A Review of Helth Effect of Aircraft Noise

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Special supplement

A review of the health effects of aircraft noiseStephen Marrell, Richard Tay/or and David Ly/e

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REVIEW

A review of health effects of aircraft noise*Stephen Morrell and Richard TaylorDepartment ofPublic Health and Community Medicine, Universit;' of SydneyDavid LyleNew South Wales Health Department, Sydney

Abstract: Social surveys have established dose-response relationships between aircraftnoise and annoyance, v.rith a number of psychological symptoms being positively relatedto annoyance. Evidence that exposure to aircraft noise is associate'cl with higher psychiatric hospital admission rates is mixed. Some evidence exists of an association betweenaircraft noise exposure and use of psychotropic medications. People with a pre-existingpsychological or psychiatric condition may be more susceptible to the effects of exposureto aircraft noise. Aircraft noise can produce effects on electroencephalogram sleep patterns and cause \\'akefulness and difficulty in sleeping. Attendances at general practitioners, self-reported health problems and use of medications, have been associated \\rithexposure to aircraft noise, bu t some findings are inconsistent.Some association between aircraft noise exposure and elevated mean blood pressurehas been observed in cross-sectional studies of schoolchildren, but with little confirmation from cohort studies. There is no convincing e\1.dence to suggest that all-cause orcause-specific mortality is increased by exposure to aircraft noise. There is no strong evidence that aircraft noise has significant perinatal effects.Using the "Vorld Health Organizat ion definit ion of health, which includes positivemental and social wellbeing, aircraft noise is responsible for considerable ill-health.However, population-based studies have not found strong e,ridence that people livingnear o r under aircraft flight paths suffer higher rates of clinical morbidity or mortality asa consequence of exposure to aircraft noise. A dearth of high quality studies in this areaprecludes drawing substantive conclusions. (,lust N ZJ Public Health 1997; 21: 221-36)

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T HE introduction ofjet aircraft on commercialrou tes in the 19505 was associated \ \ ith majorincreases in noise and disruption to residentsaround large airports. Since the 1960s, ,.,'hen je t aircraft came to dominate air traffic around airports,increases in complaints to public officials and airports have been a catalyst for research into theeffects of aircraft overflights in Australia and el5e,..;here.1 The grmvth in the l iterature has reflectedcon tinu ing and increasing concerns about th eeffects of aircraft noise on the physical and mentalhealth of exposed populations. Populations near orunder the flight paths of Heathrow (London), LosAngeles and Schiphol (Amsterdam) airports, in particular, have been s tudied in some detail.Aircraft noise may produce a variety of psychosocial and e conomic effects on humans, whichinclude: interference \'lith quality of life andamenity. declines in property values, effects onscholastic per fo rmance and various effects onhealth.Of the three major types of definitions of health,that most commonly quoted is by the World HealthOrganization: 'health is no t merely the absence ofdisease or infirmity but is a positive state of physical,mental and social well-being'.'2 This definition is

Correspondence to A.ssociate Professor Richard Tay1or,Department of Public Health and Community 1\1edicine, Facultyof \1edicine, A'27, Cni\'ersit\' of Svdne\', : \'S\ \' 2006. Fax (02)9351 4l79. ..excluding auditory effects

inadequate for population-based studies , s ince itdoes not include premature death (al though it doesinclude illness and disability), and there is a lack ofagreed measures of wellbeing.Health can be considered as successful adaptationof individuals or groups to environmental circumstanceS. This requires that 'successful adaptation' bedefined. On an individual level, this is usually considered to be independent living and normal socialinteraction, and therefore can include well-adjustedpeople ,\1.th severe physical handicap. On a population level, it may be considered as perpetuation ofthe species at near zero population grmvth \vith minimal environmental disturbance, or adjustment toen,1.ronmental changes with little or no social dislocation. In relation to aircraft noise, those who adaptwould be considered healthv, while those '\'.;ho donot might be considered unhealthy.The third, or 'classical' approach is to considertha t people are hea lt hy unt il they are detenninedno t to be so, and to use a range of comparative population measures ofmortality, morbidity and impairment to determine the relative health of variousgroups. This approach has the advantage of usingroutinely available data, but there is difficulty indefining 'disease' at the margins. For example, inmenta l hea lth t he defmi ti on and separat ion areindistinct between clinical anxiety and depressionon the one hand, and anger, annoyance, irritation,sadness, loss of morale and other normal sensationson the other. Furthermore, disagreement in themedical l iterature on the role played by 'st ress ' in

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the aetioloblJ' of illness indicates current uncertaintyregarding plausible biological pathways for mentaland emotional states in 'determining' or 'predetermining' physical health. CIResearch on the health effects of noise has severalpoints of departure. In the least rigorous studies,exposed persons relate not only what they considerto be health concerns, but also attribute th e cause toaircraft noise (for example, on complaint hotlinesetc.). On firmer ground, health practitioners maypu t together case series of instances in which anadverse effect may plausibly be attributable to envi-ronmen tal noise on the basis of knov,'Il pathophysiology. The hest approach is open-ended orhypothesis-driven studies, which seek to identify pos-sible adverse health outcomes in popu la tion s (o rsamples) by separately measuring noise exposureand possible health effects, and changes in theseoyer time.Possible health effects on individuals andpopulations exposed to th e noise of aircraftmovementsFor this review, th e possible (nonauditory) healtheffects have been classified by the authors as: psy-chological effects, acute physiological effects andeffects on sleep, possible chronic cardiovasculareffects, effects on morbidity and mortality of populations, and perinatal effects. The main explanatorypathways proposed for physical health effect.,; ofnoise is that they may be med iat ed by 'stress'(including psychosocial stress), anxiety and/or perceiyed lack of control over the source of exposure. 4Furthermore, annoyance and cognitive effects ofnoise, and ideation about the possibility ofa crash inthe context of aircraft noise may merge into psycho-logical effects, particularly in the presence of additional effect modifiers (property O1\'nership,atti tudes), which may then cause physical effects.

People who live in close proximity to aircraft flightpaths tend to be of lower socioeconomic status thanthose who do not. Levels of morbidit\' and mortalityamong populations v:ith low s o c i o e ~ o n o m i c s t a t u ~haye long been known to be significantly higherthan among populations of average or high socio-economic status." As a major source of potential con-founding, soc ioeconomic status is particularlydifficult to correct , especially in ecological studies.Complicating the picture is the possible influence ofm o d i ~ i n g factors, such as ownership of residence(and concern with property values); individual sen-siti\;!), to noi se; and fear of an aircraft crash.Moreover, as a result of the combination of exposureand modifying factors on population migration,people li,ing under flight paths in the long termcould well be a selected population.There may be adverse health effects due to m e a ~sures t aken to r educe the exposure to noise in thedomestic en\;ronment, such as reductions in outdoor

physical and social activities. Sealing and closure ofthe home associated with sound insulation mayreduce ventilation and increase t he spread of ai1:borne infections, or encourage the proliferation ofdust mite and thus increase the pre\'alence of asthma.

Finally, an important scenario to consider is thatphysical effects of noise may manifest in susceptiblesubgroups \\'ithin populations through psychologi-cally rrtediated aggravation of existing physical ormental conditions or precipitation of complications:for example, triggering of dysrhythmias in personswith heart disease, or acute psychotic episodes inthose with mental illness.Methods and scopeThis literature review includes international studiesof the relationship bervveen aircraft noise andindices of psychological and physical health. It con-centrates on English-language publications, andfocuses on studies that have examined the nonauditorv health effects of aircraft noise. Auditor\' effectsof ~ o i s e have been well described, bu t are ~ o con-sidered of importance in relation to exposure toch'ilian aircraft noise. Aspects of cognitive and taskperformance are not covered in detail. Death orinjUlT from aircraft crashes in populated areas is no treviewed here, nor are studies of possible associa-tions between health and atmospheric pollut ionfrom aircraft emissions.The literature on stress and health, especially

regarding acute versus chronic effects, is brieflyappraised in relation to the major models ofstress-disease association that commonly' underpinreported effects of aircraft noise on health.Studies \vere assessed by standard epidemiological

criteria, including: study type, control of confounding and bias, measurement of exposure andresponse, strength of association and dose-responseeffect, numbers of subjects, and statistical signifi-cance. E\,;dence of causality "was assessed accordingto criteria outlined by Bradford Hill. 6Of the journal articles and report.'; examined, 129

separate references are i nc luded in this re\iew;about 350 were found no t to be sufficiently perti-nent to be inc luded, mos t o ft en because the\' werereview articles rather than primary r e s ~ a r c h .Publications were obtained through automatedsearches of several major bibliographic databasesincluding Medline and the Online ComputerLibrary Centre. and through secondary searches ofbibliographies accompanying relevant journal arti-cles. A considerable proportion of the literaturf're\'iev>,'ed is no t listed on Medline. :Many publications\-",ere available only in report form, and these wereobtained from the organisations that produced thereports.Stress, anxiety and physical health'Stress' has been suggested as the major mechanismthrough which noise can affect mental and physicalhealth.' Physiologically, stress manifests as a complexof autonomic endocrine processes centred on thepituitary-adrenocortical axis.1> Se1ye employed theterm to refer to the physiological reaction of thebody to an en\ironmental threat or challenge, andelaborated a stress response scenario called the 'general adaptation syndrome'.!! An imp0rtant contribution was also made by Cannon's investigation of therole of adrenaline in the 'flight or fight' response. Hi

