения дополнительных комментариев и предложений от 193 Государств-Членов Международного союза электросвязи, а также от сотен Членов Секторов. 12 1 Па2*ч – это единица измерения акустической энергии. Глобальный стандарт ВОЗ–МСЭ состоит из двух неотъемлемых компонентов: технической спецификации и коммуникационного/образовательного элемента. Эти два компонента тесно связаны между собой, и для того чтобы быть эффективными, они должны быть реализованы вместе. 1. Технические аспекты, затронутые в Глобальном стандарте ВОЗ–МСЭ Также рекомендуется, чтобы устройство позволяло пользователю выбирать один из двух режимов эталонного воздействия. Режим 1. Стандартный уровень (ВОЗ) для взрослых. В этом режиме эталонное воздействие составляет 1,6 Па2*ч за 7 дней (то есть SPL 80 дБА за 40 часов в неделю). Режим 2. Стандартный уровень (ВОЗ) для чувствительных пользователей (например, детей). В этом режиме эталонное воздействие составляет 0,51 Па2*ч за 7 дней (то есть SPL 75 дБА за 40 часов в неделю). Выбор режима осуществляется при первом использовании проигрывателя (или когда устройство перезагружается на заводские настройки). В дальнейшем выбранный режим можно в любое время изменить, например, в меню настроек устройства. Ограничение громкости. Это функция, при которой каждый раз, когда пользователь достигает 100% своего недельного допустимого уровня звукового давления, автоматически появляется сообщение об ограничении громкости и предлагается вариант выбора. Сообщение должно предоставлять пользователю возможность "продолжить прослушивание", если он не хочет уменьшить громкость. Если сообщение не подтверждено, громкость на выходе по умолчанию будет уменьшена до заранее заданного уровня. По возможности пользователям следует предоставлять возможность настраивать этот уровень (то есть тот уровень, до которого они хотели бы, чтобы их устройство ограничивало громкость) в соответствии со своими предпочтениями. Некоторые пользователи могут использовать эту функцию для того, чтобы по желанию самим ограничивать воздействие звука, установив на своем устройстве максимальный уровень громкости звука на выходе. Родительский контроль. Рекомендуется, чтобы на устройстве была предусмотрена функция, позволяющая устанавливать максимальный уровень громкости звука на выходе и блокировать его настройку, возможно с помощью пароля. Это позволило бы родителям (или другим взрослым) ограничивать максимальную громкость звука на выходе устройства, которым пользуется ребенок, таким образом, чтобы ребенок не мог ее изменить. Дозиметрия. Согласно рекомендации Глобального стандарта ВОЗ–МСЭ каждое устройство должно иметь систему отслеживания времени воздействия на пользователя и оценки уровня громкости звука, а также процентного отношения звукового воздействия к эталонному воздействию (допустимый уровень звукового давления). В такой акустической дозиметрии должны учитываться все медиаданные, которые воспроизводятся на устройстве (хранящиеся в памяти устройства или проигрываемые в потоковом режиме) в то время, когда пользователь использует головные наушники или наушники-вкладыши. (Голосовые звонки не учитываются, так как они регулируются отдельно другими стандартами.) Дозиметрия Расчет и оценка уровня звука, поступающего в ухо, по сравнению с эталонным воздействием (или допустимым уровнем звукового давления) 13 2. Коммуникационные аспекты, затронутые в Глобальном стандарте ВОЗ–МСЭ Глобальный стандарт ВОЗ–МСЭ предназначен для предоставления пользователям информации и руководящих указаний, позволяющих им делать безопасный выбор при прослушивании, отслеживая и анализируя собственное поведение и делая соответствующие выводы. Этот компонент включает в себя: – персональную информацию об использовании, которая основана на данных системы отслеживания, упомянутой в связи с техническим компонентом. Это поможет пользователю получить представление: • о своих собственных привычках, связанных с прослушиванием (использование суточного и недельного допустимого уровня звукового давления); • о том, как использовать функции безопасного прослушивания в конкретных устройствах; – персональные рекомендации и указания в отношении того, что надо делать для безопасного прослушивания, с учетом профиля прослушивания каждого пользователя; – общую информацию по следующим вопросам: • безопасное прослушивание и его практическая реализация; • риски, связанные с небезопасным прослушиванием; • риск потери слуха вследствие воздействия громких звуков из других источников, помимо персональной аудиосистемы. Задачи настоящего комплекта материалов Настоящий комплект материалов призван служить практическим руководством по реализации и контролю выполнения Глобального стандарта ВОЗ–МСЭ, который должен использоваться всеми Государствами-Членами в качестве основы для разработки нормативных положений или законодательных актов или быть добровольно принят производителями для защиты пользователей от потери слуха в результате воздействия шума. Глобальный стандарт ВОЗ–МСЭ предназначен для оказания поддержки странам, отраслям промышленности и гражданскому обществу в реализации стратегического, основанного на фактических данных и удобного для пользователей подхода к профилактике потери слуха в результате воздействий шума. Настоящий комплект материалов включает три раздела. Каждый из разделов адресован определенной группе лиц, чья деятельность крайне важна для обеспечения принятия Глобального стандарта ВОЗ–МСЭ и защиты пользователей. В их число входят следующие группы: •органы государственного управления, в частности министерства и ведомства, осуществляющие деятельность в области здравоохранения, технологий, торговли, промышленности, защиты прав потребителей и любые другие ведомства, занимающиеся вопросами инвалидности или обеспечения условий для лиц с ограниченными возможностями; •отрасли промышленности, в частности производители персональных аудиосистем; •организации гражданского общества, занимающиеся проблемами слуха или прав потребителей. 14 В каждом разделе приводится обоснование для принятия заинтересованными сторонами мер по обеспечению безопасного прослушивания; перечисляются возможности данной конкретной группы в отношении реализации или содействия реализации Глобального стандарта ВОЗ–МСЭ; а также предлагаются инструменты для принятия мер. Процедуры, этапы и инструменты представлены в качестве ориентира и могут быть скорректированы, модифицированы или приспособлены заинтересованными сторонами к потребностям конкретных стран и производителей. Реализация правительствами 16 Данный раздел служит руководством (в частности) для следующих категорий субъектов: •государственные должностные лица, ответственные за разработку политики, консультирование министерств, определение приоритетных задач в области здравоохранения, например в области охраны здоровья подростков, образования, технологий, информационно-коммуникационных технологий, электросвязи, а также регуляторные органы или органы по стандартизации; организации по защите прав потребителей и руководители программ в области охраны слуха или здоровья подростков в рамках министерства здравоохранения; •должностные лица, ответственные за школьную гигиену или закупку оборудования в рамках министерств образования; •должностные лица, отвечающие в государственных ведомствах за вопросы обеспечения условий для лиц с ограниченными возможностями. Обоснование Масштабы распространения потери слуха увеличиваются во всех регионах мира, что создает проблему для общественного здравоохранения, влекущую за собой значительные финансовые затраты. По оценкам ВОЗ, нерешенная проблема потери слуха обходится миру примерно в 750 млрд. долл. США в год (в международных долларах). Инвестиции в профилактику потери слуха могут помочь правительствам сэкономить и без того ограниченные ресурсы. Министерства образования и министерства технологий должны пропагандировать и поддерживать меры по профилактике потери слуха, что отчасти достигается посредством реализации Глобального стандарта ВОЗ–МСЭ, в целях выполнения своих мандатов по защите лиц, пользующихся технологиями в целом, и, в частности, детей, использующих технологии для обучения. Расширение доступа к технологиям во всем мире и их ненадлежащее использование создают в этом отношении огромные проблемы. Для снижения связанных с этим рисков важно, чтобы люди научились правильно пользоваться технологиями, что позволит свести их вредное воздействие к минимуму. Глобальный стандарт ВОЗ–МСЭ предоставляет возможность использовать технологические интерфейсы в качестве основы для предотвращения потери слуха вследствие воздействия шума. . Реализация правительствами 17 Какие действия могут предпринять правительства? Правительства могут способствовать реализации Глобального стандарта ВОЗ–МСЭ посредством следующих мер 1. Законодательство. Глобальный стандарт ВОЗ–МСЭ должен быть интегрирован в нормативные положения и законодательные акты, касающиеся производства, импорта и продажи персональных аудиоустройств. 2. Другие стратегии a. Государственное регулирование. Соответствующее государственное ведомство (в области технологий, здравоохранения, защиты прав потребителей и т. д.) должно определить механизм для обеспечения выполнения политики или нормативных положений с таким расчетом, чтобы все персональные аудиоустройства и системы, продаваемые в пределах его юрисдикции, соответствовали Глобальному стандарту ВОЗ–МСЭ и обеспечивали защиту пользователей от потери слуха вследствие воздействия шума. b. Политика в области закупок. Государственные ведомства, регулярно закупающие технологии в больших масштабах (посредством тендеров и государственных закупок), должны обеспечить соответствие всех закупаемых ими устройств Глобальному стандарту ВОЗ–МСЭ. В 2003 году МСЭ разработал международный стандарт сжатия видеоизображений (Рекомендация МСЭ T H.264), который был широко внедрен в промышленности. Во Франции был разработан регламент, а в Бразилии издан президентский указ, предписывающий применять стандарт МСЭ-Т H.264 к услугам эфирного вещания, что принесло пользу конечным пользователям: благодаря этому не только значительно улучшилось качество изображения, передаваемого по телевидению в этих странах, но и снизились цены на требуемые абонентские приставки. В тех случаях, когда ведомство, занимающееся вопросами технологий, выполняет консультативную функцию и обеспечивают информационную основу для решений, принимаемых другими ведомствами (в отношении соответствующих устройств), оно должно рекомендовать, чтобы такая политика закупок была приведена в соответствии с функциями, определенными в Глобальном стандарте ВОЗ–МСЭ. Государственные закупки используются в качестве инструмента поддержки государственной политики во многих областях и могут способствовать достижению общественных целей [20]. 3. Наряду с законодательством и другими стратегиями реализации Глобального стандарта ВОЗ–МСЭ для безопасных слуховых устройств правительства должны начать информационно-разъяснительную работу в целях повышения осведомленности общественности: •о рисках, создаваемых громкими звуками, особенно в местах развлечения; •о методах безопасного прослушивания, которые могут способствовать снижению риска потери слуха у слушателей. 18 Привлечение партнеров Следует привлекать все заинтересованные стороны в данной области, в том числе: • различные государственные ведомства, занимающиеся такими вопросами, как технологии, здравоохранение, образование, торговля и промышленность, окружающая среда, молодежь; • группы гражданского общества, в том числе ассоциации слабослышащих людей; НПО, профессиональные общества; • молодежные организации; • производителей; • ассоциации бытовой электронной техники; • крупные группы предприятий розничной торговли; • организации по защите прав потребителей; • прочих партнеров, которые могут играть важную роль в условиях конкретной страны. Предлагаемые шаги Для обеспечения включения Глобального стандарта ВОЗ–МСЭ в соответствующие стратегии и нормативные акты рекомендуется применение пошагового подхода, описанного ниже. Шаг 1. Оценка и разработка политики a. Проведение оценки ситуации. Ведомство-инициатор должно выполнить оценку ситуации, для того чтобы получить: • информацию о функциях безопасного прослушивания на устройствах, находящихся в продаже в стране в настоящее время; • актуальные статистические данные о потере слуха в стране/регионе, особенно о потере слуха, вследствие воздействия громких звуков, если такие данные имеются; • информацию о существующих стратегиях предупреждения потери слуха, контроля шума и безопасного прослушивания; • информацию о том, кто является основными заинтересованными сторонами, включая государственные ведомства, группы гражданского общества, молодежные организации, производителей. Форма для проведения оценки ситуации приводится в Дополнении 1. b. Организация консультации по планированию. После оценки ситуации ведомство/ министерство-инициатор должно провести собрание для составления плана реализации Глобального стандарта ВОЗ–МСЭ и получить одобрение всех соответствующих заинтересованных сторон. На этом собрании должны присутствовать все основные заинтересованные стороны, определенные на шаге 1. В ходе этого собрания должны быть представлены результаты оценки ситуации, краткое описание Глобального стандарта ВОЗ–МСЭ и предложены дальнейшие шаги по его реализации. Общий план консультации с заинтересованными сторонами приводится в Дополнении 2. c. Разработка политики в отношении безопасных устройств прослушивания. Ведомству-инициатору следует подготовить проект закона, политики или нормативного акта и обсудить его с соответствующими министерствами/государственными ведомствами. Затем этот проект следует передать заинтересованным сторонам для получения их отзывов, которые должны быть рассмотрены до окончательной доработки и утверждения документа о политике. d. Определение способов и средств повышения осведомленности целевой группы. Наряду с разработкой политики в отношении безопасных устройств прослушивания, ведомству-инициатору следует наметить стратегию повышения осведомленности о безопасном прослушивании и информирования пользователей о новых функциях безопасного прослушивания, предусмотренных нормативными положениями. Для этого необходимо провести консультации с соответствующими работниками здравоохранения и специалистами в сфере коммуникации. Страна может воспользоваться проверенными материалами ВОЗ по повышению осведомленности, которые можно адаптировать и перевести для использования в конкретной стране.