Possible Options for the Identification of SOAEL and …randd.defra.gov.uk/Document.aspx?Document=13333_NANR316...reasonable steps should be taken to mitigate and minimise adverse

Environment

DEFRA January 2013 Minor revisions 2014

Possible Options for the Identification of SOAEL and LOAEL in Support of the NPSE

Prepared by: ............................................................. Checked by: ........................................................................ Phil Abbott (AECOM) Phil Abbott Bernard Berry (Berry Environmental ltd) Regional Director

Anna Hansell (MRC-HPA Centre for Environment and Health, Imperial College London) Helga Laszlo (MRC-HPA Centre for Environment and Health,

Imperial College London) Dr Bernadette McKell (AECOM)

Approved by: ............................................................. Dr Bernadette McKell Director Possible Options for the Identification of SOAEL and LOAEL in Support of the NPSE

Rev No Comments Checked by Approved by

Date

1 PA BM 2013

225 Bath Street, Glasgow, G2 4GZ Telephone: 0141 222 6400 Website: http://www.aecom.com Job No 60238724 Reference Final Report Date Created January 201 Minor revisions 2014 This document has been prepared by AECOM Limited for the sole use of our client (the “Client”) and in accordance with generally accepted consultancy principles, the budget for fees and the terms of reference agreed between AECOM Limited and the Client. Any information provided by third parties and referred to herein has not been checked or verified by AECOM Limited, unless otherwise expressly stated in the document. No third party may rely upon this document without the prior and express written agreement of AECOM Limited. document3

1 Executive Summary .......................................................................................................................................................... 1

2 Introduction to Issues ..................................................................................................................................................... 10

3 Objectives ........................................................................................................................................................................ 20

4 Phase 1: Literature Review ............................................................................................................................................. 22

5 Neighbour and Entertainment (Amplified Music) Noise .............................................................................................. 29

6 Phase 2: Synthesis of Relevant Research, Standards and Guidance ........................................................................ 35

7 Phase 3 Identification of Possible LOAELs and SOAELs ............................................................................................ 41

8 Phase 4: Case Study ....................................................................................................................................................... 46

9 General Discussion ......................................................................................................................................................... 56

10 Summary and Conclusions ............................................................................................................................................ 64

11 References ....................................................................................................................................................................... 68

Appendix 1 - Details of Literature Review .............................................................................................................................. 70

Appendix 2 - Judging the quality of review papers published in peer review journals ..................................................... 90

Appendix 3 - List of Identified Studies ................................................................................................................................... 93

Appendix 4 - Extracts from Literature for Table 4.1 ............................................................................................................ 110

Appendix 5 - Papers published after 2006: noise and cardiovascular disease (inc. hypertension) ............................... 118

Appendix 6 - Papers related to noise and cardiovascular disease published after 2006 (in bold if considered) .......... 121

Appendix 7 - Email Notification of Questionnaire Survey .................................................................................................. 135

Appendix 8 - Details of Replies to Questionnaire Survey .................................................................................................. 138

Appendix 9 - Stansted Noise Contours, LAeq,16-hour day, 2015 and 2030 ............................................................................... 146

Appendix 10 - Exposure-response relationships considered in the 2009 Stanstead G2 HIA ........................................... 148

Table of Contents

AECOM Possible Options for the Identification of SOAEL and LOAEL in Support of the NPSE 1 Environment

Noise assessments prepared in respect of environmental, neighbour and neighbourhood noise sources are required

to be undertaken within the context of the current Government advice relating to the management of noise. For

England, the overall policy can be found within The Noise Policy Statement for England (NPSE) [Defra 2010]. The

aims of the policy are to:

• avoid significant adverse impacts on health and quality of life;

