Identification of critical industry skills in an industrial hygiene graduate training program.

Graduates of industrial hygiene training (IH) programs must be able to meet continuously evolving health and safety needs in a wide variety of occupational settings. Therefore, academic IH graduate programs must regularly evaluate their curricula and solicit input from industry professionals to make curricular changes that will better prepare their students for professional roles in industry. The purpose of this study was to identify the training gaps that existed between industry needs and the current curriculum for a United States-accredited IH graduate training program. The research team facilitated two group interviews with the IH program advisory board, collected alumni survey data, and performed a qualitative analysis to identify skills gaps/needs for the IH Program graduates. The research team identified 3 themes from participant interviews and alumni surveys (technical, applied, and essential skills) and selected several skills within each theme that interview participants thought were necessary proficiencies for junior IH professionals. The skills identified in the qualitative interview and survey data can be incorporated into the curriculum to improve the training of IH graduate students. Additionally, by using qualitative analysis, the researchers uncovered essential skills previously unidentified in IH needs assessments, providing valuable information for all IH graduate programs.

A temporal evaluation of respirable crystalline silica exposure for construction tasks.

Personal air monitoring using a TSI SidePak AM520 personal aerosol monitor was performed on a northern Colorado construction site during five tasks from the OSHA Table 1: Specified Exposure Control Methods When Working With Materials Containing Crystalline Silica to estimate silica dust concentrations in real time. Photometric measurements were modified using a gravimetric correction factor and a % respirable crystalline silica adjustment. Each task was sampled once; sample time ranged from 14 min to 40 min, with a mean sample time of 27 min. The mean silica dust concentration estimates (µg/m3) (standard deviation [SD]) for the five tasks computed from the TSI SidePak AM520 respirable dust measurements were core drilling 12 µg/m3 [2.46], grinding 918 µg/m3 [1134.08], cutting with a walk-behind saw 36 µg/m3 [79.67], jackhammering 27 µg/m3 [23.24], and dowel drilling 66 µg/m3 [77.65]. Silica exposure estimates from real-time monitoring can be used to identify exposures that may be related to inadequate controls or worker behaviors that contribute to peak exposures. Respirable crystalline silica exposure estimates presented here are likely not generalizable to other construction sites or tasks.

Intra-rater and inter-rater reliability of 3D facial measurements.

Three-dimensional (3D) body scanning technology has applications for obtaining anthropometric data in human-centered and product development fields. The reliability of 3D measurements gathered from 3D scans must be assessed to understand the degree to which this technology is appropriate for use in place of manual anthropometric methods. The intra- and inter-rater reliabilities of 3D facial measurements were assessed among four novice raters using 3D landmarking. Intraclass correlation coefficient (ICC) statistics were calculated for the 3D measurement data collected in three phases to assess baseline reliabilities and improvements in reliabilities as the result of additional training and experience. Based on the results of this study, the researchers found that the collection of 3D measurement data, by multiple raters and using 3D landmarking methods, yielded a high percentage of ICC statistics in the good to excellent (>0.75 ICC) reliability range. Rater training and experience were important considerations in improving intra- and inter-rater reliabilities.

The Evaluation of Worker Exposure to Airborne Silica Dust During Five OSHA Table I Construction Tasks.

