Translation of the Youth Attitude to Noise Scale and evaluation of Samoan university student attitudes towards recreational and environmental noise: A cross-sectional study to support the development of noise health promotion strategies

Abstract

Objectives:

According to the World Health Organisation, nearly 50% of people aged 12–35 years worldwide are at risk of permanent hearing loss due to excessive and prolonged recreational and environmental noise exposure. There is no research literature on noise-induced hearing loss in the Pacific Islands. This study was conducted in order to support the development of public health policies and health promotion campaigns aimed at addressing preventable hearing loss among youth and young adults in Samoa.

Methods:

The Youth Attitude to Noise Scale is a validated 19-item questionnaire requiring a response on the 5-point Likert scale. The Youth Attitude to Noise Scale was formally translated into Samoan, and a bilingual version (English/Samoan) was administered to university students in Samoa to assess their attitudes towards recreational and environmental noise. Participants (N = 129, 39.5% male, 38% female, 22.5% missing data) represented the School of Medicine (N = 24), the Center for Samoan Studies (N = 29), and the Faculty of Technical Education (N = 76). Age range was 15–30 years (mean = 19.54, median = 19.00, SD = 2.9).

Results:

A total of 61.2% of participants agreed that there should be more rules/regulations for the sound levels in society, with more female students agreeing with this statement than male; 46.6% felt entertainment venues were too loud, with more medical students supporting this statement than either technical education or Samoan Studies students. A total of 72.9% agreed it should be quiet in classrooms; 60.5% were prepared to help make the educational environments quieter; 58.9% responded that listening to music helps them concentrate when doing homework; and 45.7% responded that it was difficult to concentrate when surrounded by many different sounds.

Conclusion:

Results indicated that there was a readiness among young adults to participate in the co-design of noise health policies, including the development of noise health promotion campaigns.

Keywords

Noise exposure recreational noise environmental noise young adults public health health policy pacific islands

Background

According to the World Health Organisation (WHO), nearly 50% of people aged 12–35 years worldwide are at risk of permanent hearing loss due to excessive and prolonged recreational and environmental noise exposure.¹ The WHO ‘Make Listening Safe’ Initiative is a collaboration between the WHO and the International Telecommunication Union that aims to reduce this avoidable cause of permanent hearing loss among youth and young adults. In addition to preventing hearing loss, reducing the level of excessive noise exposure should also reduce adverse consequences such as tinnitus, headaches and poor sleep and concentration.²

Health promotion plays a central role in the prevention of this avoidable cause of hearing loss among youth and young adults. Research from high-income nations has investigated various health strategies and education models that may successfully address noise-induced hearing loss among different age groups, including children, adolescents and young adults.^3
–6 Positive attitudes are known to act as catalysts for hearing health behaviour change,⁷ and studies have demonstrated the positive impact of health promotion and health education campaigns for improved attitudes and hearing protection behaviours among youth and young adults.^3,8
–14 Indeed, the role of positive attitudes appears to have a greater impact on hearing health behaviour change among youth and young adults than simply increasing their knowledge of noise-induced hearing loss.¹⁵

A review of the literature found studies from high-income nations investigating the attitudes of university students towards environmental and recreational noise exposure. Students generally reported at least some recreational noise exposure, including nightclubs and sporting events, and positive attitudes towards the use of hearing protection were most influenced by temporary or permanent tinnitus (ringing in the ears) and ear pain.^16
–19 Given the likely high prevalence of tinnitus among the young adult age group from recreational noise, health promotion activities may prove more relevant by emphasising tinnitus, rather than hearing loss, in their campaigns.^20
–24 Furthermore, the role of peers for behaviour choices in this age group cannot be underestimated.²⁵ The research available also suggests some differences in attitudes between the genders, with male university students showing a more favourable attitude towards excessive noise, and female students displaying less risky behaviour towards noise exposure.^26,27 Differences were also noted between university students based on their chosen field of study, with music students more concerned about noise-induced hearing loss than other university students²⁸; this is unsurprising given that excessive noise exposure is a daily occupational health hazard for this cohort of students, and for whom hearing health is essential to their professional success.