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Stress can manifest itself as a prolonged or acutephenomenon.The stress response has been found to be modified b ~ innate or learned predispositions of theorganism. 11 For example, consistent cardiovascularfindings have emerged pOinting to a posit ive rela

tionship betv..,'een coronary heart disease and hostility.':!-H\'\11ile haemodynamic reactivity is regarded as a

marker for hypertension,15 at least one prospectivestudy presents evidence that heightened haemodynamic r e a c t i v i t ~ , . - t o stress can precede future elevatedblood pressure levels by a considerable period. '6Xeyertheless, increased blood pressure labili ty as aresult of long-term exposure to intermittent stresSOl'S has not been shown to be a cause of sustainedhypertension.l'i"11' The number of factors, bothendogenous and exogenous, that can contribute toindividual yariations in blood pressure is large.Some of these include age, sex, body habitus andsomatotype, muscle mass, electrolyte and glucosemetabolism, habitual and recent dietary intakes ofsalt, potassium, caffeine, alcohol and nicotine.Cardiovascular conditions may resul t from situations percei\'ed by the respondent to be psychologically stressful, bu t findings have no t been uniform.Some studies have shO\\'11 a relat ion between perceived stress and anxietv and fatal and/or nonfatalcoronary arterv events l ~ J , ~ ( l pointing to evidence ofan a s s o ~ i a t i o n hetweed chronic psychological stressand coronary heart disease. However, con trar)' evidence comes from a study of 1040 bus drivers in SanFrancisco whose self-reported st ress was relateddirectly to gastrointestinal, respiratory and musculoskeletal ailments but inversely related to levels ofh ~ " p e r t e n s i o n . 1 1Peaks of blood pressure are not as significant a

predictor for hypertension as mean 24-hour bloodpressure level.22 Studies have yet to establish that sustained hypertension in humans results from stress,regardless of differing response modes to stressors,and despite ample laboratory and naturalistic eyidence of transitory blood pressure effects inducedby stressors, including tha t induced by noise (seebibliography by T h O l l l p s o n 2 ~ ) .The role of acute stress (as distinct from chronicstress) in precipitating arrhythmia and stroke is con

\incing, and has often been deriyed from case seriesor case-control studies that v-,'ere a byproduct ofother i m ' e s t i g a t i o n s . 2 ' l - 2 ~ 1Annoyance reactions to aircraft noiseSocial sun'evs on noise annoyance have been carriedout in England, France,' Switzerland, Sweden,l-nited States of America, "",'est Germanv, andAustralia. l Borsky is credited as the first to' assessannoyance in terms of reported disturbance of specific activities including conversation, watching tele\ision, and sleeping.1.311 Subsequent suryeys have alsoprO\ided data on general annoyance, without directreference to specific acti\ities.The predictive validity of noise metrics vis a visannoyance was examined bv Schultz when he svnthesised th e results of 11' international s u r \ ' ~ y s

EFFECTS OF AIRCRAFT NOISE

between 1 ~ 6 1 and 1974: six studies of aircraft noise,four of traffic noise, and one railroad sun'ey. Schultzfound a consistent relationship bet\veen nonimpulsive noise exposure (measured by Ldll , an averageday-night sound level) and community annoyance,inespecth'e of its source."l The dose-response relationship has been reproduced in more recent community s u r v e y s . : ~ 2 _ : l : i Support for Schultz 's synthesishas not been unanimous (for example, Griffiths:-\4).

Other studies have shown that th e associationbenveen noise exposure and annoyance does varyaccording to source,35-37 while th e level of background noise (for example, road traffic) may no tinfluence reported annoyance from aircraftnoise.3us.3YFor their own 1981 population survey of residents

around Svdnev, Adelaide, Perth and Melbourne airports, Hede and Bullen proposed using a lower levelof reaction as a cut-off point, on e more broadlybased on affectedness, dissatisfaction, three annovance ratings, and fear of an aircraft c r a s h . 3 ~ Theiroutcome measure was designated as the percentage'seriously .affected', rath er than the percentage'highly annoyed'. The investigators found that atAustralian noise exposure forecast (Ac"EF) of 20, 12per cent of r e s i d e n t ~ were seriously affected by aircraft noise and 38 pe r cent were at least moderatelyaffected. At Aol\EF of 35, 36 per cent of residentswere seriously affected and 73 pe r cent were at leastmoderately affected.

Bjorkman et al. found a significant relationshipbern'een exposure and annoyance 'when exposurewas measured as the number of noise events above70 dBA-when these events occur red more thanthree times daily.40 The finding suggests that annoyance reaction may be more highly correlated ",:ithexposure \vhen th e basis is metrics Vlith counts ofextreme noise events r athe r than energy-averagedmeasures.

It remains to be established if noise metrics basedpartly on annoyance-reaction levels are appropriatefor conelating with possible health outcomes.Despite the predictive yalue of noise measures

using aggregated data, noise metrics fail to predictindi\idual responses to noise accurately. signifyingthat noise is no t th e only factor inyolved in annoyance reactions. Psychosocial factors affect perception and annoyance reactions to noise in communitysuryeys.:\O.-4I--J:I ) ,Annoyance reactions are greater in people who

indicate a fear of aircraft crashes, are concernedabout the hea lth effects of noise, or report interference \'\o1th acti\1ties such as watching tele\,ision, talking and s l e e p i n g . g ~ Recorded aircraft noise, when itinterfered with tasks requiring concentration (forinstance, proofreading and figure-tracing), was perceived to be more annoying and less pleasant thanthe same noise when these tasks were no t beingattempted. 44 People \'\-'ho report t ha t they are sensitive to noise , so cal led 'noise sensitive' people, arealso more likely to indicate intense anno)-"ance reactions.I:H;Hh

Studies have been repo rted to show that: 1.sociodemographic factors of age, sex, marital status

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and socioeconomic status have low correlation \: of about 1700 health-related complaintsattributed to aircraft noise (from about 450 callers),about 20 per cent concerned sleeping difficulties; asimilar proportion ''''ere about increased (mental)tension; 15 per cent about increased anxiet\'; andabout 10 per cent about fatigue. Other complaint'ii nc luded heada che, pol lu ti on effects, tinnitus,breathing difficulties and sleeping an d concentrat ion difficulties of children. 1\0 i nfonna tion onexposure ,vas reported. 51Results reported by Lercher of a survev of 1989respondents from five villages in r ura l A ~ s t r i a suggest an association bet\veen aircraft noise exposureabove 55 dBA (assigned levels), an d higher levels ofreporting of tiredness, nenrousness, 'loss of wellbeing and safety', sleep dis turbance , headache andpalpitations:):t These were adjusted for age, sex andeducation. \"rhen annoyance was taken into account,the association was stronger. The participation ratefor this study (62 per cent) could render some of itsfindings biased in tha t the remaining 38 per cent of

the populat ion would probably cOlltain a comparatively 10\,,' proportion of noise-sensitive persons.From a review of general noise-reaction studies

between 1963 and 1985/>:'1 we estimated from thequoted correlations pertinent to aircraf t noise that,on average, about 20 per cent of th e \ 'ariat ion inindividual reaction (that is, individuals vvith indi\1dually measured exposure levels) to aircraf t noise isexplained by exposure level; and around 72 per centof group reaction is explained by the exposure level(that is, ecological, in groups ass igned to broadexposure categories). Moreover, th e findings ofBjorkman et al. and Lercher appear to suggest thatannoyance and reaction is correlated more highlyV \ ~ t h exposure when the latter is measured as countsof extreme events rather than as energy-averagednoise levels.Mental healthPsychiatric hospital admissionsIn 1969 an ecological retrospective study of populations living in boroughs surrounding London 'sHeathrowAirport reported significantly higher ratesof admissions to the Springfield psychiatric hospitalamong th e noise-exposed populat ion than those living i n a reas with low aircraft-noise exposure."4 Totalan d first-time admissions over a t\vo-year period(mid-1966 to mid-1968) were examined. Admissionrates for all groups taken together, all females (bothtotal an d first-time admissions), all females over 45years of age (both total an d first-time admissions),and all \\1dows (both total and first-time admissions)were significantly higher in the noise-exposed population than in the low-noise region. Obsen'ed valueswere consistently higher than expected values forthe high-noise areas , even if statistical significancewas no t reached in some strata. Potential confounders-for example, ease of access to mentalhealth care facilities or differences in age structurean d socioeconomic status of the populat ions beingcompared-were no t adjusted for.