Fifty-one (51) personal silica air samples were collected over 13 days on 19 construction employees while they performed five different construction tasks found in the Occupational Safety and Health Administration's (OSHA) respirable crystalline silica standard for construction, Table 1, which specifies engineering, work practice, and respiratory protection controls that employers can use in lieu of exposure monitoring to adhere to the standard. The average construction task time was 127 min (range: 18-240 min) with a mean respirable silica concentration of 85 µg m-3 (standard deviation [SD] = 176.2) for all 51 measured exposures. At least one OSHA-specified silica dust control measure was used during all 51 samples collected. The mean silica concentrations for the five tasks were: core drilling 11.2 µg m-3 (SD = 5.31 µg m-3), cutting with a walk-behind saw 126 µg m-3 (SD = 115 µg m-3), dowel drilling 99.9 µg m-3 (SD = 58.7 µg m-3), grinding 172 µg m-3 (SD = 145 µg m-3), and jackhammering 23.2 µg m-3 (SD = 5.19 µg m-3). Twenty four of 51 (47.1%) workers were exposed above the OSHA Action Level (AL) of 25 µg m-3 and 15 of 51 (29.4%) were exposed above the OSHA Permissible Exposure Limit (PEL) of 50 µg m-3 when exposures were extrapolated to an 8-h shift. When silica exposures were extrapolated to 4 h, 15 of 51 (29.4%) of workers sampled were exposed over the OSHA AL and 8 of 51 (15.7%) were exposed over the OSHA PEL. A total of 15 area airborne respirable crystalline silica samples were collected on days where the personal task-based silica samples were taken, with an average sampling time of 187 min. Of the 15 area respirable crystalline silica samples, only four were greater than the laboratory reporting limit of 5 µg m-3. The four area silica samples with reportable concentrations revealed background silica concentrations of 23 µg m-3, 5 µg m-3, 40 µg m-3, and 100 µg m-3. Odds ratios were used to analyze the apparent association between dichotomous background construction site exposures to respirable crystalline silica (detectable or not detectable), and personal exposure category (over or not over the OSHA AL and PEL) when exposure times were extrapolated to 8 h. The associations were strongly positive and significant between detectable background exposures and personal overexposures for workers conducting the five Table 1 tasks with engineering controls in place. The results of this study suggest that exposure to hazardous levels of respirable crystalline silica may be present even when OSHA-specified engineering controls are implemented. The current study findings also suggest that background construction site silica concentrations may potentially cause task-based overexposures, even when the OSHA Table 1 control methods have been put in place.

The associations between occupational health and safety management system programming level and prior injury and illness rates in the U.S. dairy industry.

U.S. dairy workers suffer occupational injuries and illnesses at rates higher than the national average. Occupational health and safety management systems (OHSMS) have been proposed as a way to reduce injuries and illnesses for businesses of all types and sizes. The Occupational Safety and Health Administration (OSHA) On-Site Consultation Service provides assistance establishing an OHSMS to U.S. businesses. As part of this service, the consultants determine the level of OHSMS programming using the Safety and Health Program Assessment Worksheet (Revised OSHA Form 33). A total of 167 dairy industry records were obtained from OSHA. Forty-five of those records had both injury rate and OHSMS data. Using these records, a Spearman Rank-Order correlation was used to determine the strength and significance of the associations between prior injury rates and OSHA measured OHSMS programming level for dairy operations. Additional analyses were conducted to examine potential relationships between workforce size, injury rates, and OHSMS programming levels. There was a negative correlation between OHSMS programming level and injury rates, both for the overall OHSMS and by OHSMS component. Management Leadership was the OHSMS component most strongly associated with lower injury and illness rates. OHSMS interventions, as part of a comprehensive risk management approach for the U.S. dairy industry, may be warranted to help reduce the unacceptable number of injury and illnesses in the U.S. dairy industry. Further research is needed to determine if similar relationships between OHSMS programming and injury rates occur in other industries.

Noise Exposure and Evaluation at Tire- Changing Facilities.

Thirty (30) personal noise-exposure samples were collected on 20 tire-changing and repair technicians in three tire-changing facilities to determine their personal noise exposures and to estimate the maximum number of tire changes that could be performed without exceeding occupational exposure limits. Of the 30 projected 8-h time-weighted average noise samples, none exceeded the Occupational Safety and Health Administration's Permissible Exposure Limit, 1 (3%) exceeded the Occupational Safety and Health Administration's Action Level, and 18 (60%) exceeded the American Conference for Governmental Industrial Hygienists Threshold limit Value of 85 dBA, indicating the need for a hearing loss prevention program. The average shift time for the technicians was 6 h and 42 min and the average number of tire changes was 18. Based on the projected 8-h noise exposure 95% upper confidence limits, the estimated maximum number of tires that could be changed without exceeding the Occupational Safety and Health Administration's noise action level was 32 tires, the permissible exposure limit greater than 40 tires, and the American Conference of Industrial Hygienists' Threshold Limit Value was less than 20 tires. In addition, area noise samples of tire-changing equipment were taken with a sound-level meter to identify the noise sources that contributed to the tire technicians' exposures. The air ratchet, tire-changing machine, and tire-bead seater were measured at noise levels >85 dBA, increasing the risk of noise-induced hearing loss to the technicians.

Effects of Known Determinants on Methylene Bisphenyl Isocyanate (MDI) Concentration During Spray-On Truck Bed-Lining Processes.