The literature review revealed one study from New Zealand that investigated attitudes to noise and hearing loss among Pasifika university students.²⁹ The study population (N = 96) was predominantly female (82.3%), the majority were born in New Zealand (65%), and the highest Pasifika ethnicities represented were Tongan (32.3%) and Samoan (24%). Although the overall findings reported a neutral attitude to noise, there was also a positive attitude to influencing the sound environment, as well as a negative attitude towards daily noise. The authors noted risky noise behaviour alongside a high awareness of the negative impact of excessive noise exposure, and attribute this seeming discrepancy to the perception of noise as a ‘normal’ part of life for young Pasifika adults. The authors further note that while this study provides the first information on attitudes to noise among a Pasifika population, the results should not be generalised to Pacific Islanders residing in the Pacific Islands.

The literature also revealed four studies from low and middle-income countries (LMICs) regarding noise-induced hearing loss among university students. A study from Jordan found that 58% of university students experienced symptoms of hearing damage, and that 56.3% would consider using earplugs following information received during hearing health promotion sessions.³⁰ Among first-year health science students in South Africa, knowledge was excellent for the symptoms associated with excessive use of personal audio devices (77.7%–93.3%), with the exception of knowledge of permanent hearing loss as a consequence of excessive recreational noise exposure (69.5%).³¹ Another study from South Africa found that university students enrolled in the Education Department (N = 462) had a good general knowledge of noise, but required more information on the adverse impacts of loud noise.³² A study of university students in Chile found negative attitudes to noise among participants who self-reported a sensitivity to noise, or who reported experiencing ear pain following excessive noise exposure.³³ Although studies were also found from LMICs investigating knowledge and attitudes to noise among adolescents,^34,35 no studies on noise-induced hearing loss were found for the Pacific Islands among any age group.

The youth attitude to noise scale (YANS) questionnaire emerges as the most frequently used instrument in the research literature for the assessment of attitudes to noise among youth and young adults. The YANS first appeared in 2006 in a study for the 17–21 age group,²⁷ and the lead/original authors again used the YANS for a study with university students in 2007.³⁶ It has been translated into multiple languages,^37
–41 and has been demonstrated to show good test-retest reliability.⁴² It may be used to provide baseline data of attitudes towards noise among young people, and then repeated at a future date to evaluate the impact of hearing health promotion activities. The YANS uses the following four factors to evaluate attitudes towards recreational and environmental noise: (1) noise associated with youth culture, (2) noise associated with concentration, (3) attitudes towards daily noise and (4) attitudes towards influencing one’s sound environment. The YANS includes questions regarding environmental noise in educational settings, and results may therefore provide support for implementing noise policies to promote and maximise learning ability. These policies should benefit not only the students but also all staff members at the educational institution.

Given the scarcity of ear and hearing health specialists in the Pacific islands,^43,44 a public health approach to addressing hearing disorders in this region is strongly advocated. Although attention is usually prioritised for hearing health among young children and older adults,^45
–47 health promotion activities aimed at youth and young adults should significantly reduce the burden of hearing loss into the future.⁴⁸ For this reason, this study was conducted in the Polynesian nation of Samoa to enable a collaboration between the Ear, Nose and Throat (ENT) Department and the Health Promotion Unit of the Ministry of Health, with the aim of developing hearing health promotion strategies for youth and young adults in Samoa.⁴⁸ This includes both hearing health education campaigns and advocacy for the implementation of formal noise health policies in public spaces. This is the first study of its kind for our region, and our findings may be translational to our Pacific Island neighbours, and benefit the development of noise health policies in recreational venues and learning/educational environments.

Methods

This study used quantitative methodology to assess university student attitudes to noise with a bilingual questionnaire instrument.

Ethical approval was obtained from the Health Research Ethical Committee of the Government of Samoa Ministry of Health and the University Research Ethical Committee of the National University of Samoa. The study was also registered/ratified by the University of Queensland Medical Ethics Research Committee (2023/HE0009000). Gatekeeper approval was also obtained from the participating faculties/schools of the National University of Samoa.