The above admissions study was repeated for theyears 1970 to 1972.5:' .After adjustments were madebenveen the high-exposure an d low-exposure populations for age, sex and marital status, the findings ofthe earl ier study were not replicated.Jenkins et aJ.'s subsequent study of on e of the psy

chiatric hospitals in the Abey-\fickrama et aJ. study(but covering a wider area and longer period) founda negative relat ionship between aircraf t noise andadmission rates. 56 A funher study of admissions tothree psychiatric hospitals around Heathrow Airportby Jenkins et al., after partial control of several measures of socioeconomic status, failed to find a consistent relationship bet\veen noise exposure an dadmission rate by hospital. There was a positive association bet\veen higher admission rates and noiseexposure at t\\'o hospitals, bu t a negative associationfor the other.-17

In an attempt to resolve the apparent contradiction bet\veen the negative dose-response relationship in admission rates by hospital, Kryterreanalysed data fromJenkins e t a lY an d showed thatimmigrant status in the study population was

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strongly and negatively correlated with psychiatrichospital admission; that th e proportion of immigrants in on e hospital catchment area was significantly higher; and that th e distribution ofimmigrants was skewed more toward the highernoise contours in that hospital's catchment areathan in the catchment areas fo r th e other tv\'o hospit a l s . ~ ' According to Kryter, the negativedose-response result ofJenkins et al. was an artefactbecause insufficient allowance was made fo r immigrant status of the populat ion fo r that particular hospital.:\mong residents near Los Angeles InternationalAirport, admissions to mental hospitals from a highnoise area were found to be 29 per cent higher thanin lownoise-area controls (significant at th e 10 per

cent level).58 Potential effects of confounders-forexample, Mrican-Americans made up 25 per cent ofthose from th e exposed area, bu t only 2 per cent ofthose from the control areas-were not allowed for.Prevalence of psychological or psychosomaticmorbidityIf aircraft noise contributes to mental illness, it isprobable tha t differences in noninstitutional psychological or psychiatric morbidity vl'Ould be evident.The community survey of 6000 people from four

noise-exposure zones living near Heathrow Airportproduced variable results: significantly higher prevalence of recent onset of night waking, depression,irritability (along with swollen ankles, minor accidents including burns and cuts, and skin problems)occurred in those from higher noise zones (basedon energy-averaged noise contours).48 SignificantlylO'\\'er prevalence of chronic irritability ",,ras noted inlower noise zones. HO'wever, psychotropic drugintake was found to have a significant negative association in relation to noise exposure, inconsistentwith a noise-psychiatric illness or noise-symptomhypothesis. 49 These f indings fai led to replica teresults of the prior pilot study by Tarnopolsky et aI.,in ,,'hich psychiatric measures showed an association"ith noise only in those respondents v.ith high education.58

In a post al follow-up survey of annoyance andnoise sensitivity of a subsample of 77 women fromthe same survey, repeated measures of le,'els ofannoyance were more highly correlated in thosesensitive to aircraft noise (r= 0.85) than in those sensitive to road traffic or other noise (r = 0.51).Sensitivity to noise was no t a significant predictor ofpS"chological morbidity (as measured by the 30-itemGeneral Health Questionnaire). 60

In the Netherlands, Knipschild found significantlyhigher contact rates for psychological problems,mental disorders' (consis tent across degrees ofseyerity), and some 'psychosomatic complaints'(spastic colon and lower back pain) in t he tvo/O noisiest of four exposure zones around Schiphol airport(near Amsterdam).61 However, some of the differences in contact rates could have been explained bydifferences in socioeconomic status between exposure zones rather than the exposure itself, since the


fonner was no t controlled for.In 552 residents surveyed from five different noisezones (including a quiet control zone) around San

Franciico Airport , s igni ficant correlat ions werefound bet\\'een noise av ..'areness and annoyance andthe number of health problems reported from asymptoms checklist. Fear of an a ir cr af t c rashexplained most of the var iance in the quiet controlzone, whereas in th e exposed areas most of th e variance was explained by noise awareness and annoyance.50

Kryter reported on an ecological study of peopleliving near airports in the Soviet Union which founda higher incidence of 'nervous diseases', amongother conditions. 52

Studies of the effects of aircraft noise on mentalhealth are summarised in Table 1.Acute physiological effectsHormonal and autonomic effectsSpecific autonomic, honnonal, muscular, skin andrespiratory changes occur in response to noise stimulation. The pat tern of somat ic responses to unexpected noise is: a vascular response characterised byperipheral vasoconstriction, minor changes in heartrate, and increased cerebral blood flow; slO\v deepbreathing; a change in skin resistance to electricit)'!(the galvanic skin response (GSR)); and a change inskeletal muscle tension.63.64 Changes in gastrointestinal motility in relation to noise exposure have alsobeen reported. 65

Responses to continuous or regular noise fromlaboratory experiments on humans vary.7 Some studies have sho\\'11 a positive honnonal and autonomicresponse to road traffic or aircraft noise;ti6-6!l somehave shov.'11 habituation to noise in skin responseand vasoconstriction;69 others found no statisticallysignificant changes in hormonal or autonomic reactivity.70

Regarding physiological reactions to continuousor regular noise, Kryter concluded:

experimental eyidence demonstrates that autonomic syStemresponses that are probably stressful occur only after consciousor unconscious cogniti\'e processes are completed. That is tosay, sound or noises are no t inherenth' ayersive or a cause ofphysiological stress except to the ear.'This conclusion is supported by Osada et aL, who

found empirically that:the effects of level and n umbe r o f aircraft noise varied witheach physiological functions [sic] and that scarcely am' relation existed between the effects and ECP;\L [equivalent continuous perceived noise levdJ.67

Blood pressureTo date, investigations of th e effects of noise onblood pressure and hea rt rate have not producedconsistent findings. AJthough studies have shov,mincreased diastolic blood pressure to be associatedwith exposure to various kinds of noise, th e effect ofnoise on systolic blood pressure and pulse rateremains unclear.Separate studies have shown decreases in systolic

blood pressure and heart rate and increases in diastolic blood pressure 1.,rith exposure to different noisesources./1- 74 Others have found significant decreases

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Table 1: Selected studies examining the effects of aircraft noise on mental healthEHect on Noise " Confounding factorsAuthors location health measure Study type adjusted for Findings

Abey-Wickrama Heathrow, Admission to >55 NNI 0 or Ecological Sex-specific; no control Significantly higheret 01. 52 London, UK psychiatric PNdBb >100 for age or admission rates inhospital 55 NNI Ecological Age-standardised; Positive result, notTarnopolsky 53 London, UK psychiatric


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in systolic and increases in diastolic blood pressure,bu t increase in heart rate owing to n o i s e . 7 ~ ) . i 6Vasoconstriction has been observed to accompanyexposure to noise.'i-'!l Lehmann and Tamm foundan increase in peripheral arterial resistance inresponse to noise , but not in heart rate or bloodpressure/IO ,,,,hile Manninen and Aro r epor ted anincrease in diastolic pressure but n o clear responseof systolic blood pressure to noise.S ),8tRelating more directly to aircraft noise, McLean

and Tarnopolsky reported on a thesis by Mosskovwhich found significant elevation of diastolic bloodpressure a fter labo ra to ry exposu re to aircraftn o i s e . 8 3 , ~ 4 The magnitude of the response ""'as dependent on the duration of the noise exposure. Bloodpressure changes apparently attributable to aircraftnoise have also been found in schoolchildren (seesection on children, p. 230).Sleep studiesThe effects of noise on sleep have been sought variously by asking study subjects to record the numberof av:akenings or to rate the q u ~ l i t y of the previousnight's sleep; by monitoring brain activity and sleepquality during sleep using an electroencephalogram(EEG); by monitoring levels of peripheral vasoconstriction; or by measuring the amount of wakefulness or sleep disturbance by an actimeter, aninstrument for measuring bodily movement. Sleeploss and deprivation has also been s tudied in relation to autonomic, immunologic and endocrineeffects.The effects of noise on brain wave activity during

sleep have been monitored extensively. Five stages ofsleep are measured by the EEG: stages 1 to 4 (sometimes called 'non-REM' or 'NREM') and rapid eyemovement sleep (REM), during which dreamingoccurs. The dep th of sleep is said to increase in thesequential stages 1 to 4, after which there is a s lightlightening to the REM stage. There are usuallyabout five cycles of s leep a night .Loud a ircraf t noise s imulated in a laboratory

experimental setting was shown to increase the number of awakenings; older males woke to less noisethan younger males-although the resul t was no ttested for statistical significance.8" In a survey of1500 people living in four noise-level areas based ondistance from John F. Kennedy (JFK) Airport in NewYork, 60 per cent of respondents living within onemile of the airport , 33 pe r cent of those five milesaway, and less than 10 pe r cent of persons residing12 miles out reponed some sleep disturbance. 86Another study found no difference in reportedsleep quality from exposure to 80 dBA and 65 dBA

laboratory simulated je t aircraft flyovers, althoughthere was significantly less disturbance to conicalactivity during fast-V\'ave EEG activity when the quieter stimulus w a applied.Hi Ando and Hattori , in anaturalistic setting, found that deep sleep of babieswas disturbed by aircraft noise louder than 95 dBAaround Osaka i ~ t e r n a t i o n a l airport. HR There is general agreement in the literature that noise-inducedchanges in EEG stages of s leep are no t sujbect tohabituation. I


