Hearing Loss Research at NIOSH

Reviews of Research Programs of the National Institute for Occupational Safety and Health

Committee to Review the NIOSH Hearing Loss Research Program

Board on Health Sciences Policy

INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health Hearing Loss Research at NIOSH Reviews of Research Programs of the National Institute for Occupational Safety and Health Committee to Review the NIOSH Hearing Loss Research Program Board on Health Sciences Policy INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was requested by the National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention and supported by Contract Nos. 200-2000-00629 (Task Order #0033) and 200-2005-10881 (Task Order #0004), between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-10: 0-309-10274-X International Standard Book Number-13: 978-0-309-10274-2 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested Citation: Institute of Medicine and National Research Council. 2006. Hearing Loss Research at NIOSH. Committee to Review the NIOSH Hearing Loss Research Program. Rpt. No. 1, Reviews of Research Programs of the National Institute for Occupational Safety and Health. Washington, DC: The National Academies Press.

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health COMMITTEE TO REVIEW THE NIOSH HEARING LOSS RESEARCH PROGRAM BERNARD D. GOLDSTEIN (Chair), Professor, Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pennsylvania BETH A. COOPER, Manager, Acoustical Testing Laboratory, NASA John H. Glenn Research Center at Lewis Field, Cleveland, Ohio SUSAN E. COZZENS, Professor, School of Public Policy, Georgia Institute of Technology, Atlanta KAREN J. CRUICKSHANKS, Professor, Department of Population Health Sciences and Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison JUDY R. DUBNO, Professor, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston DENNIS A. GIARDINO, Acoustical Consultant, Pittsburgh, Pennsylvania RENA H. GLASER, Manager of Medical Surveillance (Retired), 3M Corporation, St. Paul, Minnesota WILLIAM W. LANG, President, Noise Control Foundation, Poughkeepsie, New York LAURA C. LEVITON, Senior Program Officer for Research and Evaluation, Robert Wood Johnson Foundation, Princeton, New Jersey BRENDA L. LONSBURY-MARTIN, Research Professor, Division of Otolaryngology, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California MICHAEL A. SILVERSTEIN, Clinical Professor, Department of Environmental and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington, Seattle Framework Committee Liaison FRANKLIN E. MIRER, Director, Health and Safety Department, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW), Detroit, Michigan Project Staff LOIS JOELLENBECK, Senior Program Officer JANE DURCH, Senior Program Officer KRISTEN GILBERTSON, Research Assistant

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health Independent Report Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Kathleen Campbell, Department of Surgery, Southern Illinois University School of Medicine William W. Clark, Program in Audiology and Communication Sciences, Washington University School of Medicine in St. Louis, Missouri Christine Dixon-Ernst, Occupational Health Issues and EHS Information Systems, Alcoa, Pittsburgh, Pennsylvania Joseph A. Main, Consultant, Mining Health and Safety, Spotsylvania, Virginia Susan Megerson, Intercampus Program in Communicative Disorders, The University of Kansas David Roessner, School of Public Policy, Georgia Institute of Technology Kenneth Rosenman, Division of Occupational and Environmental Medicine, Michigan State University

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health Scott D. Sommerfeldt, Department of Physics and Astronomy, Brigham Young University, Provo, Utah Evelyn Talbott, Department of Epidemiology, University of Pittsburgh, Pennsylvania Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Paul D. Stolley, University of Maryland School of Medicine, and David G. Hoel, Medical University of South Carolina. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health Preface It has been a great pleasure to work with the group of consummate professionals who served on the Committee to Review the NIOSH Hearing Loss Research Program. The committee was fortunate that the Institute of Medicine’s recognition of the unusual challenges posed by this report led to its assigning particularly superb staff to work with us. The dedication, hard work, and patience of Lois Joellenbeck and Jane Durch were essential to the completion of this task. Kristen Gilbertson’s very able assistance deserves high praise as well. We also want to thank the many individuals working for NIOSH (National Institute for Occupational Safety and Health) with whom we interacted. Being reviewed produces anxiety in any organization—and this is particularly true now that accountability is so prominent in the pronouncements of the Office of Management and Budget and of Congress. The discomfort of NIOSH participants was no doubt exacerbated by our committee’s own learning curve, which led to many requests for different types of information, and by the lack of familiarity of NIOSH professionals with this new review process, which was still evolving during their preparation of materials for this committee. We hope that this has been a valuable learning experience both for NIOSH and for future National Academies committees reviewing NIOSH research programs. Our committee was presented with a number of challenges that went beyond the usual assignment of analyzing and synthesizing information about a program and then making recommendations. No previous committee had worked under this new NIOSH review program, which may include up to 14 other similar re-