Шаг 2. Начало реализации и коммуникация Шаг 2. Начало реализации и коммуникация a. Организация информационно-разъяснительного семинара-практикума. После того как политика или законодательство будут окончательно доработаны, ведомству-инициатору следует провести информационно-разъяснительный семинар-практикум в сотрудничестве с другими вовлеченными ведомствами. Цель такого семинара-практикума заключается в том, чтобы представить производителям и основным группам предприятий розничной торговли обоснование и цели принятия нормативных положений и заручиться их поддержкой в реализации этих целей. Краткое описание семинара-практикума приведено для ознакомления в Дополнении 4. b. Проведение информационно-пропагандистской кампании в СМИ. Реализацию новых нормативных положений следует начать с сообщения в прессе. Это должно сопровождаться кампанией в средствах массовой информации по всем каналам, играющим важную роль в условиях конкретной страны и имеющим отношение к целевой группе, например в социальных сетях, печатных СМИ, цифровых СМИ и т. д. Для получения максимального пропагандистского эффекта правительства могут объявить о введении этих нормативных положений во Всемирный день слуха. Шаг 3. Осуществление и контроль a. Контроль за осуществлением политики. Осуществление политики и внедрение нормативных положений или законодательства должно контролироваться правительством посредством установленных механизмов. b. Проведение оценки и пересмотра. Необходимо регулярно, через определенные промежутки времени (например, каждые 2 года) проводить оценку политики, нормативных положений или законодательства и их осуществления. Результаты такой оценки следует затем обсуждать с заинтересованными сторонами и вносить коррективы в зависимости от полученных отзывов. 19 Дополнительные действия Всегда, когда это возможно, правительству следует прилагать усилия к осуществлению следующих действий. a. Мониторинг эпидемиологии потери слуха. Соответствующий департамент министерства здравоохранения должен регулярно проводить оценку распространенности потери слуха в целевой группе населения, организуя исследования распространенности популяционного уровня. Такое исследование в идеале должно быть проведено на первом этапе инициативы и затем повторяться каждые 5 лет. b. Проведение исследования. Соответствующие ведомства должны оценить частоту потери слуха среди пользователей персональных аудиоустройств. Инструменты В настоящем комплекте материалов предлагаются следующие инструменты, которые могут служить для правительств руководством по применению Глобального стандарта ВОЗ–МСЭ: • инструмент оценки/анализа ситуации (Дополнение 1); • формат проведения консультации с заинтересованными сторонами (Дополнение 2); • вводная презентация, содержащая основные идеи (Дополнение 3); • формат проведения информационно-разъяснительного семинара-практикума (Дополнение 4); • материалы для повышения осведомленности (Дополнение 5). Планирование: оценка ситуации, обсуждение, разработка политики, повышение осведомленности населения Мониторинг осуществления: мониторинг, оценка, обратная связь, пересмотр Вспомогательные действия: оценка результатов в отношении потери слуха и поведения, связанного с прослушиванием Начало реализации: проведение информационно-разъяснительного семинара-практикума, пропагандистская работа с помощью средств массовой информации 20 Реализация отраслевыми партнерами Данный раздел служит руководством для следующих субъектов. • Производители персональных аудиосистем, в том числе: – смартфонов; – MP3-плееров – других устройств с возможностью воспроизведения музыки; – головных наушников/наушников-вкладышей. Обоснование Вложение средств в охрану здоровья слуха клиентов целесообразно с коммерческой точки зрения в отрасли, которая в значительной степени зависит от способности клиентов слышать. В настоящее время все более широкое применение технологий представляет собой одну из угроз для здоровья слуха. Легкий доступ к таким технологиям в отсутствие какой-либо информации или просвещения о методах безопасного прослушивания подвергает угрозе слух миллионов молодых людей во всем мире. Если не предпринять конкретные шаги, то с ростом проникновения технологий масштабы этой проблемы скорее всего также будут увеличиваться. В то же время технологии успешно используются для повышения осведомленности населения о различных проблемах со здоровьем и пропаганды здорового образа жизни. В связи с этим увеличивается число приложений медицинского назначения, доступных пользователям на некоторых устройствах. При надлежащем использовании технологий такой подход может помочь снизить риск, который такие технологии создают для слуха. Таким образом в рамках мер по снижению риска и в соответствии с принципами ответственного ведения бизнеса производители персональных аудиоустройств также должны взять на себя долю ответственности за содействие внедрению практики безопасного прослушивания и уменьшение любого потенциального вреда от использования их продукции. Для этого необходимо обеспечить надлежащее применение Глобального стандарта ВОЗ–МСЭ. Безопасное прослушивание приведет к уменьшению рисков, создаваемых для слуха, и потенциально может привести к снижению частоты случаев его потери. Какие действия могут предпринять производители? Производителям следует предпринять следующие действия. • Взять на себя лидирующую роль в области безопасного прослушивания, добровольно выполняя Глобальный стандарт ВОЗ–МСЭ и обеспечивая соответствие производимых ими персональных аудиоустройств: – требованиям Глобального стандарта ВОЗ–МСЭ; – дополнительным функциям, предусмотренным Глобальным стандартом ВОЗ–МСЭ. 22 Реализация отраслевыми партнерами • Повысить точность измерения соотношения доза/допустимый уровень посредством: – шагов, направленных на совершенствование алгоритма тестирования и сведение к минимуму ошибок измерений; – обеспечения совместимости алгоритмов с широким ассортиментом видов наиболее распространенных головных наушников/наушников-вкладышей, имеющихся на рынке (в том числе производимых другими компаниями). • Экспериментировать и создавать пользовательский интерфейс, который является одновременно привлекательным и информативным. Пользовательский интерфейс должен: – представлять информацию о безопасном прослушивании в увлекательной форме, интересной для пользователя; – представлять информацию об используемых пользователем параметрах прослушивания, а также о применении допустимого уровня звукового давления в простой для понимания форме; – обеспечивать доступ к надежным и проверенным источникам информации о безопасном прослушивании. Еще одним примером могут служить технологии цифровой абонентской линии (DSL), которые обеспечивают возможность широкополосного доступа в интернет из дома. В числе прочего МСЭ разработал стандарт МСЭ-T G.993.1, который, хотя и не был предписан правительствами к обязательному выполнению, был выбран сетевыми операторами в рамках их закупочной деятельности в качестве технологии, позволяющей осуществлять передачу данных между их помещениями и домами пользователей на скорости до 25 Мбит/с. Помимо обеспечения высокоскоростного интернета это позволило сетевым операторам упростить предоставление услуг и сократить расходы. Производители оборудования теперь могут подавать заявки на участие в торгах на заключение большего числа контрактов и предлагать конечным пользователям устройства через розничные каналы. Для пользователей это означает снижение эксплуатационных расходов и возможность выбирать из множества поставщиков оборудования (при гарантированной функциональной совместимости). 23 Привлечение партнеров Следует привлекать все заинтересованные стороны в данной области, в том числе: • других производителей, которые внедрили Глобальный стандарт ВОЗ–МСЭ; • розничных продавцов устройств, производимых компанией; • группы потребителей, целевую группу; • правительство; претендуя на получение каких-либо государственных контрактов, производители могут делать акцент на наличие в их устройствах функций безопасного прослушивания; прочих партнеров, которые могут играть важную роль в данном контексте. 24 Предлагаемые шаги Шаг 1. Планирование a. Проведение внутренней оценки. Производители должны провести оценку текущего положения дел в отношении функций безопасного прослушивания в устройствах, которые они производят в разных частях мира. b. Загрузка Глобального стандарта ВОЗ–МСЭ и ознакомление с ним. Глобальный стандарт ВОЗ–МСЭ размещен по адресу https://itu.int/rec/T-REC-H.870. Резюме приводится в Дополнении 6 к настоящему документу. Сотрудникам компании, занимающимся вопросами безопасности и акустикой, следует прочитать полный текст Глобального стандарта ВОЗ–МСЭ и соответствующую справочную литературу и понять их значение. c. Обсуждение реализации. Проведение внутренних обсуждений вопроса о способах внедрения предлагаемых функций безопасного прослушивания в устройства и разработка комплексного плана реализации. Шаг 2. Разработка и тестирование функций безопасного прослушивания a. Разработка и тестирование пользовательского интерфейса. Глобальный стандарт ВОЗ–МСЭ содержит руководящие указания относительно того, какую информацию следует передавать посредством интерфейса устройства. Производители должны по мере возможности провести исследование этого аспекта и разработать для функций безопасного прослушивания удобный интерфейс в соответствии с Глобальным стандартом ВОЗ–МСЭ. В случае если производители не могут или не хотят проводить такое исследование, они могут придерживаться рекомендаций, приведенных в Дополнении 7. b. Разработка и тестирование сообщений и указаний к действию. Такие сообщения и инструкции должны быть включены в пользовательский интерфейс. При проведении их тестирования важно принимать во внимание культурный, языковой и региональный контекст. Если производитель не может или не хочет заниматься разработкой и тестированием интерфейса и сообщений, он может воспользоваться примерами, приведенными в инструментах (см. Дополнение 7 и Дополнение 8). c. Проверка соответствия устройства глобальному стандарту ВОЗ–МСЭ. После того как параметры безопасного прослушивания стандарта H.870 будут реализованы в продукции компании, их следует протестировать на предмет соответствия с использованием заранее разработанного плана оценки соответствия. Шаг 3. Широкое освещение и рекламирование a. Информирование и обучение розничных продавцов. После того как продукция, соответствующая Глобальному стандарту ВОЗ–МСЭ, поступит в продажу, следует проинформировать розничных продавцов об этих функциях и обучить их способам рекламирования. b. Широкое освещение функций безопасного прослушивания устройства. Во всех случаях, когда это возможно, в рекламных объявлениях и на веб-сайтах следует делать акцент на функциях безопасного прослушивания, что поможет повысить осведомленность населения о безопасном прослушивании и наглядно продемонстрирует ответственное отношение компании к потребителям. Планирование: оценка ситуации, ознакомление со стандартами, внутренние обсуждения Широкое освещение и реклама: информирование розничных продавцов, реклама, веб-сайты Обзор и внесение изменений: отзывы, обновления, изменения Разработка и тестирование: пользовательский интерфейс, сообщения, тестирование на предмет соответствия 25 Шаг 4. Обзор и внесение изменений a. Сбор отзывов пользователей. Производителям следует регулярно запрашивать у пользователей отзывы о востребованности, удобстве использования и понятности функций безопасного прослушивания в их устройствах. b. Внесение изменений и улучшений. Следует периодически вносить изменения в пользовательский интерфейс и систему сообщений на основе отзывов пользователей. c. Отслеживание и учет наиболее актуальной версии Глобального стандарта ВОЗ–МСЭ. Производителям следует вносить изменения в эти функции в соответствии с внесением изменений в Глобальный стандарт ВОЗ–МСЭ. Инструменты В настоящем комплекте материалов содержатся следующие инструменты, которые могут использоваться производителями в качестве ориентира при применении Глобального стандарта ВОЗ–МСЭ: • резюме Глобального стандарта ВОЗ–МСЭ (Дополнение 6); • пример информационного потока (Дополнение 7); • основные факторы, которые необходимо учитывать при составлении сообщений, с типовыми примерами (Дополнение 8); • перечень источников информации (Дополнение 5). 26 Роль гражданского общества Данный раздел служит руководством для профессиональных ассоциаций, а также организаций и групп гражданского общества, осуществляющих деятельность в сфере: • профилактики потери слуха; • контроля шума; • защиты прав потребителей. Обоснование Воздействие громких звуков является основной причиной развития предотвратимой потери слуха. По оценкам, 50% людей, имеющих персональные аудиосистемы, пользуются ими так, что подвергают свой слух риску. Внедрение Глобального стандарта ВОЗ–МСЭ может способствовать формированию навыков безопасного прослушивания и снижению риска, создаваемого для слуха персональными аудиосистемами. Партнерам из гражданского общества следует проводить информационно-пропагандистскую работу среди лиц, отвечающих за формирование политики, в целях внедрения принципов безопасного прослушивания как средства профилактики потери слуха. Какие действия могут предпринять организации гражданского общества? Организациям гражданского общества следует осуществлять следующие виды деятельности: • вести информационно-пропагандистскую деятельность с целью убедить правительства разработать нормативные положения, касающиеся реализации Глобального стандарта ВОЗ–МСЭ; • проводить информационные кампании в целях привлечения внимания населения к вопросам профилактики потери слуха и принципам безопасного прослушивания; • повышать информированность производителей устройств с целью мотивировать их добровольно реализовать Глобальный стандарт ВОЗ–МСЭ в продаваемой ими продукции. Привлечение партнеров Следует привлекать все заинтересованные стороны в данной области, в том числе: • другие организации, осуществляющие деятельность в области профилактики потери слуха, контроля шума и защиты прав потребителей; • департаменты здравоохранения, образования и технологий; • местные школы; • средства массовой информации; • отделы корпоративной социальной ответственности (КСО) производственных предприятий; • прочих партнеров, которые могут сыграть важную роль в данном контексте. 