A laboratory sleep study by Carter et al. of nineadults with cardiac arrhythmia found that: en,ironmental noise levels (roa'd traffic and aircraft) of 65to 72 d])A increased arousals from sleep by aroundfivefold, regardless of sleep stage; the frequency ofventricular premature contraction (VPC) was no tincreased by noise in patientswith heart disease andmoderately frequent low-grade VPCs; arousalsoccurring during slow-wave sleep reduced the frequency of VPCs (which otherwise increased duringslow-wave s leep without being rel at ed to noiseevents); and urinary catecholamine levels were no tsignificantly affected by noise exposure. 89

Much of the preceding work on noise and sleepwas either laboratorv-based simulation or involvedsources of noise other t h a ~ aircraft. Kryter presented a detailed analysis of three studies of aircraftnoise conducted in the community. I The first, astudy by Globus et al. found a decrease in deep sleepin six couples exposed to 77 dBA, bu t no t in five cont ro l couples exposed to 57 dBA. 90 The second, astudy byVallet et aI., ploued the probability of awakening at different levels of noise exposure whichpeaked a t 'between 45 and 65 dBA.9J This did no tconfonn to laboratory data suggesting that the number of awakenings increases in parallel with thenoise.The third study referred to by Kryter was the air

craft noise s tudy by the Directorate of OperationalResearch and Analysis (DORA) which provided dataon difficulties people had getting to sleep and awakenings caused by aircraft movements aroundHeathrow and Gatwick Airports in London. 92Correlations were charted betvveen aircraft noiseand difficulty getting to sleep on specific nights andin generaL The authors concluded that sleep disturbance d id not occur until the noise level reachedLeq (an average-energy noise metric comparable toA'IEF) of 65 dBA, and that people had difficulty getti ng to s leep when it was higher than Leq 70 dBA.Kryter re-examined the DORA study graphs andargued that the critical levels should be reduced bylO dBA to 60 dBA each.'Sumitsuji et aL used a facial electromyogram(EMG), which records muscle contraction readingsas a prm,.''y for sl eep disturbance, and found anincrease in the duration of contractions in sleepers

exposed to aircraft noise.9.'\ Contrary to some otherstudies, one study found a decrease in heart rateduring n o i s e - a f f ~ c t e d sleep.'H Another study, byVaBet et aL, found no habituation of the acute heartrate response to aircraft flvovers after seven veal'S inresidents living near Roiss)' (Paris) airport.9':;'An actimetric field sleep study of 400 subjects

around eight airports in the United Kingdom (totalof 5742 nights of monitored sleep), found that differences in sleep dis turbance did no t vary greatly",,1.th different levels of exposure, although maleswere more likely to respond to aircraft noise eventsthan females.B6Results of field and laboratory studies of sleep dis

turbance from aircraft noise were compared byMaschke (Berlin) .97 Nocturnal awakenings associated with aircraft overflights increased by 100 per

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cent in laboratory subjects, compared with 80 pe rcent in field study subjects; subjective sleep gnalitywas 25 pe r cent and 30 per cent less in laboratoryand field study subjects respectively; and adrenalinesecretion was higher by 60 pe r cent in laboratorysnbjects, but only by 20 per c en t i n the field studysubjects (no indication of statistical significanceayailable); all were compared with no exposure tonocturnal aircraft noise. If similar studies can replicate these findings, the validity of extrapolating laboratory-based sleep effects without appropriateadjus tment would be doubt ful, for it appears thatthe effects of noise exposure in the laboratory onsleep is greater than in the natural setting.Sleep deprivation has been shown to affect theimmune system in various laboratory and field settings, in both animal 98 and human studies.!19 Humanimmune system effects from sleep disturbance ormild sleep deprivation have not been established.Long-term effects on healthThe long-term effects of noise on health have beenconsidered in occupational settings and residentialcommunities. 'Stress' has been suggested as themajor mechanism by which noise affects physicaland mental health, ' operating through psvchological rather than direct physiological means, and inresponse to the disruption of nonna l activities oremotional feelings (fear, annoyance ete.) tha t t henoise is known to be associated with. The proposedrelationship between stress and health is complex,not fully understood, lOO and in some dispute.Cardiovascular disease effectsIn the early 1980s several independent experts wereorganised to review critically 83 papers investigatingthe relationship of noise (industrial, transport ete.)to elevated blood pressure.101 Only one of the threecohort studies reviewed demonstrated a positiveassociation betvveen elevated blood pressure andnoise exposure. Most (44 of 55) of the cross-sectional studies showed a positive association betweennoise and elevated blood pressure, \\'ith the preYalence of high blood pressure in the noise-exposedgroups being betvveen 1.6 and 2.8 t imes that theunexposed groups. Problems identified in thesestudies included: failure to measure indi\;dual noiseexposure, lack of a standard blood pressure measurement technique and failure to adjust for knmvnconfounders. The reviewed evidence, ""hile of poorquality, was considered sufficient to justify furtherresearch in this area.During the 1970s a series of community studies

into the health effects of aircraft noise were carriedout around Schiphol airport in Holland hyKnipschild et al. These studies examined by surveyand physical examination the relat ionship betweennoise exposure and community prevalence of cardiovascular disease in 6000 residents (42 pe r cent ofthe total) aged 35 to 64 years. After a llowing forsmoking, age, sex, height and weight differencesbetween th e d iff erent populations, Knipschildfound that treatment rates for 'heart trouble' andhypertension and taking of medications for cardio-

vascular disease (especially in women) were higherin th e exposed area. 102 Prevalence of hypertensionand 'pathological heart shape' on x-ray were alsofound" to be greater in the exposed area.'Cardiovascular impairment' was found to be 50 pe rcent higher in the exposed areas. The prevalence ofhypertension was highe st in villages exposed toh ighe r than 37 1\'1\'1 (noise number index). Thestudy was affected by a high rate of nonresponse (58per cent), which may have resulted in selection bias(where a higher proportion of annoyed or noise-sensitive persons f rom th e high-noise areas may haveparticipated than from the low-noise area).Although there was adjustment for age , sex, smoking, adiposity and size of village, socioeconomic status was only par tly controlled, while dietary factorswere no t considered.

From a study of attendance rates (per population)for 19 general practitioners servicing the populationin three villages around Sch ipho l a ir po rt,Knipschild found tha t a ttendances for cardiovascula r disease in the highest noise area was greater thanfor the lower noise areas (see below also); and thatthe usage rate of antihypertensive medicationamong v\"Omen in the noisiest area was higher. 103This study, \vhile reporting positive findings, doesno t provide strong evidence because i t "''as conducted over a short period, not repeated, and didnot make adjustments for possible confounders.Stronger evidence comes from a longitudinal aggregate study by Knipschild et al. of pharmacy drug purchase data over a four-year period. This study foundthat purchase rates per population of cardiovasculardrugs (especially antihypertensive medication) correlated positively with increasing aircraft noise levels. 104In 1993 a small-area (ecological-aggregate) study

of routinely collected hospital admissions data forareas around Schiphol airport was conducted by theDutch National Institute of Public Health andEnvironmental Protection,lOS as part of a mandatoryenvironmental impact assessment accompanyingfuture expansion plans for the airport. Spatial patterns of hospital admission rates around the airportfor a cu te myocardial infarction and hypertensionduring 1991 were investigated. ~ A . f t e r empiricalBayesian methods had been us ed to smooth highlyvariable rates (which occur with small underlyingdenominator populations), no discernible noiserelated geographical pattern in hospital admissionsfor th e outcome conditions was found. The negativefinding was not surprising, because th e units ofaggregation (local government areas) ,vere too largeto conform uniformly to exposure conditions.In a number of cross-sectional, case-control and

cohort studies of acute myocardial infarction,Babisch et al. found prevalence and incidence ofischaemic heart disease to be 10 to 30 per centhigher in high-traffic-noise-exposed populationsthan in those exposed to low levels of traffic noise. lOG"Kone of the quoted results reached statistical significance at the 5 per cent level.

