Abstract
BACKGROUND: Studies suggest electronic dance music attendees (EDMAs) may use hearing protection (HP) more than non-EDM attendees (non-EDMAs), but reasons remain unclear. This study explores EDMA community characteristics that may explain this disparity and strategies to increase non-EDMAs' HP use. METHODS: An anonymous survey was distributed to online music forums. Descriptive statistics, t tests, and Pearson's chi-square tests were conducted alongside propensity-score matching to analyze EDMA and non-EDMAs, accounting for demographics and attendance characteristics. Multivariable logistic and ordinal regressions examined factors related to use and increased frequency of general HP and high-fidelity earplugs (HFE), adjusting for sociodemographic, attendance, and symptom characteristics. RESULTS: 2022 participants (EDMAs: n = 1049; non-EDMAs: n = 1153) were studied. EDMAs attended more live music events (> 20 events, p < 0.001) for longer durations and reported greater postevent tinnitus and trouble hearing others (all p < 0.05). After matching, EDMAs showed greater HP use (70.47% vs. 59.40%, p < 0.001), consistency ("often or always": 48.49% vs. 29.56%, p < 0.001), and preference for HFEs (64.52% vs. 31.45%, p < 0.001). They showed greater concern for hearing damage and belief in HP efficacy (p < 0.001). More non-EDMAs viewed HP as unnecessary or harmful to music quality (p < 0.05). More EDMAs reported use of their selected modality of HP from social media or acquaintance referral (p < 0.001). In multivariable regression models, EDMAs had increased odds of general HP use (OR:1.96, 95% CI: 1.53-2.51, p < 0.001), specific HFE use (OR:2.98, 2.23-4.00, p < 0.001), and HP usage frequency (OR:1.60, 1.30-1.95, p < 0.001). CONCLUSIONS: Leveraging social networks and community-driven awareness-particularly promoting HFEs and addressing concerns about music quality-may enhance non-EDMA HP uptake.