BACKGROUND: Occupational exposure to methylene bisphenyl isocyanate (MDI) presents serious worker health concerns as it may lead to short- and long-term health effects such as asthma, airway irritation, hypersensitivity pneumonitis, and irritation of skin and mucous membranes. While studies of worker isocyanate exposures during vehicle painting activities are widespread, few studies have investigated the spray-on truck bed-liner (STBL) industry. The purpose of this study was to determine the effectiveness of several ventilation system variables and process characteristics in controlling MDI concentrations in the STBL industry. METHODS: A total of 47 personal air samples were collected for MDI during 18 site visits at nine STBL companies in Colorado and Wyoming. Ventilation system and process characteristics that were assessed included: ventilation system face velocity, airflow, air changes per minute (AC/M), capture velocity, percent of MDI in bed-liner product, application temperature, application pressure, paint booth temperature, paint booth relative humidity, paint booth volume, and quantity of bed-liner product applied. RESULTS: Pearson correlation revealed percentage of MDI in bed-liner product (r = 0.557, n = 14, P < 0.05) and process temperature (r = 0.677, n = 14, P < 0.05) had high positive correlation with MDI concentration. Ventilation system face velocity (r = -0.578, n = 14, P < 0.05) and AC/M (r = -0.657, n = 14, P < 0.05) had high negative correlation with MDI concentration while airflow (r = -0.475, n = 14, P < 0.05) and capture velocity (r = -0.415, n = 14, P = 0.07) had moderate negative correlation with MDI concentration. Multiple linear regression revealed process temperature and capture velocity made a statistically significant and unique contribution in estimating MDI concentration (F (2, 11) = 10.99, P < 0.05) with an adjusted R2 of 0.61, explaining 61% of the variability in MDI concentration. CONCLUSIONS: This investigation contributed to an understudied STBL industry by targeting determinants germane to MDI exposures during STBL application processes. Increasing ventilation performance for AC/M, airflow, face velocity, and capture velocity while also decreasing bed-liner application temperature and bed-liner product MDI content may have the greatest effect on reducing worker MDI exposures during STBL activities.

Noise characterization of oil and gas operations.

In cooperation with The Colorado Oil and Gas Conservation Commission, researchers at Colorado State University performed area noise monitoring at 23 oil and gas sites throughout Northern Colorado. The goals of this study were to: (1) measure and compare the noise levels for the different phases of oil and gas development sites; (2) evaluate the effectiveness of noise barriers; and (3) determine if noise levels exceeded the Colorado Oil and Gas Conservation Commission noise limits. The four phases of oil and gas development include drilling, hydraulic fracturing, completion and production. Noise measurements were collected using the A- and C-weighted sound scales. Octave band analysis was also performed to characterize the frequency spectra of the noise measurements. Noise measurements were collected using noise dosimeters and a hand-held sound-level meter at specified distances from the development sites in each cardinal direction. At 350 ft (107 m), drilling, hydraulic fracturing, and completion sites without noise barriers exceeded the maximum permissible noise levels for residential and commercial zones (55 dBA and 60 dBA, respectively). In addition, drilling and hydraulic fracturing sites with noise barriers exceeded the maximum permissible noise level for residential zones (55 dBA). However, during drilling, hydraulic fracturing, and completion operations, oil producers are allowed an exception to the noise permissible limits in that they only must comply with the industrial noise limit (80 dBA). It is stated in Rule 604.c.(2)A. that: "Operations involving pipeline or gas facility installation or maintenance, the use of a drilling rig, completion rig, workover rig, or stimulation is subject to the maximum permissible noise levels for industrial zones (80dBA)." [8] Production sites were within the Colorado Oil and Gas Conservation Commission permissible noise level criteria for all zones. At 350 ft (107 m) from the noise source, all drilling, hydraulic fracturing, and completion sites exceeded 65 dBC. Current noise wall mitigation strategies reduced noise levels in both the A- and C-weighted scale measurements. However, this reduction in noise was not sufficient to reduce the noise below the residential permissible noise level (55 dBA).

A faceoff with hazardous noise: Noise exposure and hearing threshold shifts of indoor hockey officials.