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health views in the next few years, so we had no template to follow and were constrained to develop a format that would work not only for us but for future committees. Fortunately, we were provided with very helpful guidance for this new approach, including meeting the challenge of scoring the Hearing Loss Research Program both for impact and for relevance, by the National Academies’ Committee for the Review of NIOSH Research Programs (known as the Framework Committee). We greatly appreciated the valuable and patient input of Frank Mirer, the liaison from the Framework Committee; Evan Douple and Sammantha Magsino, the Framework Committee study staff; and David Wegman, the Framework Committee chair. Of particular note is that the scoring system for impact and relevance is in whole numbers and is not linear (i.e., a score of 3 is not equidistant from a 1 and a 5). Determining the scores required careful review of the definitions that were provided to us by the Framework Committee. Conforming to the definitions and outline of the Framework Committee required many iterations. When the overall review process is completed, scores for impact and relevance will be available for the 15 NIOSH components evaluated. Inevitably, and unfortunately, comparisons among these NIOSH programs are likely to be made based on the score alone. I urge readers to go beyond the scores to read both the commentary that is the basis for the score and the specific committee recommendations. The need to go beyond the scores for impact and relevance is particularly pertinent for a cross-cutting matrix organization such as the Hearing Loss Research Program. A standard linear logic model of the type on which this review is based begins with inputs, such as funding and staff; moves through outputs, the direct products of the program; and proceeds to outcomes, the extent to which the mission and goals of the organization have been attained. Evaluating whether the NIOSH Hearing Loss Research Program uses its inputs appropriately is complicated by two factors. First, as a classic matrix organization that has its components within various NIOSH line organizations, the Hearing Loss Research Program does not really have its own budget and staff. As such, it is difficult to evaluate whether the program is making appropriate decisions about inputs. This is further complicated by the need to follow congressional budgetary dictates that can distort the relevance score of the program—for example, devotion of more than half of the Hearing Loss Research Program budget to mining is not consonant with the relative extent to which miners represent the American workforce at risk for hearing loss. Comparisons of final scores may lead the very valuable NIOSH cross-cutting matrix organizations to be ranked lower than NIOSH line organizations due to the dictates of the logic model on which the Framework Committee based its guidance.

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health The outcomes portion of the logic model also presents some difficulty when evaluating a research organization that does not control how its output is used. NIOSH research output is added to the pool of knowledge from which many others may dip, often in unforeseen ways that do not follow the linearity of a logic model. These externalities are addressed in our review but may be lost if the focus is solely on a numerical score. What follows is the committee’s review of the NIOSH Hearing Loss Research Program. It is our hope that the results of this review will help to further build a dynamic research program responsive to protecting the hearing of American workers and will contribute to the challenging task of developing processes to fairly evaluate government health research organizations. Bernard D. Goldstein Committee Chair

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health Contents     SUMMARY   1 1   INTRODUCTION   21      Study Charge and Evaluation Committee,   22      The NIOSH Hearing Loss Research Program,   24      Evaluation Approach,   33      The Committee’s Report,   34      References,   36 2   EVALUATION OF THE HEARING LOSS RESEARCH PROGRAM   37      Hearing Loss Research Program Goals,   38      External Factors with Broad Effects on the Hearing Loss Research Program,   38      Other Factors Affecting the Hearing Loss Research Program,   42      Assessment of Relevance,   43      Overall Evaluation of the Relevance of the Hearing Loss Research Program,   70      Assessment of Impact,   72      Overall Evaluation of the Impact of the Hearing Loss Research Program,   92      References,   96

