its research and information dissemination. Taking into account several important factors beyond the program’s control, the committee found that over the past decade (the period covered by this review), the Hearing Loss Research Program has made meaningful contributions to improving worker health and safety.

Using a five-point scoring scale (where 5 is highest), the committee assigned the research program a score of 4 for impact, indicating that the program has made a moderate contribution on the basis of end outcomes (improvements in worker health or safety) or well-accepted intermediate outcomes (use or adoption of work by stakeholders). However, some of the program’s work appears to be too narrowly targeted or directed to activities that are secondary to meeting the needs of protecting the hearing of workers. For this reason the committee assigned a score of 3 for relevance, indicating that often the research focuses on lesser priorities and is loosely or only indirectly connected to workplace protection.

To enhance the relevance and impact of its work and fulfill its stated mission of providing national and world leadership to reduce the prevalence of occupational hearing loss through a focused program of research and prevention, the committee recommends that the NIOSH Hearing Loss Research Program foster effective leadership in program planning and implementation; further implement program evaluation efforts; gain access to additional intramural and extramural expertise, especially in epidemiology and noise control engineering; and initiate and sustain efforts to obtain surveillance data for occupational hearing loss and workplace noise exposure.

The National Institute for Occupational Safety and Health (NIOSH) has included prevention of occupational hearing loss as part of its research portfolio since its establishment by the Occupational Safety and Health Act of 1970 (P.L. 91-596). Occupational hearing loss is a serious concern, although the number of workers affected is uncertain. Using data from the 1980s and early 1990s (the most recent available), NIOSH estimated that at least 4 million workers in the United States were exposed to workplace noise levels that put them at risk of hearing loss. Some workers may be at risk due to exposure to ototoxic chemicals. Occupational hearing loss may impede communication and contribute to safety hazards in the workplace, and it may adversely affect other aspects of workers’ lives.

In conjunction with planned reviews of up to 15 NIOSH research programs, the Institute of Medicine (IOM) convened a committee of experts to review the NIOSH Hearing Loss Research Program to evaluate the relevance of its work to improvements in occupational safety and health and the impact of NIOSH re-

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