HLR program planning is guided by the hierarchy of preferred controls of workplace hazards that is generally accepted in occupational safety and health. That hierarchy can be summarized as:
- Prevent or contain workplace hazards at their source (engineering control);
- Control exposures to workplace hazards by relocating workers to safer areas (administrative control); and
- Control hazardous exposures with individual-level barriers between the worker and the hazard (personal protective equipment).
Five important research planning efforts have guided the HLR program within this framework over the last 17 years. In 1988, NIOSH established a priority list of the ten most important illnesses or problems in occupational safety and health. Noise-induced hearing loss was one of these “Top Ten.” As part of that process, NIOSH published “A Proposed National Strategy for the Prevention of Noise-induced Hearing Loss” based on the deliberations of both internal and external experts in the field (Appendix F). This document includes short- and long-term objectives for regulations, information dissemination, and research. Those objectives guided the HLR program for a decade.
A second HLR planning effort occurred in 1998 during preparation of a revised noise criteria document2 (Appendix G). In the NIOSH document system, criteria documents provide the scientific basis and recommendations for new occupational safety and health standards. In addition to updating exposure criteria and other policy issues, this criteria document articulated research needs for the HLR program. Those needs were selected based on recommendations of both internal and external experts and have provided guiding objectives for the HLR program over the last seven years. The research needs were introduced with these words:
Considerable progress has been made in our understanding of occupational hearing loss prevention. However, additional research is needed to clarify the risks associated with various noise and ototoxic exposures and to reduce the incidence of hearing loss among workers. Furthermore, investigations of possible biological indicators of susceptibility to noise-induced hearing loss (NIHL) would be welcome. For example, although tinnitus is a frequent complaint of the noise-exposed worker, its relationship to permanent hearing loss is not well understood. The additional topics listed in the sections below do not include all areas that would benefit from further investigations, but they represent persistent problems or emerging trends (p. 69).
The specific research needs outlined in the revised noise criteria document were:
- Noise Control
- Impulsive Noise
- Nonauditory Effects
- Auditory Effects of Ototoxic Chemical Exposures
- Exposure Monitoring
- Hearing Protectors
- Training and Motivation
- Program Evaluation
The third influential planning effort is NORA, and more specifically what has come to be known as NORA I, which ran from 1996 to 2005. The NORA hearing loss team of expert researchers and stakeholders has been working to establish research priorities. A summary of that team’s activities is provided (Appendix H). A draft of their research agenda is in review to be published.
While NORA has been used to set overall priorities for the 21 topic areas, NIOSH has also used NORA to establish a process for competitive selection of intramural programs to receive funding. In this process, NIOSH research teams propose a set of coordinated research projects to begin a new effort within a program or to augment existing efforts, particularly to address research needs identified by the appropriate NORA topic coordinating team that includes stakeholders. Proposals undergo a rigorous external peer review that includes reviews of each project within the proposal and a review of the plan for coordination of those proposals. The HLR program developed a proposal that was informed by the NORA hearing loss team’s draft agenda. The proposal was funded to begin work in fiscal year 2001 on a five year plan for its research. This award stimulated more planning and research collaborations across NIOSH divisions and more focused and detailed planning than had occurred previously in the HLR program. The HLR program also decided that the new noise or hearing loss projects to be funded by the NORA intramural NIOSH program initiative for 2001 would be focused on mining and construction. The new projects funded by this intramural NORA initiative were designed with a more narrow focus than the HLR program as a whole. They were intended to augment specific areas of the overall program that needed to be strengthened. The NORA proposal defined long-term objectives for this program augmentation to:
- Assess the prevalence of occupational noise exposure and related hearing sensitivity.
- Catalogue and evaluate noise control techniques.
- Identify critical gaps in the noise and hearing loss knowledge base.
- Implement and evaluate the effectiveness of noise control and hearing loss. prevention/intervention for specific occupational sectors.
- Conduct/support gap-filling research and develop data and recommendations to support standards and rule-making bodies.
- Disseminate information for health and safety professionals to establish effective hearing loss prevention programs and for workers to understand the occupational hazards to hearing and how to protect themselves from loss.
More specific aims were also defined:
- Establish national noise exposure and hearing loss databases to determine trends in occupational noise exposure and hearing loss.
- Create an “encyclopedia of effective noise control technology” for use by industry.
- Identify and prioritize gaps in knowledge for future research.
- Based on the knowledge gap list, develop sector-specific information for rule makers and work sites for preventing noise exposure and hearing loss.
- Convene workshops or symposia to obtain input, facilitate collaboration, and disseminate findings.
- Establish a Noise Program Management Workgroup (NIOSH and external hearing loss research leaders) to coordinate and review the proposed NORA projects and to make periodic recommendations to the NIOSH director on the focus of the HLR program.
All of those areas except the Workgroup are included in our current plans and goals.
Recently, two additional HLR planning efforts have emerged. One of these is the Mining Health and Safety Research Program Plan, which was developed as an overall strategic plan for the NIOSH mining research program. This plan is the result of work over the nine years since the PRL and Spokane Research Laboratory divisions of the U.S. Bureau of Mines became part of NIOSH. Research Goal 2 of this plan is “Reduce Noise-induced Hearing Loss (NIHL) in the Mining Industry.” Intermediate goals and corresponding performance measures have also been defined. The intermediate goals for the NIHL Research Goal in mining are:
- Develop and maintain a noise source/mine worker exposure database for prioritizing noise control technology.
- Develop engineering noise control technologies applicable to surface and underground mining equipment.
- Empower workers to acquire and pursue more effective hearing conservation actions.
- Improve the reliability of communication in noisy workplaces.
Finally, a new strategic planning effort for the overall HLR program was initiated in 2004, with the end of the five-year NORA program work in sight and the announcement of a new alignment of NIOSH research programs. To promote the development of that prospective plan, a “Futures Workshop” was conducted in April, 2005. Its purpose was to bring stakeholders and internal and external researchers together to discuss emerging topics and priorities. The emerging issues summarized in this workshop are discussed in more detail later in this package.