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health            3   IDENTIFYING EMERGING ISSUES AND RESEARCH AREAS IN OCCUPATIONAL HEARING LOSS PREVENTION   102      The Hearing Loss Research Program’s Process for Identifying Emerging Issues and Research Areas in Occupational Hearing Loss Prevention,   103      Committee Assessment of the Hearing Loss Research Program’s Identification of Emerging Issues and Research Areas in Occupational Hearing Loss Prevention,   108      Emerging Issues and Research Areas in Occupational Hearing Loss Prevention Identified by the Evaluation Committee,   110      Conclusion,   113      References,   113 4   RECOMMENDATIONS FOR PROGRAM IMPROVEMENT   115      Program Management in a Matrix Environment,   115      Access to Intramural and Extramural Expertise,   117      Program Planning,   118      Evaluation of Hearing Loss Prevention Measures,   120      Surveillance Activities,   120      Noise Control Perspective,   121      Extramural Research,   122      References,   123     APPENDIXES     A   Framework for the Review of Research Programs of the National Institute for Occupational Safety and Health   125 B   Methods Section: Committee Information Gathering   168 C   Information Provided by the NIOSH Hearing Loss Research Program   186 D   Biographical Sketches of Committee Members   197

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health Tables, Figures, and Boxes TABLES 1-1   NIOSH Hearing Loss Research Program Funding by Fiscal Year, 1997–2005,   31 2-1   Research Goals and Subgoals of the NIOSH Hearing Loss Research Program, as of February 2006,   40 2-2   NIOSH Hearing Loss Research Program Budget and Staffing by Research Goals,   46 FIGURES 1-1   NIOSH organization chart, as of December 2005,   27 1-2   Location of Hearing Loss Research Program activities in NIOSH,   28 1-3   Logic model for the Hearing Loss Research Program,   35 BOXES S-1   Scale for Rating Program Relevance,   8 S-2   Scale for Rating Program Impact,   11 S-3   Summary of Recommendations,   20

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health 2-1   Logic Model Terms and Examples,   39 2-2   Scale for Rating Program Relevance,   73 2-3   Scale for Rating Program Impact,   95 3-1   Participants in the NIOSH Hearing Loss Prevention Futures Workshop,   104 3-2   Emerging Research Issues Identified by the Hearing Loss Research Program,   105 3-3   Hearing Loss Prevention Goals in the NIOSH Mining Research Plan,   107 B-1   Agendas for Site Visits,   170 B-2   Letter Inviting Comment on the NIOSH Hearing Loss Research Program,   174 B-3   Emerging Research Areas in Occupational Hearing Loss and Noise Control Suggested by Stakeholders,   176

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health     Abbreviations and Acronyms AAA American Academy of Audiology AAOHNS American Academy of Otolaryngology–Head and Neck Surgery AAS American Auditory Society ACGIH American Conference of Governmental Industrial Hygienists ACOEM American College of Occupational and Environmental Medicine AGES Age, Gene/Environment Susceptibility Study AIHA American Industrial Hygiene Association ANSI American National Standards Institute ASHA American Speech–Language–Hearing Association BLS Bureau of Labor Statistics CAOHC Council for Accreditation in Occupational Hearing Conservation CDC Centers for Disease Control and Prevention CHABA Committee on Hearing, Bioacoustics, and Biomechanics CRADA Cooperative Research and Development Agreement DART Division of Applied Research and Technology DBBS Division of Biomedical and Behavioral Sciences DoD Department of Defense

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health DPSE Division of Physical Sciences and Engineering DSHEFS Division of Surveillance, Hazard Evaluations, and Field Studies EID Education and Information Division EPA Environmental Protection Agency FTE Full-time equivalent FY Fiscal year HHE Health Hazard Evaluation HLPP Hearing loss prevention program HPD Hearing protection device INCE Institute of Noise Control Engineering IOM Institute of Medicine ISO International Organization for Standardization MSHA Mine Safety and Health Administration NASA National Aeronautics and Space Administration NHANES National Health and Nutrition Examination Survey NHCA National Hearing Conservation Association NIDCD National Institute on Deafness and Other Communication Disorders NIH National Institutes of Health NIHL Noise-induced hearing loss NIOSH National Institute for Occupational Safety and Health NORA National Occupational Research Agenda NRC National Research Council NRR Noise Reduction Rating NSF National Science Foundation NVLAP National Voluntary Laboratory Accreditation Program OEP Office of Extramural Programs OHC Office of Health Communications ORTT Office of Research and Technology Transfer OSHA Occupational Safety and Health Administration PA Program Announcement PRL Pittsburgh Research Laboratory

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Hearing Loss Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health r2p Research to Practice RFA Request for Applications SENSOR Sentinel Event Notification System for Occupational Risks SRL Spokane Research Laboratory STS Standard threshold shift UAW United Automobile, Aerospace and Agricultural Implement Workers of America USACHPPM U.S. Army Center for Health Promotion and Preventive Medicine WHO World Health Organization

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