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General health surveysIllness and morbidityI\.oszarny et al. are reported to have found significantly more health complaints in women , but n otmen. living in a high-noisE-exposure area. 107Grandjean et aL are reported by Kryter to havefound a significantly higher use of tranquillisers andsleeping t abl et s as noise exposure increased.i,lO/iKryter attributes this increased consumption to ' theinterference effects of th e noise with sleep andspeech communications', '

Knipschild's general practitioner survey providesan estimate of incidence rates ove r a one-weekperiod. All the doctors (practically th e sole source ofprimary health care) in the four villages near th e airport were surveyed.lOC> Significantly higher attendance rates per population fo r psychologicalproblems, 'mental disorders' and some 'psychosomatic complaints' (spastic colon and lower backpain) occurred in noisy than quieter areas. The contact rate for other conditions, such as cardiovasculardisease, allergic diseases, headache and a controlcondition, did not differ significantly between th eareas. However, Knipschild noted tha t one doctor,,,hen running a clinic for aged people in the lownoise-exposure area, had recorded all the attendances as being for cardiovascular problems. Thiswould have tended to lessen differences in cardio\'ascular attendance rates between th e exposu rezones.

Knipschild's graphic presentation of total contactrate, mental disorders, psychosomatic illness, andcardiovascular disease (restricted to persons age 15to 64 years) over the four noise-exposure groupsdemonstrated clear dose-response effects (althoughstatistical significance was not given). Thereappeared to be a threshold for the general practitioner consultation rate concerning mental disorders and cardiovascular diseases at 30 l\'NI. 103 Theauthor stated that adjustment fo r age and sex wasincorporated into these analyses, and \vhile therewere minor differences in socioeconomic status, 'i tis improbable that these small differences canexplain the big differences in contact rate' .103.\djustment for factors knov:n to cause such condit ions as cardiovascular disease, such as smoking status. was not possible.Kryter tabulated data from the same study' presented in a later publication 10Y and showed significant dose-response effec ts across three noiseexposure categories fo r psychological problems, psychosomatic problems, cardioyascular disease andhypertension. It is no t clear whether these resultswere adjusted for age and sex, and it was stated thatsocioeconomic status was not taken into account.

Knipschild and Oudshoorn conducted a beforeand-after aggregate study of drug purchases in two\illages near Schiphol airport. I04 One o f th e villagesexperienced increased exposure to ai rc ra ft noi se,while noise exposure in th e other (control)remained unchanged. Purchases of prescriptiondrugs used to treat sleep disturbances, psychologicaland psychosomatic complaints, and cardiovascularand hypertensive disease were examined. The out-


come measure, a drug index, was computed fromthe ratio of th e number of drugs purchased in agiven year over th e adult population in that area fo rthat 'tear. Changes in a ircraf t noise exposure weremonitored over the four years of th e study. The drugindex increased with th e noise level in the exposedarea, while remaining stable in t he con trol area.During the study period, th e a re a initially experiencing increased a irc ra ft noise later had itsexposure levels lowered, and th e drug index Correspondingly declined. The authors did no statisticaltesting because of the exploratory nature of th estudy. Despite this, aggregate evidence of this kindwhere t he outcome measure and th e study factorvary together over time is more convincing than static associations.

Meier and Muller found an increased consumption of hypnotic drugs in relation to aircraft noise. lIDThis f inding is in contrast to th e results of theHeathrow community survey, which found a significant negative relationship bet\veen psychotropicdrug use and noise exposure.49

In response to the opening of the new paralle lrunway in 1994 at Sydney airport, a general practicesurvey was conducted by Doctors Educating AboutFlyovers (DEAF) involving 100 of 155 doctor s inaffected areas during th e first half of 1995. 51 Thestudy found that of 1488 symptom complaints attributed to aircraft noise (from 1016 individuals), 28 pe rcent were fo r sleep loss; 19 per cent for (mental )tension and a similar proportion for 'nonspecific'effects; headache, pollution effects, anxiety, difficulties in hearing and tinnitus, breathing difficulties,fatigue, and child sleep and concentration deficitsmade up th e remainder. Exposure information wasnot reported.MortalityTwo studies of mortality rates around Los AngelesInternational Airport were conducted in the 1970s.Meecham and Shaw, in an ecological study, observedhigher overall mortali ty in noise-exposed areas.1 llThe data from th e study was subsequently reanalysed by Frerichs et aI., vvith adjustment fo r age,sex and race, who found mortality rates to be nohigher, suggesting that the difference found InMeecham and Shavv's study was confounded byother determinants of mortality. 112

A similar stud" of aircraft flyover and mortality inSydney was repC:rted in 1979. 11:1 The exposed p ~ p u -lation, consisting of residents of local governmentareas predominantly under th e mai n aircraft flightpaths, were compared to residents of all other localgovernment areas y..rithin 10 kilometres of the airport as controls. A significantly higher number ofdeaths (age- and sex-standardised where appropriate) above expected rates for Sydney was found inthe noise-exposed population. Subgroup analyses\vere performed fo r specific conditions (for example, circulatory system disease, hypertensive disease,congenital malformations) in 0- to 5-year-olds, 45 to64-year-old females. and people 65 years and o lder(groups thought to be most exposed or susceptibleto health effects of noise). These showed further sig-

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nifican t differences between t he exposed populat ion , Sydney as a ",,'hole, and the con trol region.These results should to be interpreted cautiously,because, while some of the regions studied weredemographically similar, the authors did no t consider other important socioeconomic and ethnic factors associated with mortality.

In a subsequent ecological study of Sydney airport, Taylor and Lyle compared local governmentareas and postcodes exposed to a ircraf t noise withunaffected areas 'with similar socioeconomic anddemographic s ta tus wi thin the Sydney StatisticalArea. 114 In this study, exposure to aircraft noise wasdefined as the propor tion of the population of anarea or postcode to lie wi thin the 2 0 - A . . . . ~ E F contour.Outcome measures fo r th e period 1985 to 1988included mortality (all-cause and selected causes),hospital separations, and cancer incidence andmortality. Confounding variables con trol led forincluded age, sex and immigrant composition basedon individual data, and socioeconomic status basedon aggregate data fo r the areas. No strong or consistent correlations between morbidity and mortalityrates and exposure to aircraft noise were found.

Meecham and Shaw reported a further ecologicalstudy of routinely collected mortality data fo r residents around Los Angeles airport for the years 1970to 19ii.ll-, Tracts in the 90-dBA-and-above noisezone were aggregated as the test group, and selectedcensus tracts below 90 dBA matched on racial composition as th e control zone (roughly 100 000people pe r zone). The authors reported a slightlyhigher overall mortali ty rate (5 pe r cent) in thenoise-exposed area compared with th e control.Statistically significant findings were: compared withthe group in the control area, in th e noise-exposedarea cardiovascular disease mortalitv was around 18pe r cent higher in those aged 75 y e ~ r s and over; th erate of accidental death was 60 per c en t h ighe r inthose aged 75 years and over; and the suicide ratewas 100 pe r cent higher in th e 45- to 54-year agegroup. No sex breakdown was provided, and meanincome levels behveen the exposure areas were similar. Although the reported higher suicide mortalityrate ma; ' appear alanning, it should be noted thatthis is a rare event with high stochast ic variabilir:-.

A summaI1' of selected studies is shown in Table 2.Perinatal and childhood effectsPerinatalSeveral studies have examined t he assoc ia ti onbehveen aircraft noise and low birth,'\'eight, premature bir th and fetal abnormality. Ando and Hattoriexamined reproductive o u t c o ~ e s of women whohad moved f rom quieter locations to th e city ofItami, near the Osaka International Airport inJapan. 116 Birthweight was correlated ",:ith estimatesof intensity and duration of noise exposure. As well,there were significantly more babies ,vith 100v birthweight 3000 g) born in ltami over a three-yearper iod than in neighbouring cities. However, theauthors did no t adjust for several important determinants of birthweight, such as prematurity and themother's age, weight, smoking status and socioeco-

nomic status.Schell found an association bervveen aircraft noiseand gestational age in female babies, after controlling fo r maternal age, smoking and socioeconomicstatus. I " Rehm and Jansen obseIYed higher unadjusted prematurity rates with higher noise exposure,bu t statistically the result was no t significant.I!HMever et al. referred to th e art icle by Knipschild,which showed a significant association between low, birthweight and noise exposure in female babies,after controlling for parental income. lJ 9 ,120