Noise exposure and hearing thresholds of indoor hockey officials of the Western States Hockey League were measured to assess the impact of hockey game noise on hearing sensitivity. Twenty-nine hockey officials who officiated the league in an arena in southeastern Wyoming in October, November, and December 2014 participated in the study. Personal noise dosimetry was conducted to determine if officials were exposed to an equivalent sound pressure level greater than 85 dBA. Hearing thresholds were measured before and after hockey games to determine if a 10 dB or greater temporary threshold shift in hearing occurred. Pure-tone audiometry was conducted in both ears at 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz. All noise exposures were greater than 85 dBA, with a mean personal noise exposure level of 93 dBA (SD = 2.2), providing 17.7% (SD = 6.3) of the officials' daily noise dose according to the OSHA criteria. Hearing threshold shifts of 10 dB or greater were observed in 86.2% (25/29) of officials, with 36% (9/25) of those threshold shifts equaling 15 dB or greater. The largest proportion of hearing threshold shifts occurred at 4000 Hz, comprising 35.7% of right ear shifts and 31.8% of left ear shifts. The threshold shifts between the pre- and post-game audiometry were statistically significant in the left ear at 500 (p=.019), 2000 (p=.0009), 3000 (p<.0001) and 4000 Hz (p=.0002), and in the right ear at 2000 (p=.0001), 3000 (p=.0001) and 4000 Hz (p<.0001), based on Wilcoxon-ranked sum analysis. Although not statistically significant at alpha = 0.05, logistic regression indicated that with each increase of one dB of equivalent sound pressure measured from personal noise dosimetry, the odds of a ≥ 10 dB TTS were increased in the left ear at 500 (OR=1.33, 95% CI 0.73-2.45), 3000 (OR=1.02, 95% CI 0.68-1.51), 4000 (OR=1.26, 95% CI 0.93-1.71) and 8000 Hz (OR=1.22, 95% CI 0.76-1.94) and in the right ear at 6000 (OR=1.03, 95% CI 0.14-7.84) and 8000 Hz (OR=1.29, 95% CI 0.12-13.83). These findings suggest that indoor hockey officials are exposed to hazardous levels of noise, experience temporary hearing loss after officiating games, and a hearing conservation program is warranted. Further temporary threshold shift research has the potential to identify officials of other sporting events that are at an increased risk of noise-induced hearing loss.

Comparing Occupational Health and Safety Management System Programming with Injury Rates in Poultry Production.

Effective methods to reduce work-related injuries and illnesses in animal production agriculture are sorely needed. One approach that may be helpful for agriculture producers is the adoption of occupational health and safety management systems. In this replication study, the authors compared the injury rates on 32 poultry growing operations with the level of occupational health and safety management system programming at each farm. Overall correlations between injury rates and programming level were determined, as were correlations between individual management system subcomponents to ascertain which parts might be the most useful for poultry producers. It was found that, in general, higher levels of occupational health and safety management system programming were associated with lower rates of workplace injuries and illnesses, and that Management Leadership was the system subcomponent with the strongest correlation. The strength and significance of the observed associations were greater on poultry farms with more complete management system assessments. These findings are similar to those from a previous study of the dairy production industry, suggesting that occupational health and safety management systems may hold promise as a comprehensive way for producers to improve occupational health and safety performance. Further research is needed to determine the effectiveness of such systems to reduce farm work injuries and illnesses. These results are timely given the increasing focus on occupational safety and health management systems.

Client Perceptions of Occupational Health and Safety Management System Assistance Provided by OSHA On-Site Consultation: Results of a Survey of Colorado Small Business Consultation Clients.

The Occupational Safety and Health Administration (OSHA) On-Site Consultation Service provides assistance establishing occupational health and safety management systems (OHSMS) to small businesses. The Safety and Health Program Assessment Worksheet (Revised OSHA Form 33) is the instrument used by consultants to assess an organization's OHSMS and provide feedback on how to improve a system. A survey was developed to determine the usefulness of the Revised OSHA Form 33 from the perspective of Colorado OSHA consultation clients. One hundred and seven clients who had received consultation services within a six-year period responded to the survey. The vast majority of respondents indicated that the Revised OSHA Form 33 accurately reflected their OHSMS and that information provided on the Revised OSHA Form 33 was helpful for improving their systems. Specific outcomes reported by the respondents included increased safety awareness, reduced injuries, and improved morale. The results indicate that the OHSMS assistance provided by OSHA consultation is beneficial for clients and that the Revised OSHA Form 33 can be an effective tool for assessing and communicating OHSMS results to business management. Detailed comments and suggestions provided on the Revised OSHA Form 33 are helpful for clients to improve their OHSMS.