28 Роль гражданского общества Предлагаемые шаги Шаг 1. Планирование a. Определите другие заинтересованные стороны и проведите вместе с ними мозговой штурм в целях планирования действий. b. Определите целевую аудиторию, с которой будут работать в частности политики, производители, школы и университеты, общество в целом и т. д. c. Определите основные идеи, которые нужно донести до этой аудитории, и результаты, которых желательно добиться (например, разработка политики правительством; внедрение функций безопасного прослушивания производителями; использование приложений безопасного прослушивания молодыми людьми и т. д.). d. Выявите наиболее эффективную стратегию донесения этих идей до аудитории, например, в ходе собраний, мероприятий с участием средств массовой информации, информационно-разъяснительных мероприятий и т. д. Шаг 2. Подготовка a. Проведите обзор информационно-разъяснительных и пропагандистских материалов ВОЗ по безопасному слушанию и адаптируйте их к местным условиям, при необходимости, обеспечьте их перевод. b. Проведите обзор других имеющихся материалов по безопасному слушанию. c. Доработайте ресурсы и материалы, которые будут использоваться. Шаг 3. Информационно-пропагандистская работа с целевой группой, определенной доступными способами a. Средства массовой информации. b. Социальные сети. c. Веб-сайты. d. Веб-трансляции. e. Семинары-практикумы по безопасному слушанию в школах и университетах. f. Массовые мероприятия. Шаг 4. Последующая работа с целевой группой и мониторинг результатов и воздействия с точки зрения: a. введенной политики или мер, принятых по инициативе правительства; b. внедрения функций безопасного прослушивания производителями; c. использования приложений/функций безопасного прослушивания пользователями персональных аудиоустройств; d. изменения связанных с прослушиванием привычек пользователей. 29 Инструменты В настоящем комплекте материалов содержатся следующие инструменты, которые могут использоваться организациями гражданского общества в качестве ориентира в деятельности по пропаганде Глобального стандарта ВОЗ–МСЭ: • информационно-разъяснительные материалы для политиков и населения в целом (Дополнение 5); • материалы для социальных сетей (Дополнение 5); • ресурсы для проведения на базе школ семинаров-практикумов, посвященных вопросам безопасного слушания (Дополнение 9). Планирование: определение заинтересованных сторон, мозговой штурм, определение целевой аудитории, определение основных идей, выработка стратегии Информационно-пропагандистская работа: среди целевой группы Последующая деятельность и отслеживание результатов Подготовка: обзор и адаптация имеющихся информационно-пропагандистских материалов 30 Справочная литература и библиография Справочная литература 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Ginebra: Organización Mundial de la Salud; 2017 2. Addressing the rising prevalence of hearing loss. Ginebra: Organización Mundial de la Salud; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012; 14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload/noiseprevention.pdf, acceso el 21 de noviembre de 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012; 39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008; 123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002; 65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007; 77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018; 144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013; 173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 13 de abril de 2018. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 14 de abril de 2010; (4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013; Nov;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Revista Panamericana de Salud Pública. Octubre de 2014; 36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recomendación UIT-T H.870. Directrices para dispositivos/sistemas de escucha segura. 2018 (https://itu.int/rec/T-REC-H.870, acceso el 15 de enero de 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014; 14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017; 30. 10.1108/IJPSM-03-2017-0066. 32 Справочная литература 1. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Ginebra: Organización Mundial de la Salud; 2017 2. Addressing the rising prevalence of hearing loss. Ginebra: Organización Mundial de la Salud; 2018. 3. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012; 14(61):274 4. Bistrup ML, Keiding L, editors. Children and noise − prevention of adverse effects. Copenhagen: National Institute of Public Health; 2002 (http://www.si-folkesundhed.dk/upload/noiseprevention.pdf, acceso el 21 de noviembre de 2014) 5. Too Loud! For Too Long! Loud noises damage hearing. Atlanta, Georgia: Centres for Disease Control and Prevention; 2017 6. Levey S, Fligor BJ, Ginocchi C, Kagimbi L. The effects of noise-induced hearing loss on children and young adults. Contemp Issues Commun Sci Disord. 2012; 39:76−83 7. Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am. 2008; 123(1):133−44 8. Borg E, Risberg A, McAllister B, Undemar B, Edquist G, Reinholdson A et al. Language development in hearing-impaired children. Establishment of a reference material for a ‘Language test for hearing-impaired children’, LATHIC. Int J Pediatr Otorhinolaryngol. 2002; 65(1):15–26 9. Daniel E. Noise and hearing loss: a review. J Sch Health. 2007; 77(5):225−31 10. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 2018; 144, 115–126 11. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline among older adults. JAMA Internal Medicine. 2013; 173(4):10.1001/jamainternmed.2013.1868. doi:10.1001/ jamainternmed.2013.1868 12. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. Brussels: Scientific Committee on Emerging and Newly Identified Health Risks; 2008. p. 81 13. Brewster KK, Ciarleglio A, Brown PJ, et al. Age-related hearing loss and its association with depression in later life. Am J Geriatr Psychiatry. 13 de abril de 2018. pii: S1064-7481(18)30297-5 14. Institute of Medicine. Committee on Public Health Strategies to Improve Health. For the public's health: Revitalizing law and policy to meet new challenges. Washington, D.C.: NationalAcademies Press; 2011 15. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 14 de abril de 2010; (4):CD005992. doi:10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev.2016;2:CD005992. PubMed PMID: 20393945 16. Mello MM, Wood J, Burris S, Wagenaar AC, Ibrahim JK, Swanson JW. Critical opportunities for public health law: a call for action. Am J Public Health. 2013; Nov;103(11):1979-88 17. Aguilera SL, Moysés ST, Moysés SJ. Road safety measures and their effects on traffic injuries: a systematic review. Revista Panamericana de Salud Pública. Octubre de 2014; 36(4):257-65. Review. Portuguese. PubMed PMID: 25563151 18. Recomendación UIT-T H.870. Directrices para dispositivos/sistemas de escucha segura. 2018 (https://itu.int/rec/T-REC-H.870, acceso el 15 de enero de 2019) 19. Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC public health. 2014; 14, 539. doi:10.1186/1471-2458-14-539 20. Grandia J, Meehan J. Public procurement as a policy tool: using procurement to reach desired outcomes in society. International Journal of Public Sector Management. 2017; 30. 10.1108/IJPSM-03-2017-0066. 33 34 Библиография Arenas J, Suter A. Comparison of occupational noise legislation in the Americas: An overview and analysis. Noise and Health. 2014; 16(72), 306–319 Berglund B, Lindvall T, Schwela DH. Guidelines for community noise. Ginebra: Organización Mundial de la Salud; 1999. Consumidores: la UE quiere limitar los riesgos para la salud que supone la exposición al ruido emitido por los reproductores de música portátiles [Comunicado de prensa]. Bruselas; Comisión Europea: 19 de febrero de 2018 (http://europa.eu/rapid/press-release_IP-09-1364_en.htm, último acceso el 24 de agosto de 2018). Gurgel RK, Ward PD, Schwartz S, Norton MC, Foster NL, Tschanz JT. Relationship of hearing loss and dementia: a prospective, population-based study. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2014; 35(5):775–781 Joy G, Middendorf P. Noise exposure and hearing conservation in U.S. coal mines – a surveillance report. Journal of Occupational and Environmental Hygiene. 2007; 4(1), 26 Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics. 2010; 125(6):e1348−55 Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies,http://www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-continues- to-climb-in-emerging-economies/2016 Tikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S. Interventions to prevent occupational noise‐induced hearing loss. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD006396. DOI: 10.1002/14651858.CD006396.pub4 Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017; 390(10098):934 Приложения 36 Дополнение 1 Инструмент оценки ситуации Настоящий инструмент оценки ситуации разработан для содействия государственным ведомствам и министерствам в сборе соответствующей информации в целях профилактики небезопасного прослушивания, а также поощрения и регулирования в стране практики безопасного прослушивания в соответствии с Глобальным стандартом ВОЗ–МСЭ H.870 для безопасных устройств и систем прослушивания. Информацию для выполнения этой оценки можно получить из существующей литературы, прошедшей независимую экспертизу, статистических данных Всемирной организации здравоохранения (ВОЗ), национальной статистики и документов Министерства здравоохранения. ВОЗ оказывает техническую помощь в проведении оценки ситуации или использовании результатов оценки. [Название страны] Национальный профиль данных составлен Должность и квалификация Учреждение Адрес Эл. адрес Номера телефонов Данные респондента (можно сделать копию данной формы для каждого опрашиваемого) Фамилия Должность/звание Учреждение Эл. адрес Номера телефонов Факс Национальный координатор данных Фамилия лица, ответственного за проведение данной оценки ситуации 37 Сведения о населении Название зоны (штата, региона, провинции, округа) (при необходимости), в отношении которой проводится оценка ситуации Общая численность пользователей мобильных устройств в стране/ зоне Общая численность пользователей мобильных устройств в возрасте от 12 до 35 лет Общая численность пользователей смартфонов в стране/зоне Общая численность пользователей смартфонов в возрасте от 12 до 35 лет Распределение пользователей мобильных устройств по полу (%) Мужчины (%) Женщины (%) (%) Распределение пользователей мобильных устройств по сельским/городским районам (%) Сельские районы (%) Городские районы (%) Уровень грамотности пользователей мобильных устройств (в процентах от общей численности населения) Любой другой демографический фактор, который необходимо учитывать в связи с услугами, предоставляемыми с помощью мобильных устройств Зона Штат (необязательно) Регион (необязательно) Провинция (необязательно) Округ (необязательно) Раздел А. Общая информация о стране Использование мобильных устройств Языки, используемые пользователями мобильных устройств Общее количество персональных аудиоустройств, проданных в стране/регионе Количество проданных смартфонов Количество MP3-плееров Количество других связанных с ними устройств (персональных аудиоплееров) Процентная доля населения/территории, охваченной услугами интернета (%) Количество компаний, продающих персональные аудиоустройства в стране/зоне Названия брендов мобильных устройств, продаваемых в вашей стране [] Samsung [] Motorola [] Apple [] Alcatel [] Sony [] Nokia [] Huawei [] Google [] LG [] Другой (просьба указать) Названия ведущих компаний розничной торговли, которые продают мобильные устройства в стране/зоне Какова процентная доля лиц с инвалидизирующей потерей слуха, которая обусловлена воздействием шума и другими соответствующими причинами? В целом (%) В возрастной группе от 12 до 35 лет (%) В любой другой возрастной группе (согласно сообщениям в публикациях) (%) Названия Названия ведущих поставщиков услуг подвижной связи, действующих в стране/зоне Названия Потеря слуха Распространенность инвалидизирующей потери слуха В целом (%) В возрастной группе от 12 до 35 лет (%) В любой другой возрастной группе (согласно сообщениям в публикациях) (%) В случае отсутствия информации об инвалидизирующей потере слуха, укажите определение, используемое при оценке распространенности 38 39 Сведения о ведущем учреждении Координация Законодательство Другое (просьба указать) Мониторинг и оценка Имеется ли в вашей стране государственное учреждение или ведомство, ответственное за надзор и/или координацию деятельности/ планов по оказанию помощи лицам с нарушениями слуха (например, ведущее учреждение)? Какое место занимает это учреждение в структуре государственного управления? (просьба отметить один вариант) Это учреждение является отдельным министерством/ государственным ведомством или входит в состав какого-либо министерства/государственного ведомства (в соответствующих случаях просьба указать это министерство или ведомство) [] Отдельное учреждение [] Другое (просьба указать) [] Не знаю За какую из следующих функций отвечает ведущее учреждение? (отметьте все подходящие варианты) [] Да [] Нет [] Не знаю Выделено ли в государственном бюджете финансирование для выполнения ведущим учреждением перечисленных выше функций? [] Да (просьба назвать это учреждение) [] Нет (пропустите раздел B) [] Не знаю (пропустите раздел B) [] Координация межправительственных рабочих процессов на уровне центрального правительства [] Координация принятия решений в отношении оказания помощи лицам с нарушениями слуха в рамках центрального правительства [] Координация на различных уровнях правительства (например, на центральном, региональном, местном) [] Координация национальных инициатив в сфере средств массовой информации [] Создание и поддержка систем данных, используемых для мониторинга безопасных устройств прослушивания [] Сбор и распространение национальной статистики [] Периодический обзор законодательства, правил и стандартов с учетом передовой практики и вынесение рекомендаций по улучшению [] Разработка и/или пересмотр законодательства