Translation of the study questionnaire from English to FaaSamoa

This study aimed to adhere to best practice recommendations for the translation and cultural adaptation of audiology questionnaires.⁴⁹ The original English questionnaire was translated into Samoan by the Centre for Samoan Studies (National University of Samoa) under the leadership of senior linguistics lecturer and qualified Samoan translator (GH). Bilingual field expert review of the translation was performed by a Samoan ENT surgeon residing in New Zealand (PAF) and the Head of the School of Medicine (National University of Samoa) (RTP). Best practice advises a back translation; however, this was not performed due to resource restrictions. The first participants were recruited from the School of Medicine, and the first 10 participants were invited to provide feedback on the translations. Final amendments were made as advised. The final questionnaire was bilingual with both English and FaaSamoa (Appendix A).

The research team considered whether reliability, exploratory and confirmatory factor analyses should be performed. The decision was made that a translation of the validated YANS instrument (which would be administered bilingually) would suffice for our purposes for this preliminary study.

Study questionnaire administration

Given time and resource restrictions, a convenience sampling design was selected. From July to October 2022, the following schools/faculties of the National University of Samoa were approached for participation in the study: School of Medicine, School of Nursing, Centre for Samoan Studies, Faculty of Technical Education and the Faculty of Education. All expressed interest and support for the study, however, given competing priorities towards the end of semester, data were only collected from students enrolled in the School of Medicine, Centre of Samoan Studies and the Faculty of Technical Education from July to October 2022.

Inclusion criteria for the study was enrolment in the participating school/faculty, presence in class on the day of data collection and provision of written informed consent. There were no exclusion criteria. A hard copy of the bilingual questionnaire was completed voluntarily, independently and anonymously by the participants during pre-arranged class times. The questionnaire initially required participants to complete demographic information (gender/age). The questionnaire then consisted of 19 statements, and the students were instructed to respond to each statement with ‘Strongly Agree’, ‘Agree’, ‘Neutral’, ‘Disagree’ or ‘Strongly Disagree’ and to mark their response in the appropriate box with an ‘X’. Completion of the questionnaire took 10–15 min.

Data handling and statistical analysis

The completed questionnaires were collected and safely stored by the designated research team member at each participating school/faculty (RTP, GH, LT), who then ensured they were delivered to the chief investigator (AK) for data handling and entry. The chief investigator (AK) finalised participant demographic information during data entry by entering the appropriate school/faculty for each participant. All data were entered into a purposefully designed IBM SPSS Statistical Software Package spreadsheet.

All data analysis was done by the chief investigator (AK) in collaboration with the University of Queensland (CD), which included consultation with the departmental biostatistician. Participant responses were tallied for each question according to age, gender and university school/faculty subgroup. Correlation analyses were performed to investigate for any significant associations, and further Chi-squared tests were performed as appropriate to investigate for any significant differences in response proportions between subgroups.

To evaluate whether attitudes were anti-noise, neutral, or pro-noise, this study followed a similar methodology to that of the original study.³⁶ The response to each question was allocated a score (Strongly Disagree = 1, Disagree = 2, Neutral = 3, Agree = 4 and Strongly Agree = 5), and reverse coding was applied to the appropriate questions items (i.e. Questions 1, 3, 4, 7, 12, 13, 15, 18, 19). The mean, median and standard deviation was calculated for each question item, and then grouped according to the four questionnaire factors under investigation. For each of the 19 questions and each of the four factors, attitudes were assessed as anti-noise (score < 3), neutral (score = 3) or pro-noise (score > 3).

Results

Participant demographic information

The study population consisted of 129 university students (39.5% male, 38% female, 22.5% missing data), and represented the School of Medicine (N = 24), the Centre for Samoan Studies (N = 29), and the Faculty of Technical Education (N = 76). Age range was 15–30 years (mean = 19.54, median = 19.00, SD = 2.9). An overview of the study population is provided in Table 1.

Table 1.

Demographic information for study participants (n = 129).