A controversial ecological study of congenital malformations around Los Angeles InternationalAirport found a significantly higher rate of birthdefects in black people exposed to aircraft noise-after exclusion of polydactylism, a congenital anomaly-compared \\rith unexposed black people. l21This report \\'as subsequently criticised because ofth e lack of completeness and accuracy of the birthdefects data, and because potential confounding factors were no t taken into a c c o u n t . l ~ 2Edmonds et al. found that residence in high-noise

areas ( ~ 7 5 Ldn ) near Atlanta airport was significantlyassocia ted with a single birth defect, spina b if idawith hydrocephalus, but not spina bifida ,vithouthvdrocephalus. m This result was likelv to have beenan artefact of multiple comparisons, because, aspointed out by the authors, there is no e\ridence ofdiffering aetiologies fo r each type of spina bifidatha t might have caused only the on e type to occur.The authors analvsed all births from 1968 to 19i6 ofbabies 'with n e ~ r a l tube defect s, in a matchedcase-control analvsis, and found a null result (p::::0.1) after adjusting fo r hospital of birth, socioeconomic status and race. Edmonds e t at concludedthat:

Although no statistically significant association was foundbehveen the high-noise area and neural tube malformation thedat a do no t rule ou t slight association. [2'\Studies of the effects of aircraft noise on perinatal

health have been hampered by serious methodologicallimitations, both in terms of the measurement ofexposure and outcome, and failure to control forother known determinants of the outcomes underinvestigation. The lack of properly controlled studies makes it difficult t o draw conclusions aboutwhich effects aircraft noise have on perinatal outcomes.Childreneohen et al. studied pupils from four primaryschools in Los Angeles exposed to high levels of aircraft noise and compared them with pupils fromthree low-noise schools on blood pressure, distractibility and helplessness.124 The effects of noiseabatement procedures (acoustic treatment) introduced at noisy schools were also assessed. 12 ?> Thehigh-noise school students were more likely to giveup on a cognitive task after previous failure (unsolvable puzzle, a measure of helplessness); were lesseasily distracted if they had attended the school fo rup to h\'o years, about the same as th e quiet groupfo r two to four years' attendance; bu t were more easily distracted if they had attended the noisy schoolfor four years or more. No differences in reading or

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Table 2: Selected reviewed studies examining the effects of aircraft noise on cardiovascular disease and general measures ofhealthEffect on Noise Confounding factorsAuthors location health measure Study type adjusted for Findings

Graeven 48 San Francisco, Symptom


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,,-hich found that aircraft noise at levels of around 70dB in the classroom occasionally interfered withclassroom activities.' 'In a s tudy of blood pressure in children, Cahen etal. found mean systolic and diastolic blood pressures

to be significantly higher in the noise-exposedschools; the magnitude of the difference " ."as about3 mm Hg. ]24 These differences narrowed as yearsspent a t t he school increased. Reporting on the follow-up stage of the study, Cohen et al. found thatmean blood pressure readings of exposed childrenin classrooms that were noise-abated were no t significantly different from those from the unabated classr o o m ~ at noisy 5chools.12.:; No longitudinal effects,such as a widening of the difference in mean bloodpressure betvveen exposure groups, were found.This negative result may have been due to attritionbias, because a disproportionate number of childrenfrom the noisier schools who had elevated firstround blood pressure readings had left in th e interYening period. vVhile comparison schools weresimilar socioeconomical1y, high-noise schools had 32pe r cent Mrican-Americans, compared and lm't'-noise schools had 18 pe r cent Mrican-Americans.

,," study by Karsdorf and KJappach, referred to inCohen et al., found a positive correlation betweennoise levels in the classroom f rom road traffic noiseand systolic and diastolic blood pressure levels in

children.124.J27Two other studies examining the effects of domestic aircraft noise on hearing in children found nosignificant difference betvveen the noise-exposedand quiet groups.12R.12YTable 3 shows a summary of studies examining theeffects of aircraft noise on children and babies.

DiscussionResearch into the relationship of exposure to aircraft" noise to health brings into focus several questions concerning tne definition of health and theboundary, if any, between social reaction and illhealth. Such research also poses questions concerning the quality of evidence that can be accepted fordecision-making, since most studies of aircraft noiseand health would be judged as inadequate by standard epidemiological criteria.Using a definition of health that incorporates apositive sense of mental and social wellbeing, there

can be no question tha t exposure to aircraft noisecauses ill-health. There appears to be general agreement that 'energy-averaged measures of aircraftnoise exposure over a 24-hour period currently provide the best method for assessing community reaction to noise exposure. Social an d communitysUDreys and other research indicate that noise fromairports is a significant cause of community reaction

Table 3: Reviewed studies examining the effects of aircraft noise on perinatal and child healthEffect on Noise Confoundi ng factorsAuthors Location health measure Study type adjusted for Findings

Ando and Osaka, Japan Low birthweight


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and social disturbance. Social surveys in Austral iaand overseas, using grouped data that have beenused to set environmental standards for land usearound airports, have established a clear doseresponse relationship. Annoyance responses havebeen correlated with measures of psychosocial functioning and other symptomatic complaints in somestudies.

Several studies, including those by Tarnopolsky etal. an d Kryter, have shown a possible associationbetween exposure to aircraft noise and the prevalence of psychological and psychiatric symptoms.Anxiety an d depression is more prevalent in thoseexposed to aircraft noise, which would be classifiedas ill-health using both the positive and negative definitions. 'Whether these symptoms are du e to aircraftnoise exposure per se is difficult to assess becausemost evidence is cross-sectional.

Studies of psychiatric admissions in relation to aircraft noise have been contradictof\'. ' ' '"bile severalearly studies suggested an effect of ;ircraft noise onpsychiatric admissions around Heathrow an d LosAngeles International Airports, subsequent studiesaround Heathrov,' failed to replicate the findings.The early studies were ecological an d exploratory in"pe, while the later negative studies by Tarnopolskyet al. considered the effects of se\'eral importantconfounding factors, so providing better quality evidence. Re-analysis of the lat ter data by Kryter lendssupport again to the original findings.

Although responses to unexpected noises causephysiological reactions in humans, the findings concerning continuous or regular (predictable) noiseare \'aried, It has been suggested that acute physiological changes observed in association v..ith exposure to noise are media ted through psychologicalmechanisms. vVhether this is due to mechanismsassociated ""i.th personality constructs such as hostility or aggression or to noise sensitivity remainsunclear. vVhile there is evidence that noise exposuremay cause elevation in blood pressure, e\i.dence forsustained elevation when exposure is removed is no tstrong.

Overall, the evidence is relatively consistent thataircraft noise is associated with sleep loss an d awakenings, reduced quality of sleep and EEG changes,and rudimentary dose-response relationships havebeen produced. V\l1ile it is unclear how much sleeploss is required before being considered a healtheffect. no studies have detailed secondarv' effects onhealth of sleep loss ( for example, imrr'Iunologicaleffects) from aircraft noise. Interference ",,;th sleepcompromises positive mental wellbeing.

Thompson reported frequent association bet\veennoisy environments and hypertension. 1nl However,the association is primarily cross-sectional in nature,and a clear relationship between noise exposure an dhypertension has no t been confirmed by cohortstudies, although the number o f these studies hasbeen small. A cross-sectional association betvo.,'een aircraft noise and blood pressure of schoolchildren wasfound in one study,124 the implications of which areno t clear. A causal association bet\veen aircraft noiseand other forms of cardiovascular disease is no t sup-


ported by available epidemiological data becausestudies \\ith designs capable of testing the hypothesis have no t been conducted.There is no convincing evidence to suggest that

general population mortality is increased by exposure to a ircraf t noise , as differences observedaround airports appear to be related to other factorssuch as age and sex distribution, socioeconomic status an d ethnicity.

General measures of community health such asattendances at general practitioners an d prevalenceof self-reported halth problems have been associated with exposure to aircraft noise. The a s s o c i a ~tions are based primarily on ecological an dcross-sectional data, an d a clear relationship has no tbe sought by cohort studies. The purchase of psychotropic and hypertension medications have beenshown by Knipschild to be associated \"'>1th changesin aircraft noise exposure over time.

Studies of effects of aircraft noise on perinatalhealth has been hampered by serious methodologicallimitations, both in terms of the measurement ofexposure an d the fai lure to control for other knov"ndeterminants of the outcomes under investigation.The lack of properly controlled studies makes it difficult to draw conclusions about what effects aircraftnoise have on perinatal outcomes.

Future research could focus on the relationship ofannoyance reactions to measures of men tal andp h y s i ~ a l hea lth, using relevan t study designs thataltO'w control of bias an d confounding factors . Inparticular, bias in exposure measurement needs tobe addressed. Measurement an d adjustment foroccupational and domestic noise exposure fromother sources remains a significant problem whenresearchers are t1)i.ng to assess the effects of aircraftnoise. Detai led medical , psychological an d socialcase studies would be of value in refining hypothesesfor more detailed investigation. A cohort study ofsufficient size an d scope, controlling for knm\'n confounding variables, an d conducted under conditions of Changing exposures to aircraft noise, wouldbe valuable in providing evidence for causation an dquantification of possible acute , adaptative an dlong-term effects on hea lth f rom exposure to aircraft noise. Such studies could be supplemented bysmall-area ecological analyses of routinely or specially collected data such as mortality, hospital andp e r i ~ 1 a t a l morbidity and general practi tioner surveys, using the smallest census units (roughly 200 to300 households) rather than postcodes or municipalities. which are general ly too large for accurateassignment to noise exposure levels.