Раздел B. Руководство и управление 40 Раздел C. Стратегия и целевые показатели Национальный профиль стратегии Имеется ли в вашей стране национальная стратегия профилактики глухоты и потери слуха? Если да, предусматривает ли эта стратегия профилактику потери слуха вследствие воздействия шума в местах развлечений? Имеются ли нормативные положения, касающиеся функций безопасного прослушивания в личных аудиоустройствах? Если ответ на любой из вышеуказанных вопросов положительный, предусматривают ли какие-либо существующие стратегии регулирование громкости на личных аудиоустройствах, таких как мобильные телефоны, MP3-плееры, планшеты и т. д.? Существует ли программа повышения осведомленности о контроле шума в естественной среде и в местах развлечений? Если да, уделяется ли в программе повышения осведомленности особое внимание вопросам безопасного прослушивания? Имеются ли в наличии финансовые средства для осуществления части или всех существующих стратегий? Если национальная стратегия имеется, установлены ли в ней измеримые целевые показатели в отношении увеличения количества персональных музыкальных проигрывателей с функциями безопасного прослушивания? [] Да (просьба представить соответствующие документы-источники) [] Нет [] Не знаю [] Да (просьба представить соответствующие документы-источники) [] Нет [] Не знаю [] Да (просьба представить соответствующие документы-источники) [] Нет [] Не знаю [] Да (просьба представить соответствующие документы-источники) [] Нет [] Не знаю [] Да (просьба представить соответствующие документы-источники) [] Нет [] Не знаю [] Да (просьба представить подробную информацию/ документы-источники в приложении) [] Нет [] Не знаю [] Да [] Нет [] Не знаю Если да, просьба указать целевые показатели и сроки их достижения • Запланированное увеличение количества устройств • Период времени, к которому относятся целевые показатели по устройству (просьба указать начальный и конечный годы, к которым относятся эти целевые показатели, например (2002–2012 годы), (2016–2020 годы) [] Да, финансирование имеется в полном объеме [] Финансирование обеспечено частично [] Финансирование отсутствует [] Не знаю Включает ли национальная стратегия рекомендации в отношении каких-либо из следующих параметров Уменьшение уровня громкости Предоставление пользователям возможности контролировать уровень громкости звука [] Да [] Нет [] Не знаю [] Да [] Нет [] Не знаю [] Да [] Нет [] Не знаю [] Да [] Нет [] Не знаю [] Да [] Нет [] Не знаю Направление пользователю сообщения при достижении небезопасных уровней громкости Направление сообщения о методах безопасного прослушивания Поощрение использования беруш в шумных местах, например в барах, на спортивных мероприятиях и концертах 41 42 Укажите все потенциальные и существующие в вашей стране заинтересованные стороны, которые участвуют или могут быть привлечены к участию в оказании услуг помощи в связи с болезнями уха и нарушениями слуха. Определите, где это возможно, ведущего специалиста или ответственное лицо и предоставьте контактную информацию. Сведения о заинтересованных сторонах Государственные ведомства Перечислите в порядке предполагаемой приоритетности для сотрудничества в разработке и осуществлении стратегии безопасного прослушивания Название ведомства Уровень влияния (1–10) Уровень заинтересо ванности (1–10) Контактная информация Ведущий специалист/контактное лицо (фамилия и должность) Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта 1. 2. 3. 4. 5. Раздел D. Обзор заинтересованных сторон 43 Уровень влияния (1–10) Уровень заинтересо ванности (1–10) Контактная информация Ведущий специалист/контактное лицо (фамилия и должность) 1. 2. 3. 4. 5. Профессиональные и академические круги Перечислите в порядке наличия опыта и заинтересованности в разработке и осуществлении стратегии безопасного прослушивания Название учреждения или ассоциации Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта 44 Уровень влияния (1–10) Уровень заинтересо ванности (1–10) Контактная информация Ведущий специалист/контактное лицо (фамилия и должность) 1. 2. 3. 4. 5. Название учреждения или ассоциации Группы гражданского общества, в том числе организации лиц с ограниченными возможностями Перечислите в порядке предполагаемой приоритетности для сотрудничества в разработке и осуществлении стратегии безопасного прослушивания Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта 45 Уровень влияния (1–10) Уровень заинтересо ванности (1–10) Контактная информация Ведущий специалист/контактное лицо (фамилия и должность) 1. 2. 3. 4. 5. Название учреждения Учреждения ООН Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта 46 Уровень влияния (1–10) Уровень заинтересо ванности (1–10) Контактная информация Ведущий специалист/контактное лицо (фамилия и должность) 1. 2. 3. 4. 5. Отраслевые партнеры Перечислите в порядке предполагаемой приоритетности исходя из потребности заинтересованной стороны в сотрудничестве и ее возможной заинтересованности в разработке и осуществлении стратегии безопасного прослушивания Название компании Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта 47 Уровень влияния (1–10) Уровень заинтересо ванности (1–10) Контактная информация Ведущий специалист/контактное лицо (фамилия и должность) 1. 2. 3. 4. 5. Любые другие (могут включать любые другие группы, которые заинтересованы в профилактике потери слуха, контроле шума, аудиологии, акустике или защите прав потребителей) Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта Адрес Номер телефона Эл. почта 48 Дополнение 2 Общий план совещания заинтересованных сторон по планированию, посвященного нормативным положениям в области безопасного прослушивания На совещание следует пригласить следующие группы заинтересованных сторон: • соответствующие государственные ведомства, занимающиеся вопросами технологий, здравоохранения, образования, торговли и промышленности, окружающей среды, молодежи; • группы гражданского общества, в том числе ассоциации лиц, страдающих расстройствами слуха; НПО, профессиональные общества; • молодежные организации; • всех производителей; • ассоциации бытовой электроники; • крупные группы предприятий розничной торговли; • организации по защите прав потребителей; • представителей ВОЗ и МСЭ. Цель: • проинформировать заинтересованные стороны о глобальных стандартах и о намерении страны внедрить их; • получить поддержку соответствующих заинтересованных сторон в этом отношении; • обсудить дальнейшие шаги в направлении принятия стандартов и их внедрения; • согласовать сроки; • обсудить вопросы, связанные с адаптацией информационных материалов к конкретным условиям. Предлагается следующий план • Введение • Необходимость безопасного прослушивания • Текущее положение в стране с точки зрения нормативных положений в области безопасного прослушивания • Глобальные стандарты безопасного прослушивания • Заинтересованные стороны, мнения которых необходимо учесть при реализации стратегий и нормативных положений в области безопасного прослушивания: – органы государственного управления (занимающиеся вопросами технологий, здравоохранения, каких-либо других) – пользователи (один представитель, выражающий точку зрения пользователей) – отрасль (головная организация или ведущая компания, выступающая от имени отрасли) – специалисты в области оказания помощи лицам с нарушениями слуха (один представитель профессиональной организации, занимающейся проблемами слуха, выражающий мнение профессионального сообщества) – гражданское общество (один оратор из соответствующей группы гражданского общества, выражающий ее мнение) • Возможности в отношении принятия и внедрения Стандарта в стране (включая сроки): обсуждение • Необходимость повышения осведомленности населения и имеющиеся средства • Определение дальнейших шагов в следующих направлениях: – разработка нормативных положений/законодательного акта – подготовка кампании по повышению осведомленности населения и адаптация информационных материалов По оценкам ВОЗ, 1,1 миллиарда молодых людей во всем мире могут быть подвержены риску потери слуха из-за практики небезопасного прослушивания. Stevens G, Flaxman S, Burnsville E, Mascarenhas M, Mathers CD, Finucane M. Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries. Eur J Public Health 2013; 23: 146-52 (http://dx.doi.org/10.1093/eurpub/ckr176, acceso el 19 de enero de 2019). Все больше людей страдает потерей слуха! Основные идеи • Рост численности и старение населения мира • В настоящее время 466 миллионов человек в мире живут с инвалидизирующей потерей слуха • По оценкам, к 2030 году в мире будет насчитываться 630 миллионов человек с инвалидизирующей потерей слуха • По оценкам, к 2050 году число людей с инвалидизирующей потерей слуха превысит 900 миллионов человек Как мы слышим? Дополнение 3 Инициатива "Не подвергайте свой слух опасности". Вводная презентация 49 Здоровые волосковые клетки Поврежденные волосковые клетки Нервные волокна Улитка 466 млн. человек 630 900 млн. человек млн. человек Шум в местах развлечений, практика небезопасного прослушивания и воздействие потери слуха • Люди, которые на протяжении последних 20 лет подвергались воздействию громких звуков в общественных местах, более чем в три раза чаще рискуют потерять слух по сравнению с теми, кто не подвергался такому воздействию. • 50% людей, слушающих музыку на своих персональных аудиоустройствах, устанавливают уровень громкости, подвергающий их слух риску. • У 5–10% радиослушателей может развиться потеря слуха из-за их личных предпочтений в отношении уровня громкости и продолжительности прослушивания. • У пожилых людей с потерей слуха депрессия, изоляция, фрустрация, снижение когнитивных способностей и снижение личной безопасности встречаются в два раза чаще, чем у пожилых людей без потери слуха. Вызванная воздействием шума потеря слуха необратима Фотографии предоставлены (сверху вниз): Тибо Трилле, Кевином Гривом, Саймоном Матцингером, Adobe PhotoStock 50 Инициатива "Не подвергайте свой слух опасности" Глобальный стандарт ВОЗ–МСЭ H.870 для безопасных устройств и систем прослушивания Технология смартфонов может обеспечить платформу для принятия адресных индивидуальных мер по обеспечению безопасного прослушивания, не прерывая получение людьми удовольствия от прослушивания. Технические аспекты Акустическая дозиметрия • Отслеживание времени воздействия звука на пользователя • Оценка уровня звука • Оценка процентного отношения звукового воздействия к эталонному воздействию (допустимый уровень звукового давления) • Режим 1. Стандартный уровень (ВОЗ) для взрослых. В этом режиме эталонное воздействие составляет 1,6 Па2*ч за 7 дней (то есть SPL 80 дБА за 40 часов в неделю). • Режим 2. Стандартный уровень (ВОЗ) для чувствительных пользователей (например, детей). В этом режиме эталонное воздействие составляет 0,51 Па2*ч за 7 дней (то есть SPL 75 дБА за 40 часов в неделю). Профилактика Это означает создание среды, которая способствует применению практики безопасного прослушивания, в том числе посредством: • регулирования воздействия громких звуков в персональных аудиосистемах; • проведения кампаний по повышению осведомленности общественности в целях изменения поведения слушателей в возрасте от 12 до 35 лет; • разработки нормативно-правовой базы в области безопасного прослушивания в местах развлечений. 51 52 Ограничение громкости • Сообщение об ограничении громкости • Опция "Продолжить прослушивание" • Действие по умолчанию – уменьшить громкость до заранее установленного уровня • Возможность индивидуальной настройки Родительский контроль • В настройках устройства можно устанавливать максимальный уровень громкости звука на выходе и блокировать его изменение Коммуникационные аспекты Персональная информация об использовании • Привычки, связанные с прослушиванием, в том числе допустимый уровень звукового давления • Как использовать функции безопасного прослушивания Персональные рекомендации и сигнальные сообщения • Что надо делать для безопасного прослушивания • Индивидуальные рекомендации в зависимости от предпочитаемого пользователем режима прослушивания Общая информация • Безопасное прослушивание и его реализация на практике • Риски, связанные с небезопасным прослушиванием • Риск потери слуха вследствие воздействия громких звуков не из персональных аудиоустройств и аудиосистем, а из других источников Комплект материалов "Не подвергайте свой слух опасности" Практическое руководство по внедрению и контролю выполнения глобальных стандартов для безопасного прослушивания в местах развлечений, которые должны быть приняты всеми странами мира: • предназначено для оказания странам, отраслям и гражданскому обществу содействия в реализации стратегического, основанного на фактических данных и удобного для пользователей подхода к профилактике потери слуха, вызванной воздействием шума; • адресовано трем основным заинтересованным сторонам, которые могут сыграть важную роль в реализации стандартов; • правительствам – министерствам/ведомствам, осуществляющим деятельность в сфере здравоохранения или технологий; • отрасли – производителям персональных аудиоустройств и аудиосистем; • организациям гражданского общества – в сфере охраны слуха или защиты прав потребителей. Процедуры, этапы и инструменты предлагаются в качестве ориентира и могут быть скорректированы, изменены или адаптированы заинтересованными сторонами к потребностям конкретных стран и производителей. 