Developing effective worker health and safety training materials: hazard awareness, identification, recognition, and control for the salon industry.

OBJECTIVE: In addition to formaldehyde, workers in salons can be exposed to other chemical irritants, sensitizers, carcinogens, reproductive hazards, infectious agents, ergonomic, and other physical hazards. Worker health and safety training is challenging because of current product labeling practices and the myriad of hazards portending risk for a wide variety of health effects. METHODS: Through a Susan B. Harwood Targeted Topic Training grant from the Occupational Safety and Health Administration and assistance from salon development and training partners, we developed, delivered, and validated a health and safety training program using an iterative five-pronged approach. RESULTS: The training was well received and resulted in knowledge gain, improved workplace safety practices, and increased communication about health and safety. CONCLUSIONS: These training materials are available for download from the Occupational Safety and Health Administration's Susan B. Harwood Training Grant Program Web site.

A comparison of two sampling methods for the detection of airborne methylene bisphenyl diisocyanate.

The purpose of this study was to determine if there was a significant difference between two readily available sampling methodologies for airborne methylene bisphenyl diisocyanate (MDI), which is an essential precursor in the spray-on truck bed lining industry. Seventy-two personal airborne samples of MDI were collected and analyzed from nine spray-on truck bed liner businesses in northern Colorado. Wide ranges of exposure concentrations were encountered during the spray-on application, including concentrations that exceeded the OSHA permissible exposure limit. The highest airborne MDI concentration measured was 690 ppb. A statistically significant difference between field-desorbed and laboratory-desorbed methods was determined. The field-desorbed sampling methodology yielded consistently higher MDI concentrations than the laboratory-desorbed sampling methodology, which suggests that immediate desorption minimizes isocyanate loss and potential underestimations. Results from the analysis of variance also indicated that different facility factors and environmental conditions within each company, such as the use of ventilation or humidity level, affected the MDI concentrations, indicating the potential for better mitigation of exposures using the hierarchy of controls.

Firefighter noise exposure during training activities and general equipment use.

Multiple noise measurements were taken on 6 types of fire station equipment and 15 types of emergency response vehicle-related equipment used by firefighters during routine and emergency operations at 10 fire stations. Five of the six types of fire station equipment, when measured at a distance of one meter and ear level, emitted noise equal to or greater than 85 dBA, including lawn maintenance equipment, snow blowers, compressors, and emergency alarms. Thirteen of 15 types of equipment located on the fire engines emitted noise levels equal to or greater than 85 dBA, including fans, saws, alarms, and extrication equipment. In addition, noise measurements were taken during fire engine operations, including the idling vehicle, vehicle sirens, and water pumps. Results indicated that idling fire-engine noise levels were below 85 dBA; however, during water pump and siren use, noise levels exceeded 85 dBA, in some instances, at different locations around the trucks where firefighters would be stationed during emergency operations. To determine if the duration and use of fire fighting equipment was sufficient to result in overexposures to noise during routine training activities, 93 firefighter personal noise dosimetry samples were taken during 10 firefighter training activities. Two training activities per sampling day were monitored during each sampling event, for a mean exposure time of 70 min per day. The noise dosimetry samples were grouped based on job description to compare noise exposures between the different categories of job tasks commonly associated with fire fighting. The three job categories were interior, exterior, and engineering. Mean personal dosimetry results indicated that the average noise exposure was 78 dBA during the training activities that lasted 70 min on average. There was no significant difference in noise exposure between each of the three job categories. Although firefighters routinely use equipment and emergency response vehicles that can produce hazardous levels of noise, this study showed that the average noise levels experienced by firefighters was below generally accepted guidelines.

Occupational and recreational noise exposure from indoor arena hockey games.

