Emily Gao

Background/Objectives: Music is an important component of quality of life and is increasingly recognized as a meaningful patient-centered outcome in hearing healthcare. Although individuals with hearing loss frequently report reduced enjoyment of music, research in this area has focused on auditory perception, including pitch, timbre, melody, and sound quality. Consequently, music enjoyment is often conceptualized and measured primarily through perceptual performance, despite growing evidence that enjoyment represents a broader subjective experience. Methods: This narrative review examines the current conceptualization of music enjoyment in individuals with hearing loss by integrating literature from audiology, music psychology, affective neuroscience, and patient-reported outcome measurement. Results: We discuss music enjoyment as a multidimensional construct influenced by, but not limited to, auditory perception. Additional determinants include emotional reward, musical engagement, prior musical experience, expectations, identity, listening behaviors, and social context. We further examine evidence demonstrating that music perception and music enjoyment, while related, may diverge substantially across individuals with hearing loss, highlighting the limitations of equating perceptual fidelity with patient experience. Finally, we consider the implications of this conceptual distinction for hearing rehabilitation and music-related outcome measurement. Conclusions: We argue that a broader patient-centered understanding of music enjoyment is necessary to guide future research, inform clinical practice, and support the development of next-generation patient-reported outcome measures capable of capturing the complexity of music experience in individuals with hearing loss.

Objective: Hearing aids (HAs) and cochlear implants (CIs) improve speech perception for individuals with hearing loss (HL), yet their impact on music outcomes remains unclear. We examined music perception, engagement, and reward in a large cohort of individuals across various hearing conditions. Study design: Cross‐sectional survey. Setting: Tertiary academic medical center and community. Methods: Adults (≥18 years) including normal hearing (NH) individuals, unaided individuals with HL, HA users, and CI users were assessed using the Barcelona Music Reward Questionnaire (BMRQ), Goldsmiths Musical Sophistication Index perceptual abilities subscale (GMSI‐PA), and music engagement items. ANOVA/ANCOVA was used to assess group differences, adjusting for age, gender, race, education, and musical training. Results: Among 201 participants (NH = 30, unaided HL = 23, HA = 84, CI = 64; 55.2% female; mean age 61.3), hearing status was associated with perceptual abilities; in particular, CI users had lower perceptual abilities than other groups (CI adjusted mean = 33.1 vs 38.6‐42.9 for NH, unaided HL, HA; all P < .01). However, non‐perceptual factors, including musical training and age, were stronger determinants of engagement and reward than hearing condition. A 1‐SD increase in musical training (10.1 points) was associated with a 3.1‐point increase in GMSI‐PA, 21.7 additional listening days/year, 32.3 additional participation days/year, and 3.1‐point increase in BMRQ. Conclusion: Poorer hearing status was associated with reduced music perception but not engagement or reward, even among CI users. Non‐perceptual factors like musical training and age may play a stronger role in explaining individual differences, highlighting the role of modifiable behavioral factors in enhancing music reward for individuals with HL.

To describe trends in emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) PrEP uptake in 2012-2018 and characterize high risk individuals who use PrEP. The study identified individuals aged ≥ 15 years old with claims suggesting high risk for HIV infection in the IBM MarketScan® Commercial Claims and Multi-state Medicaid Databases. High risk was defined using ICD codes indicating high risk sexual behavior or rectal/repeated bacterial sexually transmitted infection (STI). The index date was defined as the earliest of the first high risk sexual behavior diagnosis, the first rectal bacterial STI diagnosis, or the second non-rectal bacterial STI diagnosis within 12 months. Individuals were considered PrEP users if they had at least one FTC/TDF PrEP prescription within 12 months of index date. Individuals with evidence of HIV prior to or within 30 days after PrEP initiation/index date were excluded. Comorbidities were assessed using a modified Charlson Comorbidity Index that excluded HIV/AIDS. FTC/TDF PrEP uptake increased from 0.1% to 7.3% among commercially insured individuals between 2012-2018, and from 0.01% to 0.5% among Medicaid insured individuals between 2012-2017. Individuals ≥ 35 years old had the largest increase in PrEP uptake (0.1% to 13.0%), while those 16-25 years old had the smallest increase (0.03% to 2.3%). The largest proportion of PrEP users across all years were aged 25-34 while the largest proportion of non-PrEP users were aged 18-24. Compared to PrEP users, a larger proportion of PrEP non-users were female (62.9% vs. 1.4%, p < 0.05) and blacks/African American (49.1% vs. 40.3%, p < 0.05). A larger proportion of PrEP users had a risk status of homosexual (46.6% vs. 1.5%, p < 0.05) or bisexual (3.9% vs. 0.8%, p < 0.05) behavior than non-PrEP users. PrEP users also had more comorbidities than non-users among individuals with Medicaid and were less likely to have fee-for-service insurance plans overall (p < 0.05). Table 1. Characteristics of people at high-risk for HIV who do vs. do not use FTC/TDF PrEP measured during the follow-up period Despite an increase in FTC/TDF PrEP initiations, uptake was low, especially among young adults, women, heterosexuals and blacks/African Americans. Low initiation rates in these groups may illustrate that FTC/TDF PrEP is not meeting the needs of all high-risk individuals. Mo Zhou, PhD, Merck & Co., Inc. (Consultant) Yan Song, PhD, Merck & Co., Inc. (Consultant) Emily Gao, MS, MPH, Merck & Co., Inc. (Consultant) Yohance Whiteside, PhD, MSPH, Merck & Co., Inc. (Employee) Emma Billmyer, BA, Merck & Co., Inc. (Consultant) James Signorovitch, PhD, Merck & Co., Inc. (Consultant)