53 Дополнение 4 План ознакомительного семинара-практикума, посвященного нормативным положениям в области безопасного прослушивания Для участия в семинаре-практикуме следует пригласить следующие группы • соответствующие государственные ведомства, занимающиеся вопросами технологий, здравоохранения, образования, торговли и промышленности, окружающей среды, молодежи; • всех производителей; • ассоциации бытовой электроники; • крупные группы предприятий розничной торговли. Цель Ознакомить производителей и компании розничной торговли с нормативными положениями, касающимися безопасных устройств прослушивания, и дать им руководящие указания в отношении их внедрения, сроков и отчетности. Предлагается следующий план • Введение • Обоснование стандартов безопасного прослушивания • Краткая характеристика национальных нормативных положений, касающихся стандартов, – основные и дополнительные компоненты • Сроки внедрения • Механизм контроля внедрения/представления отчетности о внедрении • Проблемы и вопросы, вызывающие обеспокоенность производителей • Информационно-разъяснительные материалы, которые могут использоваться производителями для распространения, а также размещения в социальных сетях и на веб сайтах 54 Дополнение 5 Информационно-пропагандистские материалы Цель Эти информационно-разъяснительные материалы предназначены для информирования людей о риске потери слуха из-за небезопасного прослушивания, о концепции безопасного прослушивания, а также об имеющихся средствах для пропаганды практики такого прослушивания. Для кого предназначены эти материалы? Эти основанные на фактических данных информационно-пропагандистские материалы призваны обеспечить основным заинтересованным сторонам (правительству, отрасли и организациям гражданского общества) инструменты для повышения осведомленности политиков и общественности о безопасном прослушивании. Цели в области коммуникации • Повышение осведомленности общественности и привлечение ее внимания к важности соблюдения принципов безопасного прослушивания. • Проведение обсуждения по вопросу о риске потери слуха вследствие воздействия громких звуков из таких источников, как персональные аудиосистемы и мобильные устройства. • Повышение осведомленности общественности о рисках небезопасного прослушивания для подростков и молодых людей. • Обеспечение понимания важности участия многих секторов и их совместных действий по реализации Глобального стандарта ВОЗ–МСЭ H.870 для безопасных устройств и систем прослушивания. • Распространение примеров эффективного взаимодействия многих секторов, результатом которого являются успешные меры, направленные на решение проблемы воздействия громких звуков в местах развлечений. Основные идеи • Вызванная воздействием шума потеря слуха необратима! • Профилактика является одной из наиболее эффективных стратегий снижения распространенности потери слуха, вызванной воздействием шума. • Поддержание безопасного уровня громкости и ограничение времени участия в шумных мероприятиях может привести к уменьшению риска потери слуха. • Технологии смартфонов могут использоваться в качестве средства пропаганды безопасного прослушивания и его реализации на практике. • Разработка и выполнение специальных законодательных актов могут способствовать снижению уровня воздействия звука. Информационно-пропагандистские материалы Ресурсы ВОЗ по пропаганде безопасного прослушивания размещены по адресу: www.who.int/deafness/make-listening-safe/advocacy-materials/en/ z 55 Инфографика Распространение информации и материалов в социальных сетях Наши каналы социальных сетей • Следите за нами в Twitter, Facebook и Instagram @WHO и отмечайте нас в своих постах Официальный хештег в Twitter • #SafeListening Официальный хештег в Twitter • #WHO • #HearingCare • #HearTheFuture • #WorldHearingDay 56 Плакаты 57 Брошюра Советы по безопасному прослушиванию 58 Пресс-релиз Соответствующий документ 59 Видеоматериалы Посты в Facebook Посты в Instagram 60 Посты в Twitter 61 Часто задаваемые вопросы 1. Введение 2. Как измеряется громкость? Что такое децибел (дБ)? 3. Что такое безопасное прослушивание? 4. Каким образом громкие звуки воздействуют на мои уши? 5. Как я могу узнать, пострадал ли мой слух? 6. Если я потеряю слух, можно ли его восстановить? 7. Можно ли использовать мобильный телефон для контроля уровня прослушивания? 8. Как я могу отслеживать воздействие звука или суточный допустимый уровень звукового давления в отношении музыки, которая не хранится на моем устройстве? 9. Что я могу сделать для того, чтобы прослушивание было безопасным? 10. Что я могу сделать как родитель, чтобы обеспечить безопасное прослушивание? 11. Что я могу сделать как учитель, чтобы обеспечить безопасное прослушивание? 12. Что я могу сделать как врач, чтобы обеспечить безопасное прослушивание? 13. Что я могу сделать как управляющий развлекательным заведением, чтобы обеспечить безопасное прослушивание? 14. Что я могу сделать как производитель персональных аудиоустройств, чтобы обеспечить безопасное прослушивание? 15. Что могут сделать органы государственной власти, чтобы обеспечить безопасное прослушивание? Соответствующие веб-сайты • Всемирная организация здравоохранения (ВОЗ) http://www.who.int/deafness/make-listening-safe/en/ • Центры по контролю и профилактике заболеваний https://www.cdc.gov/hearingloss/default.html • Организация "Action on Hearing Loss" https://www.actiononhearingloss.org.uk/ • Европейский союз глухих https://www.eud.eu/ • Фонд "Услышать мир" ("Hear The World") https://www.hear-the-world.com/en • Кампания "Listen To Your Buds" Американской ассоциации специалистов в области речи и слуха https://www.asha.org/buds/ • Кампания "Dangerous Decibels" http://dangerousdecibels.org/ Интерес СМИ Если вы журналист и хотите освещать вопросы, связанные с инициативой "Не подвергайте свой слух опасности", напишите нам по адресу whopbd@who.int. 62 2 Полный текст Рекомендации МСЭ-Т H.870 "Руководящие принципы реализации безопасных устройств/систем прослушивания" размещен по адресу https://www.itu.int/rec/T- REC-H.870-201808-I/en. Дополнение 6 Резюме Глобального стандарта ВОЗ–МСЭ H.870 для безопасных устройств и систем прослушивания Под безопасным прослушиванием понимается такое поведение слушателя, которое не подвергает его слух риску. Риск потери слуха зависит от уровня (громкости), продолжительности (временнóго периода) и частоты воздействия громких звуков. Люди могут подвергаться такому воздействию, используя персональные аудиоустройства, находясь в развлекательных заведениях или за пределами помещений (например, в транспорте), на рабочем месте или дома. В стандарте ВОЗ–МСЭ H.870 описаны требования к персональным и портативным аудиосистемам, особенно к тем, которые используются для воспроизведения музыки. Эти требования предназначены для защиты людей от развития потери слуха вследствие использования таких систем. В стандарте содержится глоссарий общих терминов для облегчения понимания, а также справочная информация о звуке, слухе и потере слуха. Для предотвращения небезопасного прослушивания в стандарте в качестве рекомендаций приводятся два критерия – один для взрослых и другой для детей, при этом оба критерия основаны на принципе равной энергии. Важным моментом является то, что в стандарте содержатся руководящие указания в отношении медико-санитарного просвещения по вопросам безопасного прослушивания, с тем чтобы при необходимости было возможно передавать соответствующие предупреждающие сообщения. Примеры таких сообщений содержатся в Дополнении VII к стандарту. Наконец, в стандарте также содержится информация о применении дозиметрии и связанных с этим вопросах. Основные аспекты стандарта ВОЗ–МСЭ H.870 для безопасных устройств/систем прослушивания кратко представлены ниже2. 63 1. Сфера применения стандарта В настоящем документе описаны требования к персональным/портативным аудиосистемам, особенно к тем, которые используются для воспроизведения музыки. Эти требования предназначены для уменьшения риска потери слуха, которому подвергаются пользователи таких устройств. В таких устройствах "источник" может храниться в памяти или загружаться через удаленный доступ, например, с помощью потоковой передачи с локального сервера или из интернета (см. рисунок 6.1). Персональная аудиосистема предназначена для бытового использования и • рассчитана на то, чтобы пользователь мог прослушивать аудио- или аудиовизуальный контент/материалы; а также • предусматривает использование устройства для прослушивания, такого как головные наушники или наушники-вкладыши, которые могут вставляться в уши, надеваться на уши или обхватывать их; а также • предусматривает наличие проигрывателя, который можно носить на теле (то есть такого размера, чтобы его можно было положить в карман одежды) и который предназначен для того, чтобы пользователь мог передвигаться, не прерывая прослушивания (например, на улице, в метро, в аэропорту и т. д.). Примерами являются портативные проигрыватели компакт-дисков, MP3-аудиоплееры, мобильные телефоны с функциями MP3, КПК и аналогичные устройства. Настоящий стандарт не распространяется на следующие типы устройств: • устройства связи (портативные радиостанции и т. д.); • реабилитационные и медицинские устройства (например, слуховые аппараты, FM-системы и другие вспомогательные слуховые устройства (ALD), одобренные в качестве компонентов слуховых аппаратов и систем кохлеарной имплантации, и т. д.); • персональные устройства усиления звука; • профессиональное аудиооборудование и аудиоустройства; • портативные игровые приставки. Персональное аудиоустройство Персональная аудиосистема Устройство прослушиванияЭффект Контроль громкостиИсточник ЦАП Преобразователь Рисунок 6.1. Архитектура персональной аудиосистемы Эффект 64 2. Принцип равной энергии Рекомендации, содержащиеся в настоящем стандарте, основаны на принципе равной энергии. Он заключается в допущении, что суммарное воздействие звука на ухо и слух пропорционально суммарному количеству звуковой энергии, воспринимаемой ухом, независимо от распределения этой энергии во времени. Согласно этому принципу равные количества звуковой энергии, как ожидается, должны приводить к равной величине вызванного звуком постоянного смещения слухового порога, независимо от распределения энергии во времени. На практике это означает, что прослушивание при более низком уровне громкости в течение длительного периода времени может оказать такое же воздействие, что и прослушивание при очень высокой громкости в течение короткого периода времени. Например, воздействие звука на уровне 100 дБ в течение 16 минут будет иметь тот же эффект, что и воздействие звука на уровне 80 дБ в течение 40 часов. В соответствии с этим принципом "доза" звуковой энергии определяется как квадрат А-взвешенного звукового давления , интегрированного по времени воздействия. В математическом виде это можно представить следующей формулой: где pA – А-взвешенное значение звукового давления с поправкой на диффузное звуковое поле. Единицей измерения этого параметра является Па2*ч. 3. Эталонное воздействие/допустимый уровень звукового давления, режимы воздействия Рекомендуется, чтобы каждое устройство имело систему, которая отслеживает время воздействия на пользователя и уровень громкости звука и оценивает процентное отношение звукового воздействия к эталонному воздействию (также называемое допустимым уровнем звукового давления). При этом должны учитываться все медиафайлы, воспроизводимые на устройстве (как те, которые хранятся в памяти устройства, так и те, которые проигрываются в потоковом режиме) в те периоды времени, когда пользователь использует головные наушники или наушники-вкладыши. Голосовые звонки могут не учитываться, так как они регулируются отдельно другими стандартами. Также рекомендуется, чтобы устройство позволяло пользователю выбирать один из двух режимов эталонного воздействия. Режим 1. Стандартный уровень (ВОЗ) для взрослых. В этом режиме эталонное воздействие составляет 1,6 Па2*ч за 7 дней (то есть 80 дБА за 40 часов в неделю). Режим 2. Стандартный уровень (ВОЗ) для чувствительных пользователей (например, детей). В этом режиме эталонное воздействие составляет 0,51 Па2*ч за 7 дней (то есть SPL 75 дБА за 40 часов в неделю). Пользователю должна быть предоставлена возможность выбора одного из двух режимов при первом использовании проигрывателя (или когда устройство сбрасывается на заводские настройки). В дальнейшем пользователь должен иметь возможность в любое время изменить выбор режима, например, в меню настроек устройства. dose = (pA (t))2dt t2 t1 ʃ 65 Допустимый уровень звукового давления Обозначает оценку дозы звукового воздействия в течение определенного учетного периода времени (например, за сутки или за неделю), которая обычно выражается в процентах от эталонного воздействия. Недельный допустимый уровень звукового давления, равный 100%, эквивалентен недельному эталонному воздействию для соответствующего выбранного режима. Примеры продолжительности еженедельного времени прослушивания на основе допустимых значений уровня звукового давления для вышеописанных режимов приведены в таблице 1 и таблице 2. Таблица 1. Пример продолжительности еженедельного времени прослушивания для режима 1 Таблица 2. Пример продолжительности еженедельного времени прослушивания для режима 2 дБ(A) SPL 107 104 101 98 95 92 89 86 83 80 24 минуты 12 минуты 6 минуты 3 минуты 1,5 минуты 48 минуты 6 часов 24 минуты 3 час 15 минуты 1 час 36 минуты 12 часов 30 минуты 77 25 часов 75 40 часов дБ(A) SPL В неделю (1,6 Па2ч) 107 4,5 минуты 104 9,5 минуты 101 18,75 минуты 98 37,5 минуты 95 75 минуты 92 2,5 часа 89 5 часа 86 10 часа 83 20 часа 80 40 часа В неделю (0,51 Па2ч) 66 4. Методы измерения/акустическая дозиметрия В стандарте H.870 доза определяется в контексте акустической дозиметрии. В режиме 1 100% недельного допустимого уровня звукового давления составляют 1,6 Па2ч, что соответствует 100% расчетной дозы звукового давления (calculated sound dose – CSD) в соответствии с определением, данным в [EN 50332-3]. Для режима 2 суммарная величина недельного допустимого уровня звукового давления, или эталонное воздействие, составляет 0,51 Па2ч. Стандарт H.870 также содержит ссылки на другие соответствующие стандарты, в которых описывается система измерения дозы в портативных музыкальных проигрывателях (ПМП). В стандарте [IEC 61252] содержится описание акустических дозиметров, которые можно носить на теле, включая указанные в [EN 50332-1], [EN 50332-2] и [EN 50332-3]. В Дополнении II к стандарту H.870 приведен пример дозиметра в персональной аудиосистеме, используемого при измерении цифрового мультимедийного сигнала с учетом известных или предполагаемых параметров наушников. В этом примере оценка риска потери слуха базируется на принципе равной энергии, в соответствии с которым доза звука равна квадрату А взвешенного звукового давления, интегрированному по времени воздействия. Функциональность дозиметра проверяется путем воспроизведения программно моделируемого звука в соответствии с [EN 50332-1] и [IEC 60268-1] и отсчета времени до тех пор, пока оцениваемая доза не достигнет 100% расчетной дозы звукового давления с использованием интерполяции и допусков, описанных в [EN 50332-3]. Такая проверка может быть акустической (при использовании определенной гарнитуры) или электрической с использованием резистивной нагрузки 32 Ом (когда характеристики гарнитуры неизвестны). См. информацию о параметрах измерений в документе [ITU T P.381]. Факторы неопределенности: при оценке дозы звукового давления действует целый ряд факторов неопределенности, и погрешность может быть очень высокой. В связи с этим предлагается воздерживаться от подачи пользователю сигналов "безопасный" или "зеленый" на основании значений дозы звукового давления ниже определенного уровня. Тем не менее оценка дозы важна для учета общих тенденций, а именно: • более высокий уровень сигнала означает более высокий риск; • более длительное воздействие означает более высокий риск; • учитывается спектральный состав музыки. 