development of a few standards for these devices. the ansi/cta standard 2051 on "personal sound amplification performance criteria" followed in 2017. it specified a maximum output sound pressure level of 120 db spl. in 2019, the itu published standard itu-t h.871 called "safe listening guidelines for personal sound amplifiers". this standard recommends that psaps measure the weekly sound dose and adhere to a weekly maximum of less than 80 dba for 40 hours. psaps that cannot measure weekly sound dose should limit the maximum output of the device to 95 dba. it also recommends that psaps provide clear alerts in their user guides, packaging, and ads mentioning the risks of ear damage that can result from using the device and providing information on how to avoid these risks. a technical paper describing how to test the compliance of various personal audio systems/devices to the essential/mandatory and optional features of recommendation itu-t h.870 was published in 2021. entertainment venues live rock concert at indoor entertainment venue both those working in the music industry and those enjoying recreational music at venues and events can be at risk of experiencing hearing disorders. in 2019, the who published a report summarizing regulations for control of sound exposure in entertainment venues in belgium, france, and switzerland. the case studies were published as an initial step towards the development of a who regulatory framework for control of sound exposure in entertainment venues. in 2020, a couple of reports described exposure scenarios and procedures in use during entertainment events. these took into account the safety of those attending an event, those exposed occupationally to the high intensity music, as well as those in surrounding neighborhoods. technical solutions, practices of monitoring and on-stage sound are presented, as well as the problems of enforcing environmental noise regulations in an urban environment, with country specific examples. several different regulatory approaches have been implemented to manage sound levels and minimize the risk of hearing damage for those attending music venues. a report published in 2020 identified 18 regulations regarding sound levels in entertainment venues – 12 from europe and the remainder from cities or states in north and south america. legislative approaches include: sound level limitations, real-time sound exposure monitoring, mandatory supply of hearing protection devices, signage and warning requirements, loudspeaker placement restrictions, and ensuring patrons can access quiet zones or rest areas. the effectiveness of these measures in reducing the risk of hearing damage has not been evaluated, but the adaptation of the approaches described above is consistent with the general principles of the hierarchy of controls used to manage exposure to noise in workplaces. patrons of music venues have indicated their preference for lower sound levels and can be receptive when earplugs are provided or made accessible. this finding may be region or country-specific. in 2018, the u.s. centers for disease control and prevention published the results of a survey of u.s. adults related to the use of a hearing protection device during exposure to loud sounds at recreational events. overall, more than four of five reported never or seldom wearing hearing protection devices when attending a loud athletic or entertainment event. adults aged 35 years and older were significantly more likely to not wear hearing protection than were young adults aged 18–24 years. among adults who frequently enjoy attending sporting events, women were twice as likely as men to seldom or never wear hearing protection. adults who were more likely to wear protection had at least some college education or had higher household incomes. adults with hearing impairment or with a deaf or hard-of-hearing household member were significantly more likely to wear their protective devices. the challenges in implementing measures to reduce risks to hearing in a wide range of entertainment venues – whether through mandatory or voluntary guidelines, with or without enforcement – are significant. it requires involvement from many different professional groups and buy-in from both venue managers and users. the who and itu global standard for venues and events released on world hearing day 2022 offers resources to facilitate action. the standard details six features recommended for safe listening venues and events. the standard can be used by governments to implement legislation, by owners and managers of venues and events to protect their clientele, and by audio engineers, and by other staff. a 2023 survey showed that u.s. adults acknowledge the risks posed by high sound exposures at concerts and other events. results indicated an interest towards protective actions, such as limiting sound levels, posting warning signs, and wearing hearing protection. fifty four percent of the study participants agreed that sound levels at concert venues should be limited to reduce risk for hearing disorders, seventy five percent agreed that warning signs should be posted when sound levels are likely to exceed safe levels, and 61% of respondents stated that they would wear hearing protection if s provided when sound levels were likely to exceed safe levels. personal interventions while establishing effective public and community health interventions, enacting appropriate legislation and regulations, and developing pertinent standards for listening and audio systems are all important in establishing a societal infrastructure for safe listening, individuals can take steps to ensure that their personal listening habits minimize their risk of hearing problems. personal safe listening strategies include: listening to plss at safe levels, such as 60% of the volume range. noise-cancelling headphones and sound-isolating earphones can help one avoid turning the volume up to overcome loud background noise. sound measurement apps can help one find out how loud sounds are. if not measuring the sound levels, a good rule of thumb is that sounds are potentially hazardous if it is necessary to speak in a raised voice to be heard by someone an arm's length away. moving away from the sound or using hearing protection are approaches to reduce exposure levels. monitoring the amount of time spent in loud activities helps one manage risk. whenever possible, take a break between exposures so the ears can rest and recover. watching for warning signs of hearing loss. tinnitus, difficulty hearing high pitched sounds (such as birds singing or cell phone notifications), and trouble understanding speech in background noise can be indicators of hearing loss. getting a hearing test regularly. the american speech language hearing association recommends that school-aged children be screened for hearing loss annually from kindergarten through the third grade, then again in 7th and 11th grade. adults should have their hearing tested every ten years until they reach age 50, and every three years after that. hearing should be tested sooner if any warning signs develop. teaching children and young adults about the hazards of overexposure to loud sounds and how to practice safe listening habits could help protect their hearing. good role models in their own listening habits could also prompt healthy listening habits. health care professionals have the opportunity to educate patients about relevant hearing risks and promote safe listening habits. as part of their health promotion activities, hearing professionals can recommend appropriate hearing protection when necessary and provide information, training and fit-testing to ensure individuals are adequately but not overly protected. wearing earplugs to concerts has been shown to be an effective way to reduce post-concert temporary hearing changes.