'\.llile there is a lack of strong evidence supporting the hypothesis that aircraft noise causes longterm effects on health, not all the hypothesisedhealth risks, such as aspects of mental health andperinatal outcomes, have been studied in detail.Other effects, because of possible long latencybet\\'een exposure and their manifestation, an dbecause of difficulties in measuring exposure andconfounding variables, require large long-term studies on populations in which individuals are followedover an extended period under changing conditions

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of exposnre.It is alv.;ays possible to criticise studies no mat te r

how well designed these may be. In the case of aircraft noise and health, ver;.: few studies capable ofprmiding high quali ty causal evidence have beenconducted. Accordingly, despite th e lack of stronge\idence linking aircraft noise to ill-health, it shouldalways be borne in mind that little, weak or no e\idence does not constitute evidence for little, weak orno effect.ReferencesI. Bullen RE. The effecL'> of aircraft noise: current knowledgeand future research directions. Bull Ausl Acousl So, 1984; 12:7 5 ~ 9 .

2. Bash d o c u m e l 1 i ~ . 40th edn. Geneva: Wor ld HealthOrg'anizatioll, 1994: 13. Freeman ZS. Stress an d hypertension-a critical review. Med

JAust 1990; 153: 621-5.4. Littman AB Review of psychosomatic a s p e c t ~ of cardiO\'ascu

la r disease. Psychothl'1" Psychosom 1993; 60: 148-67.3. :\lorrisJ:t\, Tiunuss R. Health and social change: a recent his

tOf")' of rheumatic heart disease. M"d Ufficer 1944; 2: 69-71,77-9,85-7.6. Bradford Hill A. A sltart textbook of medical statistics. Hodderand Stoug-hton, London, 1984.7. hryter KD. The effects of noise on man. Orlando, FL: Academic1985,482.s. Manu DS. La'a' JD. The me" cancepe issues and mea

surement. In: Julius S, Bassett DR, editors. Handbook ofh),/)ertemion. Fo!' 9. Behavioural factors in h)!j)l'1"lension. ~ e York:Elsevier,1987.

9. Selye HA .. Syndrome produced b ~ diverse nocuous agents.XalurE' 1936; 138: 32 [cited in Krantz an d Lazar'].10. Cannon \VB. Bodi(1' changes in pain, hunger, fear and rage. ~ e York: A p p l e t o n - C e n t u r y - C r o f t ~ , 1929 [cited i n Krantz and

Lazar'].11. Rosenman RH Type A behaviour and hypertension. In:Julius S, Bassett DR, editors. Handbooh of hypertension. HJ!. 9.B"havioum!factors in hypertension. :-\ew York: Else\ler, 1987.

12. :-'latthews KA.. Glass DC, Rosenman RH, et a1. Competitivedrive, pattern A. and coronary heart disease: a further analysis of some data from th e Western Collaborative CroupStudy.} Chronic Dis 1977; 30: 489-98 [cited in Coldstein eta J . l ~ ] .

13. Goldstein MC. !\iaura R. Psychological f a c t o r . ~ affectingphysical conditions: cardiovascular disease literaturere\lewed. PS)'cllOsomatics ] 992; 33: 134--45.

H. Dembroski TM, MacDougal l JM , Costa PT, et al.Components of hostility a:-. predictors of sudden death andmyocardial infarction in th e rVlultiple Risk FactorIntervention Trial. PS1'chosom Med 1989; 51: 514--22 [cited inColdstein et al.l:\J. -

Ei . Julius $. Hemodynamic, phannacologic an d epidemiologicevidence for behavi.oral fac tors in human hypertension. In:Julius S. Bassett DR, editors. Handbook of h)pertensioll. Vol. 9.Bl'havioura!faetars in h)per1ension. :\"ew York: Else\ler, 1987.

16. \latthews hA., \\'oodall KL, AlIen MT. Cardiovascular reactivity to stress predicts future blood pressure status. H)pertension1993; 22: 479-85.17. Julius S, Schork MA .. Predictors of h ~ ' p e r t e n s i o n . An n X } '

Arad Sci 1978: 304: 38-52.18. Horan MJ Kennedy HL, Padgett DE. Do borderline hvpertensive patients have labile blood pressure? Ann Intern Med1981; 4, 466-8.19. Roseng-ren A, Tibblin G, ,\""ilhelmsen L. Self-percei\'ed psy

chological stress and incidence of coronary ar tery disease inmiddle-aged men. Am} Cardiol1991: 68: 1171-5.

20. Kawachi I, Colditz GA, A ~ c h e r i o A, Rimm EB, CiO\'annucciE. Stampfer MJ, Vlillett WCTl. Prospective study of phobicanxiet\' and risk ofcoronan' heart disease in men. Circulation1994; 89: 1992-7. .

21. "'inklebv ~ \ ' l A . Ragland DR, Sm1e SL Self-reponed stressorsand hvpertension: evidence of an inverse association. Ali i}l:pidemio!1988; 127: 124--34.

~ 2 flickering TG. Blood pressure monitoring outside th e clinicfo r illn;:stigating the role of behavioral fac tors in hypertens ion. In: Julius S, Bassett DR. editors. Handbook of h.Tjil'1"len-sion. {,o!. 9. Bl'hrwioural factars in hY!Jertmsion. "cw York:EIsh1cr, 1987.23. Thompsoll SJ. Epidnniolorrifeasibility study: tj]er.ts oJnoise on thecmdiovasculM system. Apj)endix B: annotated bibliograj)hy.Washing-ton, DC: Environmental Protection Agency, 19,s1.[cited in Carter et al. sl ]24. BrodJ, Fencl V, Hejl Z,JirkaJ. Circulatory changes underlying blood pressure elevation during acute emotional stress(mental arithmetic) in normotensive an d hypertensive subjects. Clin Sci 1959; 18: 269.

2.:::>. Brad]. Haemodynamic basis of acute pressor reactions andhypertension. Br H,art} 1963; 25: 227.26. Reich P, DeSilva RA, Lovm B, et al. Acute psychological disturbance preceding life-threateningventricular arrhythmias.JAMA 1981; 246, 233-5. .27. Lo\', 'I1 B. DeSilva RA. Roles of psychologic stress and autonomic nervous system changes in provocation of ventricularpremature complexes. Am} Cardiol1978; 41: 979-85.28. Trev isan M, Ce1entano E, Meucei C, Farinaro E, et a1. Shortterm effect of natural disasters on coronary heart disease riskfactors. Arteriosclerosis 1986; 6: 491-4. .

29. Follick :\-1]. .>\hem DK, Corkin L, et a1. Relation of psychosocial and stress reactivity variables to ventricular arrhvthmiasin the Cardiac Arrhythmia Pilot Study (CAPS). Am j Cardiol1990; 66: 63-7.30. Borsky P::\". Community reactions t o Air Force noise. H'll.DDRejJOrt Day ton, OH: \Vright-Patterson Air Force Base, 1961:60-689 [ci ted in Bullen l ].31. Schultz TJ. Synthesis of social surveys on noise annoyance.}Acoust Sac Am ] 978; 64: 377-405.32. Hede .'\}. Bullen RB. Aircraft noise in Australia: a survey of communit," reaction. :t\AL report no. 88. Canberra: AustralianGovernment Publishing Sen1ce, ]982.33. Sehomer PD. A surve\' of community attitudes towards noiseI lea l' a general a\1ao'on airport. } Acoust Suc Am 1983; 74:177?>-81 [cited inJob',]].34. Griffiths ID. Review of community response to noise.Proceedings of th e Fourth International Congress on :\"oiseas a Public Health Problem; J983.35. Hall FL. Birnie SE, Taylor SM, Palmer JE. Dir ec t comparisons of community response to road traffic noise an d to aircraft noise. j Acoust Soc Am 1981; 70: 1690-8 [cited in HalI3' , ] .36. Krvte r KO. Community annoyance from aircraft and groundvehicle noise.} Acoust Soc Am ]982; 72: 1222-42 [cited inHaIP"J.37. Hall FL. Community response to noise: is all noise th e same?} Acousl Sac Am 1984; 76: 1l61-8.38. T a ~ ' l o r SM, Hal l FL, Birnie. Effect of background levels oncommunity response to aircraft noise.} Sound Fib 1980; 71:261-70 [ci ted in Hall:1h].39. Diamond ID. Walker JC . An international stud\' of the influence of residual noise on community disturbance du e to aircraft noise. lnternoise 1986;July 21-23: 94]-6.