Gender	School of medicine	Faculty of technical education	Centre for Samoan studies	Total
Male	5	43	3	51
Female	11	19	19	49
Sub-total	16	62	22	100
Missing gender information	8	14	7	29
Total	24	76	29	129

Attitudes of university students to recreational and environmental noise

An overall summary of study results is provided in Table 2. The results are described below according to the four questionnaire factors under investigation. Correlation analyses and Chi-squared tests of significance were conducted for gender and school of study subgroups only (i.e. age distribution of study population did not warrant investigation). Overall attitudes towards noise according to the four factors are summarised in Table 3.

Table 2.

Overall summary of study results (n = 129).

	Statement	Strongly disagree N (%)	Disagree N (%)	Combined strongly disagree/disagree N (%)	Neutral N (%)	Agree N (%)	Strongly agree N (%)	Combined agree/strongly agree N (%)	Missing N (%)
1	I think that the sound level at discos, dances, rock concerts and sporting events, in general, is too loud	18 (14)	26 (20.2)	44 (34.2)	25 (19.4)	34 (26.4)	26 (20.2)	60 (46.6)	0 (0)
2	Listening to music while doing homework helps me to concentrate	12 (9.3)	19 (14.7)	31 (24)	22 (17.1)	51 (39.5)	25 (19.4)	76 (58.9)	0 (0)
3	I am prepared to do something to make the school environment quieter	10 (7.8)	14 (10.9)	24 (18.7)	25 919.4)	50 (38.8)	28 (21.7)	78 (60.5)	2 (1.6)
4	I consider leaving a disco, dance, rock concert or sporting event if the sound level is too loud	15 (11.6)	19 (14.7)	34 (26.3)	24 (18.6)	51 (39.5)	20 (15.5)	71 (55)	0 (0)
5	I can concentrate even if there are many different sounds around me	27 (20.9)	32 (24.8)	59 (45.7)	19 (14.7)	35 (27.1)	16 (12.4)	51 (39.5)	0 (0)
6	I think it is unnecessary to use earplugs when I am at a disco dance, rock concert or sporting event	16 (12.4)	30 (23.3)	46 (35.7)	23 (17.8)	42 (32.6)	14 (10.9)	56 (43.5)	4 (3.1)
7	It is important for me to make my sound environment more comfortable	10 (7.8)	11 (8.5)	21 (16.3)	16 (12.4)	45 (34.9)	46 (35.7)	91 (70.6)	1 (0.8)
8	I don’t like when it is quiet around me	27 (20.9)	38 (29.5)	65 (50.4)	30 (23.3)	26 (20.2)	8 (6.2)	34 (26.4)	0 (0)
9	The sound level at discos, dances, rock concerts and sporting events is not a problem	16 (12.4)	23 (17.8)	39 (30.2)	20 (15.5)	49 (38.0)	21 (16.3)	70 (54.3)	0 (0)
10	Noise and loud sounds are natural parts of our society	9 (7.0)	29 (22.5)	38 (29.5)	17 (13.2)	45 (34.9)	25 (19.4)	70 (54.3)	4 (3.1)
11	Traffic noise is not disturbing	26 (20.2)	35 (27.1)	61 (47.3)	16 (12.4)	35 (27.1)	13 (10.1)	48 (37.2)	4 (3.1)
12	The sound level should be lowered at discos, dances, rock concerts and sporting events	11 (8.5)	30 (23.3)	41 (31.8)	23 (17.8)	35 (27.1)	23 (17.8)	58 (44.9)	7 (5.4)
13	I think it should be quiet and calm in the classroom	7 (5.4)	8 (6.2)	15 (11.6)	15 (11.6)	46 (35.7)	48 (37.2)	94 (72.9)	5 (3.9)
14	Sounds from fans, refrigerators, computers, etc., do not disturb me	9 (7.0)	34 (26.4)	43 (33.4)	16 (12.4)	46 (35.7)	21 (16.3)	67 (52)	3 (2.3)
15	I am prepared to give up activities where the sound level is too loud	14 (10.9)	30 (23.3)	44 (34.2)	25 (19.4)	41 (31.8)	14 (10.9)	55 (42.7)	5 (3.9)
16	The sound level at my school is comfortable	13 (10.1)	15 (11.6)	28 (21.7)	20 (15.5)	55 (42.6)	22 (17.1)	77 (59.7)	4 (3.1)
17	It is easy for me to ignore traffic noise	16 (12.4)	26 (20.2)	42 (32.6)	20 (15.5)	46 (35.7)	17 (13.2)	63 (48.9)	4 (3.1)
18	There should more rules or regulations for the sound levels in society	15 (11.6)	10 (7.8)	25 (19.4)	22 (17.1)	47 (36.4)	32 (24.8)	79 (61.2)	3 (2.3)
19	When I cannot get rid of sounds that bother me, I feel helpless	15 (11.6)	28 (21.7)	43 (33.3)	21 (16.3)	36 (27.9)	26 (20.2)	62 (48.1)	3 (2.3)