67 3 Обозначает аппаратные компоненты (такие как экран), которые позволяют человеку взаимодействовать с электронным устройством. 5. Информирование по вопросам здоровья Одна из важнейших целей стандарта заключается в том, чтобы предоставить пользователям инструмент, позволяющий им контролировать воздействие звука, которому они подвергаются. Такой инструмент должен обеспечивать пользователям возможность выбрать безопасное прослушивание и сделать такой выбор осознанно благодаря более высокой осведомленности. В настоящем разделе резюме стандарта кратко излагаются его аспекты, касающиеся информирования по вопросам здоровья, которые должны учитываться для обеспечения полной реализации стандартов для безопасных устройств прослушивания. В частности в нем содержатся основанные на фактических данных рекомендации о том, как информировать о рисках небезопасного прослушивания и как способствовать выработке у пользователей надлежащих моделей поведения в этом отношении. Цель включения информирования по вопросам здоровья в стандарты безопасного прослушивания с помощью персональных аудиосистем Цель заключается в том, чтобы предоставить пользователям информацию и рекомендации, которые позволят им делать выбор в пользу безопасного прослушивания. В числе прочего пользователям предоставляется: • персональная информация об использовании, для того чтобы пользователь был осведомлен: – о своих собственных привычках, связанных с прослушиванием (использование суточного и недельного допустимого уровня звукового давления); – о способах использования функций безопасного прослушивания; • персональные рекомендации и сигналы, сообщающие о том, что надо делать для безопасного прослушивания, в зависимости от предпочитаемого пользователем режима прослушивания; • общая информация по следующим вопросам: – безопасное прослушивание и как его применять на практике; – риски, связанные с небезопасным прослушиванием; – риск потери слуха вследствие воздействия громких звуков не из персональной аудиосистемы, а из других источников. Для снижения риска потери слуха эта информация и рекомендации должны предоставляться пользователям по умолчанию с помощью их мобильных устройств. Основные рекомендации в отношении информирования как компонента безопасного устройства прослушивания Информация и сообщения, касающиеся безопасного прослушивания, должны предоставляться посредством: • интерфейса устройства3 (при наличии соответствующего визуального интерфейса); • инструкций по эксплуатации; • по возможности информация об имеющихся у устройства функциях безопасного прослушивания должна находиться внутри упаковки или размещаться на упаковке. 68 6.1 Информирование по вопросам здоровья Персональная информация об использовании Пользователям должна быть доступна информация, касающаяся различных параметров прослушивания, которыми определяются связанные с прослушиванием привычки пользователя. Такая информация позволяет пользователям отслеживать воздействие звука, которому они подвергаются при использовании устройства. В случае если у устройства есть экран, это может быть обеспечено с помощью значка на экране. Посредством этого значка пользователь должен в легкой для восприятия форме получить информацию о том, каким образом он использует суточный/недельный допустимый уровень звукового давления. В частности, пользователь должен иметь возможность отследить, в какой мере он использовал недельный допустимый уровень, и понять, изменились ли его привычки, связанные с прослушиванием, за последние семь дней. В устройствах без экрана информация должна предоставляться альтернативными средствами, например звуковыми сигналами. Устройство (при наличии такой возможности) должно отображать следующие виды информации: • средний уровень звукового давления за день и за неделю; • продолжительность времени в часах и минутах, в течение которого пользователь занимался прослушиванием, за день и за неделю. На рисунке 6.2 представлены не являющиеся обязательными примеры информации о безопасном прослушивании, отображаемой на визуальном интерфейсе смартфона Рисунок 6.2. Примеры информации о безопасном прослушивании, отображаемой на визуальном интерфейсе смартфона Сегодняшний допустимый уровень звукового давления Звуковая дорожка №5 Описание 51,6% Оставшееся время: 1 ч 14 мин 17 сек Время прослушивания сегодня: 37 мин Средний уровень (Leq), дБ: 93,3 дБ 90 80 70 60 50 40 30 20 10 0 52% 52% Звуковая дорожка №5 Описание 119,5% Оставшееся время: 00 ч 00 мин 00 сек Время прослушивания сегодня: 1,8 ч Средний уровень (Leq), дБ: 93,5 дБ 90 80 70 60 50 40 30 20 10 0 120% 120% Сегодняшний допустимый уровень звукового давления Сегодняшний допустимый уровень звукового давления Сегодняшний допустимый уровень звукового давления 69 Персональные рекомендации и сигналы, сообщающие о том, что надо делать a. Когда пользователь превышает 100% недельного допустимого уровня звукового давления, устройство должно выдавать соответствующие предупреждения и сигналы, сообщающие о том, что надо делать. • Пользователь сначала получает "предупреждение" в текстовом и визуальном виде, информирующее о том, что достигнуто пороговое значение и с этого момента дальнейшее прослушивание на той же громкости будет представлять риск для слуха. • За предупреждением последует "сигнал, сообщающий о том, что надо делать", который означает, что пользователю предоставлен выбор – рискнуть продолжить прослушивание или защитить свой слух. "Сигнал, сообщающий о том, что надо делать", должен соотноситься с активными опциями, имеющимися в устройстве, такими как: – опция автоматической настройки безопасной громкости, посредством которой устройство автоматически изменяет громкость, устанавливая его безопасный уровень; – прямой доступ к настройкам громкости; – установка стандартного уровня громкости по умолчанию; – опция "напомнить позже"; – опция "игнорировать и продолжить". • Если пользователь не предпринимает никаких действий, громкость автоматически уменьшается до уровня ниже стандартного уровня громкости (80 или 75 дБА в зависимости от того, что было выбрано). b. Устройство должно выдавать соответствующие сообщения, когда допустимый уровень звукового давления достигает некоторого заранее заданного значения. Предлагаемые значения уровня громкости, при которых могут выдаваться предупреждения/сигналы, содержатся в Дополнении 8, где также приведены примеры таких сообщений. То, какие предупреждения будут выдаваться, зависит от возможностей устройства, при этом предупреждающие сообщения должны быть мультимодальными, то есть совмещать в себе, например, визуальные, вибрационные и звуковые предупреждения, с тем чтобы гарантировать привлечение внимания пользователей. На рисунке 6.3 приводятся не являющиеся обязательными примеры сообщений, отображаемых на дисплее умных часов. Рисунок 6.3. Пример сообщения, отображаемого на дисплее умных часов 50% суточной нормы: ты израсходовал 50% своего уровня безопасного прослушивания в день. Убавь громкость, чтобы слушать дольше. БЕЗОПАСНОЕ ПРОСЛУШИВАНИЕ Ого! Твоя последняя доза звука составила 60%. Отлично! Продолжай слушать в безопасном режиме. БЕЗОПАСНОЕ ПРОСЛУШИВАНИЕ Ежедневные сообщения. Устройство должно выдавать ежедневные сводные сообщения на основе предпочтений пользователя при прослушивании в последние дни, поощряющие безопасное прослушивание и не рекомендующие или предупреждающие об опасности небезопасного прослушивания. Примеры таких сообщений приводятся в Дополнении 8. Общая информация. В случае если устройство имеет экран, на экране должна отображаться информация о безопасном прослушивании и его преимуществах, а также о рисках, связанных с небезопасным прослушиванием. Рекомендуется, чтобы доступ к этой информации был отображен в пользовательском интерфейсе (на главном экране) с помощью отдельного узнаваемого значка. На рисунке 6.4 приведен не являющийся обязательным пример значка безопасного прослушивания, отображаемого на экране смартфона. Рисунок 6.5. Примеры экранов со ссылками на информацию о безопасном прослушивании и внешними ссылками Рисунок 6.4. Значок безопасного прослушивания, отображаемый на экране смартфона Также должна иметься инструкция, информирующая пользователей о безопасном прослушивании, о рисках небезопасного прослушивания, а также о функциях безопасного прослушивания, имеющихся в устройстве, а также о том, как их использовать. Кроме того, на экране должны отображаться ссылки на соответствующие веб-страницы, где пользователь может найти дополнительную информацию. На рисунке 6.5 приводятся не являющиеся обязательными примеры экранов, содержащих ссылки на источники информации о безопасном прослушивании, а также внешние ссылки. 70 Как громкая музыка влияет на мои уши? Что такое безопасное прослушивание? Как я могу сделать прослушивание на моем устройстве безопасным? Нет, спасибо. Воспроизвести мою музыку. Безопасное прослушивание Каковы первые признаки нарушения слуха? Что значит потерять слух? На начальном этапе нарушение слуха может быть незаметным. Сперва вы можете начать хуже слышать только высокочастотные звуки, такие как звон колокольчика, или ощущать постоянный шум в ушах. Узнайте здесь. Центры по контролю и профилактике заболеваний Услышать слово Информация Что такое безопасное прослушивание? Хорошо, спасибо. Воспроизвести мою музыку. 71 6.2 Информация, получаемая из других источников, помимо самого устройства Руководство для пользователя В руководстве для пользователя должно быть четко указано, что небезопасное прослушивание с использованием устройства создает риск не подлежащей восстановлению потери слуха. В нем также должны быть подробно описаны функции ограничения громкости и сигналы, сообщающие о том, что надо делать. В руководстве для пользователя также должно быть четко изложено, как работает система оценки допустимого уровня, и обращено внимание на ее неопределенный характер. Должно быть указано, что информация об устройстве не учитывает дополнительные источники звукового воздействия, такие как другие аудиоустройства или окружающая среда. В руководстве также может быть представлена информация о средствах защиты слуха от громких звуков окружающей среды в целях сведения к минимуму риска потери слуха. Упаковка По возможности на внешней упаковке устройства должно быть размещено четкое и краткое сообщение или предупреждение. Рекомендуется, чтобы такое предупреждение/сообщение: • было кратким, простым и понятным; • сопровождалось соответствующей иллюстрацией; • было расположен на однотонном фоне. Веб-сайт и реклама Информация о безопасном прослушивании должна быть размещена на веб-сайте производителя. Такая информация должна соответствовать спецификациям, предусмотренным в стандарте H.870. Веб-сайт производителя также может содержать ссылку на веб-сайт ВОЗ и другие соответствующие авторитетные веб-сайты. Во всех случаях, когда это возможно, реклама продукции также должна содержать соответствующую информацию. Такая информация может касаться как потенциального ущерба для слуха вследствие неправильного использования устройства, так и преимуществ безопасного прослушивания, которое способствует и сохранению здорового слуха и получению удовольствия от прослушивания. 7. Контроль громкости Ограничение громкости. В соответствии со стандартом H.870 пользователю устройства должно быть предоставлено подходящее средство ограничения громкости. Под этим понимается функция, с помощью которой до достижения 100% недельного допустимого уровня, или по его достижении пользователь получает соответствующее сообщение, при этом ему предлагается вариант "продолжить прослушивание", в случае если он не желает уменьшить громкость звука. В случае если сообщение не получает подтверждения, действием по умолчанию будет уменьшение громкости на выходе до заранее заданного уровня. По возможности пользователям должна быть предоставлена опция индивидуальной настройки этого уровня (то есть установки уровня желательного ограничения громкости) в соответствии с их предпочтениями. Родительский контроль. Рекомендуется, чтобы в устройстве была предусмотрена функция, позволяющая фиксировать максимальный уровень громкости звука на выходе и блокировать его настройку, возможно, с помощью пароля. Цель этой функции заключается в том, чтобы родители (или другие взрослые) могли ограничивать максимальную громкость звука на выходе устройства, которым пользуется ребенок, таким образом, чтобы ребенок не мог ее изменить. Некоторые пользователи также могут использовать эту функцию для того, чтобы самим ограничивать воздействие звука, установив максимальный уровень громкости звука на выходе своего устройства. 