40 ~ j 6 r k m a n \--1. Rylander R. Aircraft noise exposure units andr e a c t i o n ~ in humans. l:,pidemiolop:J 1995; 6: S27 (abstract" ofp a p e r . ~ presented a t th e ]9 95 Ann ua l Conference of theInternational Society for EJ1\'ironmental Epidemiolob':).

41. McKennell AC. .-\ircraft noise annoyance around London(Heathrow) .-\irpon. 1963 S.S. 33i [c'ited in Bullen l ].42. MIL Research Ltd. Sl'cond survt:l' of aircraft noise anno)'ancl'around London (Heathrow) Airport. London: He r Majesty'sStationer, Office, 1971 [cited in Bullen l ].43. Borsky P ~ Sociopsychological factors affecting t he humanresponse to noise exposure. OlolarJngol Clin lVarth Am 1979;12: 521-35.44. Moran SL. Loeb .\-1. Annovance and beha\10ural after e f f e c L ~follO\\ing interfering and non-interfering aircraft noise . }A.f)j}lied Psychol ]977; 62: 719-26.45. Fiedler FE, Fiedler ]. Port noise complaints: verbal andbeha\ioural reactions to airport-related,noise.} Appl Psychol19i5: 60: 498-506 [cited in A.hrlin an d Ohrstronyl"].46. Ahrlin A. Ohrstrom E. i\-1edical effects o f n o i s ~ on humans.}Sound Fih 1978: :'19: 79-87.47. jenkins L, Tarnopolsky A, Hand D. Psychiatric admission"and aircraft noise from London Airport: f O U l " ' ~ ' e a r , three-hospitals' study. P ~ J C ' w l Aled 1981: 1J: 765-S2.

41). Tarnopolsb A. \\'atkim C, Hand PJ. Aircraft noise an d mental health: I. Prevalence of individual symptoms. PS)'chol Med19HO: 10: 68?>-98.234 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOl. 21 NO 2


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- - - ~ ~ ~ ~ ~ ~ ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

EFFEGS OF AIRCRAFT NOISE

4 ~ Watkins G. Tarnopolsky A, JCllkim LM. Airrr3ft noise andmental health: 11. Lse of medicines and health care sen'ices.Pm"hot Med 19B]; 11: I :"i5-Gi:\.

, ~ O . G ~ a e v e n DB. Th e effecu. of airplant' n oise o n healt.h: anexamination ofthrt't ' hypotheses.}Health Sor Bl'hm' 1974; 13:336-43.

?i 1. Department of Senate. Falling on deaf mrs: 1"l'!JOrl of the SenalfSelert Commiltf'1' on AiraaJI .i.\'Oi.\f 111 S)dne..... Canberra: SenatePrinting Cnit, Parliament House, 1995: 15l.

5:2. Lercher P. Distinguishing effect modifiers of psychologicalmorbidity associated with traffic noise exposure. epidemiology1995: 6: 528.53. Jo b RFS. Community response to noise: a rev iew of factorsinfluencing the relat ionship between noise exposure an dreaction.} Acoust Soc Am 1988; 83: 991-1000.54. A b e v ~ \ \ i i c k r a m a 1, Brook lVIF, Gattoni FE, Herridge Cr.M : . ~ t a ~ - h o s p i t a l admissions and aircraft noise. Lance[ 1969; 2:12/:)-1.

55. Ganoni F, Tarnopolsky A. Aircraft noise and psychiatric m o r ~bidity. Psychol Med 1973; 3: S16--20.56. Jcnkins LM, Tamapolsky A, Hand DJ. Barker SM.Comparison of three studies of aircraft noise and psychiatrichospital admissions conducted in t he same area. Psychol MedJ979; 9; 68J-93.

57. Kryter KD. A.ircraft noise and social factors in psychiatrichospita l admiss ion rates: a re-examination of some data.Psych Med 1990; 20: 395-411.SS. Yleecham WC, Smith HG. Effec t; of je t aircrafl noise onmental hospital admissions. Br} Audio11977; 11: 81-5.

59. Tarnopolsky A, Barker S\1, Wig-gins RD, : 'ItcLean EK. Th eeffect of aircraft noise on the men ta l hea lth of a communit\"sample: a pilot stud:'. Ps)'Chol Med 1978; 8: 219-33. '

60. Stansfield SA. !\'oise, noise sensitivity and psychiatric disorder: epidemiol0i:;ical and psychoph\'siological studies. PS)'clwlMed 1992; supplement 22.61. Knipschild P. VI. ::vledical effecL'> of aircraft noise: generalpractice survey.Int Arch OCC1IjJEnviron Hf'afth 1977; 40: 191-6.

62. Karogodina IL, Soldatkina SA, \ ' inokur IL Klimukhin At\..Effect of aircraft noise Oi l the population near airports. HygSand (USSR) 1969; 34: 182-7 [ci ted in Kryter7].63. Davis RC, Buchwald Alvl, Frankman RW. Autonomic andmuscular responses an d their relation to simple stimuli.Psychol MonlJgr 1955; 405: 69 [ci ted in Cantrell t,4J.64. Cantrell RW. Prolonged exposur e to intennittent noise:audiometric, biochemical, motor, psychological and sleepe f f e C L ~ . Laryngoscope 1974; 84: I-SS.65. Da\'is RC. Berry T. Gastrointestinal r e a c t i o n ~ to responsecontingent stimulus. Psycho! RejJ 1964; Ei: 95-113 [cited inCantrellM ].66. TV[ossko\, JI , Enema .IH. rv. Extra-auditory effecL'> in longt e rm exposure to a ircraft and traffic noise. Int Arch Occuj)Ent/iam Health 1977: 40: 177-R4.67. Osada Y. Yoshida K.. Ogawa S, et al. Physiological effects ofaircraft noise, especially (I f level and numbe r o f expusure.Bull Inst Publ Health 1 9 7 ~ : ~ l :)1-9 [cited in Yamamura etal.!"].68. Yamamura K. Aushima K. An il1\'estigation of biologicalresponse induced by intermittent noise (trapeloidal noise).Eur} AjJj)1 Ph)'sio! 19HO: 44: 9- ] G.

69. Gla ss DC. SingerJE. Urban stress: eXjvrimenls 011 noise and socialslressoT.l. Orlando. FL: Academic, 1972 [cited in KJ";>ler7 ].70. Slob A, Wink A, Radder 1/. The effect of acute noise exposure on the excretion of corticosteroids, adrenaline an dnoradrenaline in man. Int Arch Arbeitsmed 1973: 31: 22.:',-35[cited in Krvter'].71. Lehmann C, Tamm J. Cber Veranderungen del' Kreislaufdynamik des rehenden Menschen unter Einworkung vonGerauschen. In[ l aTlJ.;ew Ph:i'Sio "inschl Arbeitphysiol1956; 16:218-27 [cited in Mossko\' and E t t e m a O ~ ] .72. Kubik S, Blazekova L. Complex influence of noise on humanorganism. Proceedings of 5th and 6th InternationalCongress of th e A


17/17

98.

99.

MORRELL ET Al

BrO\\"D R, Pang G, Husband AJ, King \oIG. Suppression ofimmunity to influenza \irus infection in the respiratory tractfollo\\ing sleep disturbance. Reg ImrnuTlo/ 19H9; 2: 321-S.Dinges DF, Douglas SD, Zaugg L, Campbel l DE. et al.Leukocytosis and natural killer cell function parallel nen-robeha"ioral fatigue induced by 64 hours of sleep deprivation. ! CUn Invest 1994; 93; 1930-9.

100. Cox 1:. Stress. London: Macmillan, 1980.101. Thompson SJ. Effects of noise on the cardiovascular system:appraisal of epidemiological evidene!;:. In: Rassi G, editor..\oise as a public health problem. Proceedings of thp fourth international Conference. Milan: Italy Idizioni t echoice a (UTa delcentro ricerche e studi amplifon, 1983.102. Knipschild P. Medical effects of aircraft nobe; communitycardio\>ascular survey. In t Arch Occup Environ Health 1977; 403: 185-90 [cited in Kryter7].103. Knipschild P. VI. Medical effects of aircraft noise: general

practice survey. In t Arch Occup Environ Health 1977; 40: 19]-6.104. Knipschild P, Oudshoorn N. VII. Medical effects of aircraftnoise: drug survey. In t Areh Occup Environ Health 1977; 40:197-200.]03. Health impact assessment SchijJhol airport. Rep. 441520003.

Biltho\'en: Nat iona l Inst itut e of Public H ea llh an dEnvironmental Protection, 1994.106. Babisch W, Ising H, Elwodd PC, Gallacher .rE].CardiO\

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A Review of Helth Effect of Aircraft Noise