Table 3.

Overall summary of results according to the four factors (*anti-noise (score < 3), neutral (score = 3), or pro-noise (score > 3)).

Factor	Question	Mean	Median	Interpretation*	Overall mean	Overall interpretation*
Noise associated with youth culture	1	2.81	3	Neutral	2.88	Anti-noise
	4	2.67	2	Anti-noise
	9	3.28	4	Pro-noise
	10	3.38	4	Pro-noise
	12	2.76	3	Neutral
	15	2.88	3	Neutral
	18	2.44	2	Anti-noise
Noise associated with concentration	11	2.79	3	Neutral	3.096	Pro-noise
	14	3.29	4	Pro-noise
	16	3.46	4	Pro-noise
	17	3.18	4	Pro-noise
	19	2.76	3	Neutral
Attitudes towards daily noise	2	3.45	4	Pro-noise	2.735	Anti-noise
	5	2.85	3	Neutral
	8	2.61	2	Anti-noise
	13	2.03	2	Anti-noise
Attitudes towards influencing one’s sound environment	3	2.43	2	Anti-noise	2.55	Anti-noise
	6	3.06	3	Neutral
	7	2.17	2	Anti-noise

Factor 1: Noise associated with youth culture (questions 1, 4, 9, 10, 12, 15, 18)

Results showed that 61.2% of participants agreed or strongly agreed that there should be more rules and regulations on noise levels, while 19.4% of participants selected disagree or strongly disagree, and 17.1% remained neutral. Results also showed that 46.6% of participants agreed or strongly agreed that sound levels at recreational venues was generally too loud, while 54.3% of participants agreed or strongly agreed that noise levels are not a problem at recreational venues. There were 44.9% of participants who agreed or strongly agreed that sounds levels needed to be lowered at recreational venues, while 31.8% participants disagreed or strongly disagreed with this statement.

There were 55% of participants who agreed or strongly agreed with the statement that they would leave a recreational venue if the noise was too loud, while 26.3% selected disagree or strongly disagree and 18.6% remained neutral. There were 42.7% participants who would consider giving up activities where the sound levels were too high, while 34.2% disagreed or strongly disagreed with this statement.

There were 54.3% of participants who agreed or strongly agreed that noise and loud sounds are a natural part of society.

A significant difference in response proportions was found for the gender variable, with significantly more female (69%) than male participants (58%) agreeing that there should be more rules and regulations for sound levels in society, χ² (1, N = 100) = 4.72, p= 0.029. No other significant differences in gender response proportions were found for this group of items.