72 73 Упаковка Интерфейс устройства Первое использование Персональное использование Уведомления Ежедневные оповещения • При наличии такой возможности на внешней упаковке устройства должно быть помещено четкое и краткое сообщение/предупреждение. • Сообщения должны быть размещены на однотонном фоне, быть краткими, простыми и понятными и сопровождаться соответствующей иллюстрацией. • В руководстве должно быть четко указано, что небезопасное прослушивание с помощью устройства может создавать риск не подлежащей восстановлению потери слуха. • Должно быть указано, что устройство оснащено функциями безопасности, которые помогают пользователям защитить слух. • Это сообщение должно соответствовать информации, передаваемой через интерфейс устройства. Оно должно содержать аналогичный текст о рисках потери слуха вследствие небезопасного прослушивания и рекомендации по безопасному прослушиванию. • В нем также должны быть подробно описаны функции безопасного прослушивания, имеющиеся в устройстве. • Хорошо заметный значок на экране устройства предоставляет пользователю доступ к общей информации о безопасном прослушивании. • С помощью этого же значка пользователь также может попасть на страницу (в устройствах с экранами), содержащую информацию о его собственных параметрах прослушивания и (ежедневную и еженедельную) статистику использования. • При первом использовании головных наушников/наушников-вкладышей вместе с данным устройством пользователь должен быть направлен к инструкции, содержащей информацию о безопасном прослушивании, о том, как его применять на практике, а также о его личных предпочтениях при прослушивании (ту же информацию, доступ к которой можно получить с помощью значка). • Пользователь должен быть ознакомлен с описанием стандартных уровней громкости для взрослых и детей, и ему должна быть предоставлена возможность выбрать уровень. • Пользователю также будет предоставлена возможность установить, как часто и при каком уровне использования он хотел бы получать уведомления. • Пользователь должен в любой момент времени с помощью вышеупомянутого специального значка иметь доступ к информации об использовании суточного/недельного допустимого уровня звукового давления. • При расчете должны учитываться все звуки, воспроизводимые с помощью музыкальных проигрывателей или в режиме онлайн при использовании головных наушников/внутриканальных наушников-вкладышей. • Отображаемая информация должна включать: использованную и оставшуюся части недельного допустимого уровня звукового давления; продолжительность прослушивания (в сутки/в неделю), а также по возможности сведения о том, каким было прослушивание пользователя в течение последних 7 дней, включая текущий день. • Предупреждения и сигналы, сообщающие о том, что надо делать, должны поступать всякий раз, когда пользователь достигает 100% допустимого уровня звукового давления, а также в соответствии с настройками, заданными пользователем. • Эти предупреждения и сигналы должны иметь визуальную форму (если это возможно) и сопровождаться звуковым сигналом/вибрацией, чтобы гарантировать привлечение внимания пользователя. • Уведомления должны содержать информацию об уровне использования звука и соответствующие рекомендации по безопасному прослушиванию. • Когда пользователь в первый раз за день подключает головные наушники/наушники-вкладыши или в первый раз за день начинает воспроизводить музыку, устройство может выдавать то или иное приветствие, которое зависит от уровня использования в предыдущие дни/на предыдущей неделе. Руководство для пользователя Дополнение 7 Рисунок 7.1. Информационный поток как часть стандарта для безопасных устройств прослушивания Пример информационного потока В данном разделе и на приведенном ниже рисунке представлены шаги, иллюстрирующие, каким образом коммуникационные аспекты стандарта могут быть реализованы в устройствах. Пример того, как информация о параметрах прослушивания может быть представлена пользователю С помощью четко распознаваемого значка пользователи должны получать доступ к "специальному месту" (экрану) в устройстве, где хранится, отображается и интерпретируется информация о привычках пользователя, касающихся прослушивания. На этом экране пользователь должен иметь возможность ознакомиться с графическим представлением своих привычек или предпочтений, касающихся прослушивания в целом, и узнать, имело ли место небезопасное прослушивание (и какого вида). Визуальное отображение привычек пользователя, касающихся прослушивания, должно включать: • графическое представление использования недельного допустимого уровня звукового давления; • графическое представление суточного воздействия звука, маркированное разными цветами; • продолжительность прослушивания в течение каждого дня и за последние 7 дней в часах и минутах. 1. Информация об использовании недельного допустимого уровня звукового давления Использование недельного допустимого уровня звукового давления может быть отображено графически так, как показано на рисунке 7.2. Рисунок 7.2. Пример графического отображения использования недельного допустимого уровня звукового давления 2. Информация об использовании пользователем допустимого уровня звукового давления за любой день Для отображения такой информации максимальный суточный уровень звукового давления рассчитывается путем деления значения недельного уровня на 7 (приблизительно 15% от недельного допустимого уровня звукового давления). Использование за последние 7 дней (включая текущий день) отображается с помощью нескольких цветов, соответствующих разным уровням использования, например красный цвет обозначает использование более чем на 100%, а зеленый – использование менее чем на 50%. При отображении этой информации каждый день рассматривается как отдельная единица, и в цветовом кодировании каждого данного дня не учитываются данные за предыдущие дни. Таким образом каждый день будет начинаться с зеленого значка, независимо от уровня использования в предшествующие дни. Использовано Осталось 60% 40% Время прослушивания (за последние 7 дней) 4 часа 20 минут 74 75 3. Продолжительность времени прослушивания Также должна отображаться информация об общем времени, которое пользователь потратил на прослушивание аудиоконтента через устройство в каждый из дней (как показано на рисунке 7.3). Рисунок 7.3. Информация об общей продолжительности времени, которое пользователь потратил на прослушивание аудиоконтента в каждый из дней 4. Предупреждения и сигналы, сообщающие о том, что надо делать Предупреждения, сопровождаемые сигналом к действию, должны регулярно поступать к пользователю в следующих случаях: • при достижении 80% и 100% недельного допустимого уровня звукового давления; • по достижении 100% недельного допустимого уровня звукового давления устройство должно автоматически уменьшить громкость до заранее установленного уровня, если только пользователь не захочет продолжить прослушивание на большой громкости, несмотря на риски, о которых он проинформирован; • каждое предупреждение должно сопровождаться сигналом к действию, который побудит слушателя уменьшить громкость или прекратить прослушивание; • каждый день пользователь должен получать уведомление с информацией о том, каким было его прослушивание в предшествующий день, и предложением о действиях на сегодня. Это сообщение может быть носить поощрительный или предостерегающий характер. Примеры таких сообщений и сигналов к действию содержатся в Дополнении 8. Дата-6 Дата-5 Дата-4 Дата-3 Дата-2 Дата-1 Дата (сегодня) Время 1 ч 5 мин 1 ч 20 мин 2 ч 1 мин 1 ч 50 мин 2 ч 5 мин 3 ч 2 мин 2 ч 50 мин Безопасно Небезопасно 76 Дополнение 8 Основные факторы, которые необходимо учитывать при составлении сообщений, и примеры Ниже приводится ряд основанных на фактических данных факторов, которые необходимо учитывать производителям, составляющим сообщения для отображения на устройствах в составе функций безопасного прослушивания. Производителям следует по мере возможности стремиться составлять такие сообщения, которые соответствуют культурному и языковому контексту страны. • Цель таких сообщений заключается в том, чтобы привлечь внимание, вызвать интерес и побудить пользователей применять практику безопасного прослушивания. • Такие сообщения должны содержать информацию о тех действиях, которые можно выполнить, предлагать осуществимые альтернативные модели поведения и способствовать выработке навыков безопасного прослушивания. При составлении таких сообщений/сигналов следует учитывать следующие моменты • Они должны содержать четкую информацию о преимуществах безопасного прослушивания и рисках, связанных с небезопасным прослушиванием. • Для каждого сообщения следует предусмотреть 3–4 варианта, которые могут передавать одну и ту же информацию различными способами и которые адресованы широкой аудитории. • Текст должен быть простым, понятным и не содержать жаргонизмов, с тем чтобы его могли понять большинство пользователей. • Некоторые сообщения должны содержать формулировки в позитивном ключе, а другие – в негативном. • Для простоты понимания письменная информация должна дополняться графической информацией. • Сообщения должны основываться на рекомендациях из надежного источника. • По возможности перед использованием сообщения должны быть предварительно протестированы производителем. Ниже приводятся некоторые примеры предупреждений и сигналов к действию, касающихся функций безопасного прослушивания. Примеры предупреждений и сигналов к действию в зависимости от недельного уровня использования Информация, которая отображается, когда пользователь достигает: a. 80% недельного допустимого уровня звукового давления – доброжелательное предупреждающее сообщение. Вы уже использовали 80% своего допустимого уровня. Уменьшить громкость для защиты слуха. Уменьшить громкость/Прекратить прослушивание/Игнорировать предупреждение/Перейти к персональной информации об использовании ИЛИ Привет! Похоже, в последнее время вы слушали много громкой музыки. Почему бы не сделать небольшой перерыв, чтобы защитить свой слух? Уменьшить громкость/Прекратить прослушивание/Игнорировать предупреждение/Перейти к персональной информации об использовании 77 b. 100% недельного допустимого уровня звукового давления – предупреждающее сообщение (с опцией немедленной приостановки прослушивания): теперь вы ПРЕВЫСИЛИ 100% уровня безопасного прослушивания. Небезопасное прослушивание ставит под угрозу слух. Уменьшить громкость/Прекратить прослушивание/Игнорировать предупреждение/Перейти к персональной информации об использовании ИЛИ Привет! В последнее время вы слишком часто слушали громкую музыку. Сделайте перерыв и защитите свой слух. Уменьшить громкость/ Прекратить прослушивание/Игнорировать предупреждение/Перейти к персональной информации об использовании Если пользователь не выберет вариант "игнорировать предупреждение" или "приостановить прослушивание", по умолчанию громкость будет уменьшена до уровня ниже среднего значения 80 или 75 дБ. Примеры сообщений в зависимости от суточного уровня использования Ежедневное сообщение (отображаемое при открытии приложения или на странице проигрывателя) зависит от характера использования пользователем допустимого уровня звукового давления в течение последних нескольких дней. a. Преимущественно в зеленом цвете (в случае если пользователь в течение большей части дней использует менее 50% недельного уровня использования, не превышая нормы ни в один из дней): одобряющие сообщения. Отлично. Именно так и надо прослушивать Отлично! Продолжайте слушать музыку без вреда для слуха, чтобы получать нескончаемое удовольствие Очень хорошо. Продолжайте слушать без вреда для слуха и получайте нескончаемое удовольствие b. Преимущественно в зеленом или желтом/оранжевом цвете (в случае если пользователь в течение большей части дней использует менее 80% недельного уровня использования, не превышая нормы ни в один из дней). Будьте осторожны и слушайте без вреда для слуха Привет! Кажется, иногда вам нравится слушать на большой громкости! Будьте осторожны и защитите свой слух, чтобы получать нескончаемое удовольствие! Вы можете дольше слушать без вреда для слуха, если уменьшите громкость 78 c. Преимущественно в желтом/оранжевом цвете, иногда в красном (в случае если пользователь ни в один из дней не превышает нормы недельного уровня использования). Осторожно! Уменьшите громкость, чтобы слушать дольше без вреда для слуха Ой! Кажется, иногда вам нравится слушать громкую музыку! Будьте осторожны и защитите свой слух, чтобы получать нескончаемое удовольствие! Привет! Вам следует следить за тем, как вы слушаете d. Преимущественно в красном цвете (превышает нормы недельного уровня использования в большую часть дней). Вы подвергаете свой слух опасности. Не повышайте громкость, чтобы слушать без вреда для слуха Ой! Вам следует следить за тем, как вы слушаете. Уменьшите громкость Ой! Кажется, вам нравится очень громкая музыка! Не подвергайте свой слух опасности и получайте нескончаемое удовольствие Примеры формулировки сообщений в позитивном или негативном ключе; эмоциональная или рациональная мотивация Формулировка в позитивном ключе Вы превысили суточную норму безопасного прослушивания. Прослушивание на низкой громкости позволяет слушать дольше без вреда для слуха. Уменьшите громкость. Формулировка в негативном ключе Вы превысили суточную норму безопасного прослушивания. Если вы будете продолжать слушать в таком режиме, вы рискуете навсегда повредить свой слух. Уменьшите громкость. Рациональная мотивация Данные свидетельствуют о том, что, если вы слушаете музыку с уровнем звукового давления выше 80 дБА в течение 8 часов или эквивалентным образом, вы можете навсегда повредить свой слух. Уменьшите громкость. Эмоциональная мотивация Потеряв слух, вы больше не сможете его вернуть. Слушайте без вреда для слуха. Уменьшите громкость. Пример того, как информация о параметрах прослушивания может быть представлена пользователю С помощью четко распознаваемого значка пользователи должны получать доступ к "специальному месту" (экрану) в устройстве, где хранится, отображается и интерпретируется информация о привычках пользователя, касающихся прослушивания. На этом экране пользователь должен иметь возможность ознакомиться с графическим представлением своих привычек или предпочтений, касающихся прослушивания в целом, и узнать, имело ли место небезопасное прослушивание (и какого вида). Визуальное отображение привычек пользователя, касающихся прослушивания, должно включать: • графическое представление использования недельного допустимого уровня звукового давления; • графическое представление суточного воздействия звука, маркированное разными цветами; • продолжительность прослушивания в течение каждого дня и за последние 7 дней в часах и минутах. 