Occupational and recreational noise exposures were evaluated at two sporting arenas hosting collegiate hockey games (Venue 1) and semi-professional hockey (Venue 2). A total of 54 personal noise dosimetry samples were taken over the course of seven home hockey games: 15 workers and 9 fans at Venue 1, and 19 workers and 11 fans at Venue 2. None of the sampled workers were overexposed to noise based on Occupational Safety and Health Administration criteria. However, 40% and 57% of workers at Venue 1 and 33% and 91% of fans at Venue 2 were overexposed based on ACGIH noise exposure criteria. Noise exposures for fans were significantly different between venues, but worker noise exposures between venues were not significantly different. In addition, extensive area noise monitoring was conducted at each venue to further characterize the stadium noise on a location-by-location basis. Mean equivalent sound pressure levels ranged from 81 to 96 dBA at Venue 1 and from 85 to 97 dBA at Venue 2. Mean noise peak levels ranged from 105 to 124 dBA at Venue 1, and from 110 to 117 dBA at Venue 2. These data reflect the potential for overexposure at indoor hockey events and are useful in characterizing occupational noise exposure of indoor arena support staff and may also provide a foundation for future noise control research in indoor sports arenas.

Occupational exposures to noise resulting from the workplace use of personal media players at a manufacturing facility.

This study examined the contribution of noise exposures from personal media player (PMP) use in the workplace to overall employee noise exposures at a Colorado manufacturing facility. A total of 24 workers' PMP and background noise exposures were measured. Twelve PMP users worked in high-background-noise exposure (HBNE) areas, and 12 worked in low-background-noise exposure (LBNE) areas. The self-selected PMP listening level of each worker was measured using an ear simulator, and the background noise of each employee workstation was measured using a sound level meter. Workers' self-reported PMP duration of use, PMP listening exposure levels, and background noise levels were used to estimate the daily occupational noise exposures. Measured background noise levels averaged 81 dBA for HBNE workers and 59 dBA for LBNE workers. Measured, free-field equivalent listening exposure levels were significantly greater for HBNE workers (85 dBA) compared with LBNE workers (75 dBA) (p = 0.0006). Estimated mean daily noise exposures for both groups were below the ACGIH threshold limit value for noise of 85 dBA8-hr time weighted average (TWA), specifically 84 dBA TWA for HBNE workers and 72 dBA TWA for LBNE workers. Three of 12 (25%) HBNE workers had estimated exposures greater than 85 dBA TWA when only background noise was considered, yet when PMP use was also considered, 6 of 12 (50%) had estimated exposures greater than 85 dBA TWA, suggesting that PMP use doubled the number of overexposed workers. None of the LBNE workers had estimated exposures greater than 85 dBA TWA. The contribution of PMP use to overall noise exposures was substantially less among HBNE workers than LBNE workers due to the disproportionate selection of noise-attenuating headsets among HBNE workers compared with LBNE workers. It is recommended that the facility management either restrict workplace PMP use among HBNE workers or require output-limiting technology to prevent occupational noise-induced hearing loss.

Noise exposure, characterization, and comparison of three football stadiums.

Personal noise exposure samples were collected from five workers at a large-sized college football stadium and five workers at a medium-sized college football stadium in northern Colorado during three home football games, for a total of 30 personal noise exposures. In addition, personal noise exposure samples were collected from five fans at a National Football League (NFL) stadium, and from two fans at each of the college stadiums during three home football games, for a total of 27 personal noise exposure samples. None of the workers' noise doses were above the Occupational Safety and Health Administration (OSHA) permissible exposure limit of 90 dBA. However, 11 of 28 (39%) workers' noise doses exceeded the OSHA action level of 85 dBA that would require enrollment in a hearing conservation program. Following ACGIH® recommendations for noise exposure limits, 27 of 28 (96%) workers would be considered overexposed. In addition, 24 of 25 fans (96%) were also overexposed according to ACGIH and World Health Organization recommendations. At the 95% confidence level, workers' and fans' noise exposures were not significantly different between the three stadiums. However, there was significant noise level variability between the games in each individual stadium (e.g., 82 dbA vs. 87 dbA mean worker OSHA noise exposure for two games at the large-sized college stadium, p=0.001). Given the personal sampling results for the stadium workers, the investigators believe that stadium management at these two universities should implement a hearing conservation program and provide hearing protection. Management should include a warning of possible loud-noise exposure during any sporting events held at the stadiums in fan guides, pamphlets, websites, or other appropriate communication tools. This information should include the health effects of loud noise exposure, namely, noise-induced hearing loss, the information should also be specifically targeted to parents of young children, including a strong recommendation that hearing protection be worn by all children during the sporting event.