A significant difference in response proportions was found among the three different fields of study subgroups, with more medical students (75%) agreeing that noise levels at entertainment venues are too loud in comparison to technical education students (46%) (χ² (1, N = 100) = 7.14, p= 0.0007) and Samoan studies students (24%) (χ² (1, N = 53) = 8.27, p = 0.004). There was no significant difference between the technical education and Samoan studies students for this item, χ² (1, N = 105) = 0.35, p= 0.553668. Similarly, significantly more medical students (54%) felt that noise levels at entertainment venues were a problem in comparison to technical education students (28%) (χ² (1, N = 100) = 12.15, p= 0.000491) and Samoan Studies students (13%) (χ² (1, N = 53) = 11.79, p= 0.000593). Again, there was no significant difference between the technical education and Samoan studies students for this item, χ² (1, N = 105) = 2.58, p= 0.107714 . A significantly higher proportion of Samoan Studies students (48%) did not think that the sound levels need to be lowered at entertainment or sporting events, in comparison to their medical student (13%) (χ² (1, N = 53) = 7.54, p= 0.006) and technical education student (34%) (χ² (1, N = 105) = 3.84, p= 0.049929) counterparts. There was no significant difference between the medical and technical education students for this item, χ² (1, N = 100) = 3.79, p= 0.051516. No other significant differences in fields of study response proportions were found for this group of items.

Regarding attitudes towards noise associated with youth culture, an overview of responses suggested an overall anti-noise trend (mean = 2.88). Only questions 9 (mean = 3.28) and 10 (mean = 3.38) were pro-noise, suggesting that noise levels are not a problem within the context of these two items.

Factor 2: Noise associated with concentration (questions 11, 14, 16, 17, 19)

There were 59.7% of participants who agreed or strongly agreed that the sound level at the university is comfortable, while 21.7% disagreed or strongly disagreed and 15.5% remained neutral. Results showed that 52% of participants agreed or strongly agreed that they are not disturbed by environmental sounds such as fans, fridges or computers.

There were 47.3% of participants who disagreed or strongly disagreed with the statement that traffic noise is not disturbing to them (i.e. traffic noise IS bothersome); however, 48.9% of participants also agreed or strongly agreed that it is easy for them to ignore traffic noise. A total of 48.1% of participants indicated that they felt helpless when they cannot get rid of noise that is bothersome.

A significant difference in response proportions was found for the gender variable, with significantly more female participants (57%) bothered by traffic noise than male participants (38%), χ² (1, N = 100) = 7.6, p= 0.005806. No other significant differences in gender response proportions were found for this group of items.

A significant difference in response proportions was found between fields of study subgroups, with significantly more Samoan Studies students (68%) bothered by traffic noise than technical education students (39%), χ² (1, N = 105) = 13.98, p= 0.000184. In contrast, significantly more Samoan Studies students (72%) were not bothered by environmental noise from fridges/fans/computers than technical education students (44%), χ² (1, N = 105) = 8.37, p = 0.003807. No other significant differences in fields of study response proportions were found for this group of items.

Regarding attitudes towards noise associated with ability to concentrate, an overview of responses suggests an overall pro-noise trend (mean = 3.096): environmental noise does not significantly impact on the ability to concentrate.

Factor 3: Attitudes towards daily noise (questions 2, 5, 8, 13)

There were 72.9% of participants who agreed or strongly agreed that it should be quiet and calm in the classroom, while 11.6% disagreed or strongly disagreed and 11.6% remained neutral. Results showed that 45.7% of participants disagreed or strongly disagreed with the statement that they are able to concentrate when there are many different sounds around them, and 50.4% disagreed or strongly disagreed with the statement that they do not like when it is quiet around them (i.e. they DO like the quiet).

There were 58.9% of participants who agreed or strongly agreed that music helped them to concentrate when studying, while 24% disagreed or strongly disagreed, and 17.1% remained neutral.

There were no significant differences in response proportions for this group of items between gender and field of study subgroups.

Regarding attitudes towards daily noise, an overview of responses suggests an overall anti-noise trend (mean = 2.735). Only responses towards question 2 were pro-noise (mean = 3.45), with students indicating that music helps with concentration while studying.

Factor 4: Attitudes towards influencing one’s sound environment (questions 3, 6, 7)

There were 70.6% of participants who agreed or strongly agreed that it is important to make the sound environment more comfortable, and 60.5% also agreed or strongly agreed that they were prepared to make the university environment quieter.

