Exploring the Awareness of Noise-Induced Hearing Loss from Headphone Use: A Cross-Sectional Study Integrating the Health Belief Model and COM-B Framework

<b>Background/Objectives:</b> Noise-induced hearing loss (NIHL) is a growing public health concern, particularly with the widespread use of personal listening devices (PLDs). Limited evidence exists on NIHL awareness and risk factors in the Northern Border Region of Saudi Arabia. This study assessed awareness of NIHL associated with headphone use, identified associated risk factors and preventive attitudes, and interpreted the findings using the Health Belief Model (HBM) and the COM-B framework. <b>Methods:</b> A cross-sectional survey was conducted among 462 adults (18-60 years) using a validated online questionnaire distributed via social media. The collected data included demographics, PLD utilization, manifestations of hearing loss, knowledge, attitudes, and risk factors. Analysis included descriptive statistics and mapping results to HBM and COM-B constructs. <b>Results:</b> Among respondents, 54.3% were male, and 61.9% held a university degree. Additionally, 40.7% regularly used headphones/earphones, and 53.9% reported exposure to workplace noise. Overall, 74.7% noted at least one symptom of hearing loss, and 42.4% experienced tinnitus. Age, smoking, chronic disease, family history, workplace noise, and PLD use frequency/duration were significantly associated with hearing loss problems (all <i>p</i> < 0.05). While 78.4% recognized high-volume risk, only 58.0% believed NIHL is preventable. Social media was the primary source of information, and most participants favored device- or behavior-based interventions. Model-based analysis revealed gaps in perceived susceptibility and behavioral capability. <b>Conclusions:</b> Despite moderate general awareness, substantial knowledge gaps and unsafe listening behaviors persist. Integration of HBM and COM-B analysis highlights the need for tailored public health approaches and multifaceted NIHL prevention strategies.