1. Информация об использовании недельного допустимого уровня звукового давления Использование недельного допустимого уровня звукового давления может быть отображено графически так, как показано на рисунке 7.2. Рисунок 7.2. Пример графического отображения использования недельного допустимого уровня звукового давления 2. Информация об использовании пользователем допустимого уровня звукового давления за любой день Для отображения такой информации максимальный суточный уровень звукового давления рассчитывается путем деления значения недельного уровня на 7 (приблизительно 15% от недельного допустимого уровня звукового давления). Использование за последние 7 дней (включая текущий день) отображается с помощью нескольких цветов, соответствующих разным уровням использования, например красный цвет обозначает использование более чем на 100%, а зеленый – использование менее чем на 50%. При отображении этой информации каждый день рассматривается как отдельная единица, и в цветовом кодировании каждого данного дня не учитываются данные за предыдущие дни. Таким образом каждый день будет начинаться с зеленого значка, независимо от уровня использования в предшествующие дни. 79 Дополнение 9 Ресурсы для проведения на базе школ семинаров-практикумов, посвященных вопросам безопасного слушания В рамках программы "Cheers for Ears", разработанной Научно-исследовательским институтом слуха Австралии, школьники в возрасте от 10 до 12 лет получают информацию об опасности потери слуха и ее профилактике. В рамках программы используются различные мультимедийные материалы и проводятся интерактивные занятия в школах. Помимо реализации этой программы сотрудники института осуществили ряд мероприятий, в том числе "Safe Hearing Suzie", "Epic Ear Defense" и "Cheers for Ears Charlie". За последние три года эти мероприятия позволили добиться успеха в популяризации безопасного прослушивания среди 21 300 детей в 226 школах. Проект преследует следующие три цели: "разработать программу укрепления здоровья для ознакомления детей младшего школьного возраста с опасностью воздействия опасного уровня шума и музыки", "разработать приложение для контроля и отслеживания воздействия шума, источником которого являются персональные музыкальные проигрыватели" и "разработать интернет-ресурс, который будет служить основным информационным сайтом по всем вопросам, связанным с потерей слуха вследствие воздействия шума и воздействия звуков в местах развлечения". Дополнительную информацию о программе "Cheers for Ears" можно получить по адресу: http://www.hearingservices.gov.au/wps/wcm/connect/8c6fc19a-4f10-4307-93f3-d350f50fbe5b/cheers-for-ears.pdf ?MOD=AJPERES Ресурсы • Сьюзи в "Safe Hearing Suzie" представляет собой голову манекена со встроенным измерителем уровня звука и симулятором потери слуха. Сьюзи показывает уровень звука в децибелах и сообщает о том, является ли прослушивание с этим уровнем громкости звука безопасным. Таким образом Сьюзи информирует учащихся о фактах и рисках, связанных с потерей слуха вследствие воздействия шума. • "Epic Ear Defense" – это онлайн-игра, в которой учащиеся могут активно получать информацию о важности защиты слуха. Во время игры игрокам приходится использовать защитные приемы, чтобы бороться с поступающими громкими звуками (противником). "По мере того как все большему числу громких звуков удается убежать от игрока и достичь барабанной перепонки, игра с помощью звукового сопровождения начинает постепенно симулировать потерю слуха и звон в ушах". Эта симуляция представляет собой увлекательное занятие, от которого участники могут получать удовольствие, одновременно узнавая о важности слуха. • Чарли в "Cheers for Ears Charlie" – это рекламный персонаж, который представляет собой супергероя, демонстрирующего наушники как способ уменьшить риск развития потери слуха вследствие воздействия шума. Этот персонаж участвует в разных мероприятиях, таких как Неделя просвещения по вопросам слуха, школьные собрания и детские праздники. • В школах проводятся семинары-практикумы, на которых используются презентации, соответствующие возрасту. Классные мероприятия включают конкурсы плакатов, создание телевизионной или радиорекламы и проведение викторин. Контактная информация Для получения дополнительной информации обращайтесь по электронной почте к Натали Лейшман: natalie.leishman@earscience.org.au Cheers for Ears 80 Hear 4 Tomorrow "Hear 4 Tomorrow" – это учебная программа, включающая просвещение детей младшего школьного возраста по вопросам здоровья слуха. Он была разработана в первую очередь для школьных учителей в качестве учебно-методического пособия, включающего различные учебные планы. Комплексный учебный план состоит из четырех учебных модулей: основные сведения о потере слуха, слуховой аппарат и шум, что такое слишком громкий звук и защита слуха. Каждый модуль охватывает различные аспекты здоровья слуха, и учащиеся обучаются способам снижения уровня шума. Цель программы "Hear 4 Tomorrow" заключается в том, чтобы "предоставить в распоряжение учителей ресурс, который позволит им давать информацию о здоровье слуха в дополнение к имеющимся у них программам обучения". Дополнительную информацию о программе "Hear 4 Tomorrow" можно получить по адресу https://hear4tomorrow.nal.gov.au/index.html. Ресурсы • Для каждого модуля имеются разнообразные ресурсы, с помощью которых учащиеся осваивают программу. – Симулятор потери слуха позволяет учащимся получить практический опыт потери слуха разной степени. Он демонстрирует, как слышит звуки 35-летний человек с потерей слуха вследствие воздействия шума или как слышат звуки люди с потерей слуха вследствие воздействия шума и при этом с шумом в ушах. Демонстрируя различные виды заболеваний, симулятор потери слуха помогает учащимся понять, что такое потеря слуха и какие проблемы с ней связаны. – Учащиеся с помощью карточек учатся измерять уровни различных шумов и устанавливать взаимосвязь между громкостью и продолжительностью воздействия. – Имеются также рекомендации для учителей. Контактная информация • Программа "Hear 4 Tomorrow" была разработана Национальной акустической лабораторией – научно-исследовательским подразделением компании Australian Hearing. Для получения дополнительной информации обращайтесь по электронной почте enquiries@nal.gov.au. Программа "Dangerous Decibels" ("Опасные децибелы") уделяет особое внимание трем способам профилактики потери слуха вследствие воздействия шума. В рамках этой программы в школах проводятся учебные презентации, разъясняющие понятие потери слуха вследствие воздействия шума и стратегии ее профилактики. В ходе интерактивных семинаров-практикумов подчеркивается важность защиты здоровья слуха и предлагаются такие варианты поведения, как "отказаться от намерения", "уменьшить громкость" и "использовать средства защиты для ушей". Этот школьный семинар-практикум прошел испытания на эффективность, и, как показали результаты испытаний, такие презентации весьма эффективны с точки зрения влияния на изменение поведения, формирование знаний и установок у учащихся начальной школы. Цель программы заключается в том, чтобы "уменьшить частоту случаев и распространенность вызванной воздействием шума потери слуха и тиннитуса (шума в ушах) посредством формирования знаний, изменения установок и поведения у детей школьного возраста". В рамках программы был создан персонаж Джолин – манекен, оборудованный шумомером, – который нравится детям и способствует формированию у них навыков безопасного прослушивания. Dangerous Decibels 81 Ресурсы • Джолин и книга рецептов Джолин. Джолин была изготовлена на основе демонстрационного манекена, к силиконовому уху которого был прикреплен шумомер. Джолин принимает участие в мероприятиях, проводимых в школах и университетах, в научных конференциях, ярмарках здоровья и многих других общественных мероприятиях. Джолин также использовалась в качестве исследовательского инструмента для изучения представлений и предпочтений людей в отношении прослушивания с помощью персональных стереосистем. Книга рецептов Джолин – это издание Национальной ассоциации сохранения слуха, помогающее людям сделать свою собственную Джолин. • Раскраски – набор из трех раскрасок для маленьких детей. Они являются хорошим раздаточным материалом. Дополнительные ресурсы размещены по адресу http://dangerousdecibels.org/. "Noisy Planet" ("Шумная планета") – это общественная информационно-просветительская кампания, разработанная Национальным институтом изучения глухоты и других коммуникативных расстройств (NIDCD). В рамках кампании "Noisy Planet" создано множество информационных комплектов материалов для разных аудиторий (родителей, санпросветработников, школьных медсестер и специалистов здравоохранения). Их целью является "повышение осведомленности о причинах потери слуха вследствие воздействия шума и ее профилактике". Эти образовательные ресурсы включают комплекты материалов, рекомендации и советы по безопасному прослушиванию. Согласно данным двух исследований, кампания "Noisy Planet" весьма эффективно воздействует на целевую аудиторию. Кроме того, Национальным институтом изучения глухоты и других коммуникативных расстройств также проводится кампания "Wise Ear" ("Мудрое ухо"), в рамках которой ученикам начальной школы рассказывается о профилактике потери слуха вследствие воздействия шума. Дополнительная информация размещена по адресу https://www.noisyplanet.nidcd.nih.gov. Ресурсы • На веб-сайте кампании "Noisy Planet" размещены презентации, видеоматериалы, посвященные мероприятиям для учащихся, и другие ресурсы. • Есть обучающие видео, в которых показаны примеры мероприятий. Инструкции содержат подробные описания каждого мероприятия, включая необходимое оборудование, требуемое количество учащихся-добровольцев и примерное время проведения каждого мероприятия. Контактная информация • По общим вопросам обращайтесь по адресу NPInfo@nidcd.nih.gov. В рамках кампании "Listen to Your Buds" ("Слушай в наушниках"), разработанной Американской ассоциацией специалистов в области речи и слуха (ASHA), с помощью учебных материалов проводится обучение по вопросам профилактики потери слуха. В рамках этой кампании распространяется важная информация о здоровье, предназначенная всем родителям и детям. Цель кампании заключается в том, чтобы "сделать эффективную коммуникацию правом человека, доступным и достижимым для всех". В рамках кампании осуществляется информирование общественности о риске потери слуха детьми в результате небезопасного использования персональных аудиоустройств, особенно таких, как головные наушники или наушники-вкладыши. Кроме того, в школах проводятся концерты "Listen To Your Buds", в рамках которых детям рассказывают о важности использования технологий для защиты слуха. Дополнительная информация размещена по адресу https://www.asha.org/buds/. Noisy Planet Listen to Your Buds 82 Ресурсы • В начальной школе проводятся интерактивные школьные семинары-практикумы. Известные музыканты рассказывают учащимся начальной школы, как на всю жизнь защитить свой слух. Видео: https://www.youtube.com/watch?v=cfkPUnWBmiI • Закладки для книг "Listen to Your Buds" • Книжка-раскраска "Listen to Your Buds" • Песня "Turn Down the Volume" ("Уменьши громкость") • Радио Disney PSA (познавательный рассказ о защите слуха) • Самопроверка потери слуха Контактная информация • Прямого адреса электронной почты ASHA нет, но связаться с ассоциацией можно, заполнив форму по адресу https://www.asha.org/Forms/Contact-ASHA/.

Ресурсы • Джолин и книга рецептов Джолин. Джолин была изготовлена на основе демонстрационного манекена, к силиконовому уху которого был прикреплен шумомер. Джолин принимает участие в мероприятиях, проводимых в школах и университетах, в научных конференциях, ярмарках здоровья и многих других общественных мероприятиях. Джолин также использовалась в качестве исследовательского инструмента для изучения представлений и предпочтений людей в отношении прослушивания с помощью персональных стереосистем. Книга рецептов Джолин – это издание Национальной ассоциации сохранения слуха, помогающее людям сделать свою собственную Джолин. • Раскраски – набор из трех раскрасок для маленьких детей. Они являются хорошим раздаточным материалом. Дополнительные ресурсы размещены по адресу http://dangerousdecibels.org/. "Noisy Planet" ("Шумная планета") – это общественная информационно-просветительская кампания, разработанная Национальным институтом изучения глухоты и других коммуникативных расстройств (NIDCD). В рамках кампании "Noisy Planet" создано множество информационных комплектов материалов для разных аудиторий (родителей, санпросветработников, школьных медсестер и специалистов здравоохранения). Их целью является "повышение осведомленности о причинах потери слуха вследствие воздействия шума и ее профилактике". Эти образовательные ресурсы включают комплекты материалов, рекомендации и советы по безопасному прослушиванию. Согласно данным двух исследований, кампания "Noisy Planet" весьма эффективно воздействует на целевую аудиторию. Кроме того, Национальным институтом изучения глухоты и других коммуникативных расстройств также проводится кампания "Wise Ear" ("Мудрое ухо"), в рамках которой ученикам начальной школы рассказывается о профилактике потери слуха вследствие воздействия шума. Дополнительная информация размещена по адресу https://www.noisyplanet.nidcd.nih.gov. Ресурсы • На веб-сайте кампании "Noisy Planet" размещены презентации, видеоматериалы, посвященные мероприятиям для учащихся, и другие ресурсы. • Есть обучающие видео, в которых показаны примеры мероприятий. Инструкции содержат подробные описания каждого мероприятия, включая необходимое оборудование, требуемое количество учащихся-добровольцев и примерное время проведения каждого мероприятия. Контактная информация • По общим вопросам обращайтесь по адресу NPInfo@nidcd.nih.gov. В рамках кампании "Listen to Your Buds" ("Слушай в наушниках"), разработанной Американской ассоциацией специалистов в области речи и слуха (ASHA), с помощью учебных материалов проводится обучение по вопросам профилактики потери слуха. В рамках этой кампании распространяется важная информация о здоровье, предназначенная всем родителям и детям. Цель кампании заключается в том, чтобы "сделать эффективную коммуникацию правом человека, доступным и достижимым для всех". В рамках кампании осуществляется информирование общественности о риске потери слуха детьми в результате небезопасного использования персональных аудиоустройств, особенно таких, как головные наушники или наушники-вкладыши. Кроме того, в школах проводятся концерты "Listen To Your Buds", в рамках которых детям рассказывают о важности использования технологий для защиты слуха. Дополнительная информация размещена по адресу https://www.asha.org/buds/. ДЛЯ ПОЛУЧЕНИЯ ДОПОЛНИТЕЛЬНОЙ ИНФОРМАЦИИ ПРОСЬБА ОБРАЩАТЬСЯ В Департамент по неинфекционным заболеваниям, инвалидности и предупреждению насилия и травматизма, Всемирная организация здравоохранения https://www.who.int/deafness/make-listening-safe/en/ Всемирная организация здравоохранения Avenue Appia 20 CH-1211 Geneva 27 Швейцария Suiza ISBN 978-92-4-151528-3