There were 43.5% of participants who agreed or strongly agreed with the statement that it was unnecessary to wear earplugs at loud recreational venues, while 35.7% disagreed or strongly disagreed and 17.8% remained neutral.

A significant difference in response proportions was found for the gender variable, with significantly more female (81%) than male participants (60%) agreeing it was important to make their sound environment more comfortable, χ² (1, N = 100) = 7.67, p= 0.005588. No other significant differences in gender response proportions were found for this group of items.

A significant difference in response proportions was found among fields of study subgroups, with significantly less technical education students (58%) agreeing it was important to make their sound environment more comfortable than either the medical students (95%) (χ² (1, N = 100) = 7.45, p= 0.00634) or Samoan Studies students (82%) (χ² (1, N = 105) = 7.83, p= 0.005128). No other significant differences in field of study response proportions were found for this group of items.

Regarding attitudes towards influencing one’s sound environment, on overview of responses suggests an overall anti-noise trend (mean = 2.55): students are willing to improve environmental sound levels.

Discussion

From a health promotion perspective on public health policy development, key findings of the present study were that (1) 61.2% of participants felt that there should be more rules/regulations regarding noise levels in society, (2) 46.6% felt that noise levels at entertainment venues were too high, (3) 44.9% felt that sound levels at recreational venues need to be lowered, (4) 55% would leave entertainment venues where the noise levels were too high and (5) 42.7% would consider giving up activities in venues were the sound levels were too high. These results may serve as a catalyst for public noise health policy formulation and implementation for entertainment/recreational and sporting venues. Policy development should benefit from a co-design approach, where venue management and young adult representatives are included in the shaping of noise health policies that promote hearing health and recreational enjoyment for all people at entertainment venues.

Regarding noise health policy development for the educational environment, key findings were that (1) 72.9% of participants felt that it should be quiet and calm in the classroom, (2) 70.6% felt that it is important to make the sound environment more comfortable and (3) 60.5% were prepared to make the university environment quieter. Although a positive result from the present study was that 59.7% of participants agreed that the sound levels at university are already comfortable, this still indicates that there is room for improvement. At this stage, there is no noise health policy at the university, and again this study may serve as a catalyst for the formulation and implementation of noise health policies for the university environment to optimise learning and productivity for both students and staff members. Again, a co-design approach that includes all stakeholders is recommended to ensure health policies are relevant and acceptable to the university-based populations.

While the results of this study provide support for noise health policy formulation, the relatively even distribution of ‘agree/strongly agree’ and ‘disagree/strongly disagree’ responses across most questionnaire items highlights the fact that health promotion campaigns must accompany noise health policy implementation to optimise their success. Again, a co-designed collaboration that includes young adults should prove most beneficial to the crafting of suitable noise health campaigns in Samoa.

It is difficult to compare our findings with other studies that used the YANS with the university age group given the different methodologies in data analysis. A descriptive approach was the most appropriate for our purposes. Similar to previous research,^26,27 this study found significant differences between responses among our male and female participants, with female participants showing less ‘risky’ attitudes towards noise: our Samoan cohort of female university students were more bothered by traffic noise than male counterparts, felt that a comfortable sound environment was more important to them, and showed more support for the implementation of rules and regulations for noise levels in society. Similar to previous research,²⁸ this study showed some significant differences between responses based on the field of study of participants: medical students were significantly more concerned about noise levels at entertainment and sporting events than their technical education and Samoan Studies counterparts. The question on disturbance by traffic noise found that both gender and field of study variables were significant; however, this is most likely explained by the fact that most technical education students were male, and most Samoan Studies students were female.

The YANS was selected for this study given that it is the most commonly used instrument in other studies of this kind. Researchers have explored alternative methods for research addressing noise-induced hearing loss among youth and young adults, including novel questionnaires^50,51 and the social representation theory approach.^52,53 As advocated above, co-design is again promoted for future research studies on the prevention of noise-induced hearing loss to ensure all stakeholders inform the research design on which and how noise health policies should be formulated and developed.

Limitations

There are potentially several limitations associated with the study instrument. While best translation practice was adhered to as much as possible, the double-negative in the English language may have caused some confusion: we tried to limit this confusion by providing a bilingual questionnaire for students to simultaneously have English and FaaSamoan versions of the questions. As stated above, the YANS was able to serve a preliminary purpose for this study; however, a co-design approach for future noise health promotion research and policy development is strongly advocated.

From a study design perspective, limitations of the study were that we used convenience sampling and did not calculate/justify a sample size. From our clinical and health promotion perspective, participation in the study for both university students and the academic staff was in itself a health promotion activity that positively raised awareness about noise exposure and hearing loss among this population.

Future studies would also benefit from collecting data on ear and hearing health of participants (i.e. hearing aid user, experiences tinnitus, etc) to assess whether/how these variables impact on attitudes towards recreational and environmental noise exposure.

Conclusion

More than half of young adults agreed that there should be more rules/regulations regarding noise levels in society, and almost half agreed that noise levels at entertainment venues are too high. More than half of university students responded that they are willing to make the university learning environment quieter. These findings suggest a generally ‘anti-noise’ attitude and goodwill from students to engage in co-designed health campaigns and/or public health policies to reduce the adverse effects from excessive recreational and environmental noise in Samoa.

Supplemental Material

sj-docx-1-smo-10.1177_20503121251333980 – Supplemental material for Translation of the Youth Attitude to Noise Scale and evaluation of Samoan university student attitudes towards recreational and environmental noise: A cross-sectional study to support the development of noise health promotion strategies

Supplemental material, sj-docx-1-smo-10.1177_20503121251333980 for Translation of the Youth Attitude to Noise Scale and evaluation of Samoan university student attitudes towards recreational and environmental noise: A cross-sectional study to support the development of noise health promotion strategies by Annette Kaspar, Rossana Tofaeono-Pifeleti, Galumalemana Hunkin, Lineta Tamanikaiyaroi, Carlie Driscoll and Sione Pifeleti in SAGE Open Medicine

Footnotes

Acknowledgements

The authors wish to acknowledge Miracle Faautu who participated in the translation of the questionnaire during her final year of study at the Centre of Samoan Studies (National University of Samoa). The authors also wish to acknowledge Dr Penaia A Faumuina (ENT Surgeon) as our bilingual field expert who provided feedback on the translation of the questionnaire.

ORCID iD

Annette Kaspar

Ethical considerations

Consent to participate

All willing participants were required to sign an informed consent form. Written informed consent was obtained from all subjects before the study. Following discussion with Samoan co-investigators, the decision was made that it was appropriate for all students to sign their own consent forms (i.e. 17-year-old students did not need parent/guardian consent to take part in the study). The research and journal draft manuscript were reviewed by the Health Research Ethical Committee of the Government of Samoa Ministry of Health and approved for submission for publication in a research journal; the method of obtaining consent from the minor participants was approved by the Institutional Review Board.

Author contributions/CRediT

Annette Kaspar: Conceptualisation, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Visualisation, Writing – original draft, Writing – review & editing, Lead investigator, Research Concept & Design, Data Analysis, Writing of Journal Manuscript. Rossana Tofaeono-Pifeleti: Data Curation, Project Administration, Writing – review & editing, Data Collection, Feedback on Journal Manuscript. Galumalemana Hunkin: Data Curation, Project Administration, Writing – review & editing, Data Collection, Feedback on Journal Manuscript. Lineta Tamanikaiyaroi: Data Curation, Project Administration, Writing – review & editing, Data Collection, Feedback on Journal Manuscript. Carlie Driscoll: Formal analysis, Supervision, Validation, Writing – review & editing, Data Analysis, Feedback on Journal Manuscript. Sione Pifeleti: Investigation, Writing – review & editing, Feedback on Journal Manuscript.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Data availability

Requests for data may be made to the corresponding author and are subject to approval from the Government of Samoa Health Research Ethical Committee. This is a condition of the approval to publish the present research findings. The data underlying this article will be shared on reasonable request to the corresponding author.

Supplemental material

Supplemental material for this article is available online.

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Supplementary Material

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