• mitigate and minimise adverse impacts on health and quality of life; and

• where possible, contribute to the improvement of health and quality of life,

all within the context of Government Policy on Sustainable Development

This immediately raises the question as to what is meant by a significant adverse impact. The first aim of the NPSE

requires that significant adverse impacts should be reasonably avoided, and the threshold for such impacts is

effectively the Significant Observed Adverse Effect Level (SOAEL). The second aim of the NPSE refers to noise

impacts below the SOAEL but above the LOAEL (the Lowest Observable Adverse Effect Level) for which

reasonable steps should be taken to mitigate and minimise adverse effects on health and quality of life. Research

evidence shows that it is not possible to derive a single, objective noise-based measure that defines, for all sources

of noise in all situations what a significant adverse impact on health and quality of life is. The spirit of the NPSE

recognises that what may be considered as an adverse significant impact in one situation will not necessarily be

significant in another. It is for this reason that specific SOAEL and LOAEL values are not provided in the NPSE but

allows the necessary policy flexibility until further evidence and suitable guidance becomes available. Take for

example the noise level to which a new residential development will be exposed. The noise level in a vibrant and

bustling city centre or area of regeneration may not be considered as having a significant adverse impact on quality

of life for many reasons, some of which may be the nature of the area and expectations of those who choose to live

there but, the same noise level may in fact be significant for a rural development where part of the reason for

choosing to live there is the perception of peace and quiet. Consequently, as is explained within the text of the

report, guidance in respect of the SOAEL has been determined for different noise sources, for different receptors

and at different time periods.

The research undertaken examined the exposure-response relationship in relation to the following identified health

effects; namely annoyance, sleep, stress, cardiovascular, quality of life, well-being and general health and

performance on cognitive mental health. Consideration has been given regarding what values or range of values

might equate to SOAEL or LOAEL in the given circumstances. The outcome of this research is summarised in Table

1.1 below. It should be noted that where exposure levels are given they should be regarded as indicative only.

1 Executive Summary


Table 1.1 Summary of Outcomes

Possible values or range of values for LOAEL and SOAEL for a given source/effect

(Blank cells indicate no information available)

Source/

Effect

Annoyance

LAeq,16h

Sleep

Lnight Stress

1 Cardiovascular

LAeq,16h

Quality

Of

Life2

Performance

Cognitive mental health

LAeq,T

LOAEL SOAEL LOAEL SOAEL LOAEL SOAEL LOAEL SOAEL LOAEL SOAEL LOAEL SOAEL

Road 56

53-59

66

64-68

46

43-52

56

51-64 A A 58 67 Q Q

Rail 63

61-66

72

70-74

55

52-63

68

61-77

A A Q Q

Air 52

50-54

60

58-62

41

40-49

53

47-60

A A Q Q 504

Amplified

Music

QQ3 A A Q Q

Neighbour QQ3 A A Q Q

Industrial QQ3 A A Q Q 1Stress – Significance of impact based on assessment of Annoyance (A) 2Quality of Life –Significance of impact based on qualitative assessment (Q)

3Significance of impacts based on quantitative and qualitative (QQ) assessment 4Refers to significance of impacts on cognitive impairment of schoolchildren, exposure levels outside schools of 50 LAeq, T over a normal school day, T.

The approach adopted in deriving possible LOAEL and SOAEL values for transportation noise sources and effects

including sleep and annoyance are based on exposure-response relationships that have been identified in the report

as having sufficient evidence to provide robust relationships. These relationships refer to community responses over

the long term and therefore may not be relevant for assessing either the noise impacts on individuals or the short

term responses where there is an abrupt change in noise exposure.


Annoyance

Transport Sources

Previous planning policy on noise [DETR, 1994] identified Noise Exposure Categories (NEC) to assist local planning

authorities in their consideration of applications for residential development near transportation noise sources. The

NEC A/B boundary defined the noise exposure for a particular mode as the criteria above which noise should be

taken into consideration with regard to planning and therefore could be viewed as a candidate for deriving LOAEL

values for each transport mode. The continuous nature of people’s response to noise means that this approach

most certainly would have left some groups of people genuinely highly annoyed, the aim of that planning framework

was is to provide an approach to minimise the adverse impact of noise without placing unreasonable restrictions on

development. Similarly, the NEC B/C boundary defined the noise exposure for a particular mode as the criteria

above which planning would not normally be granted due to noise impact (although there were circumstances when

development could occur with appropriate noise mitigation measures. This boundary therefore could be viewed as

a candidate for deriving appropriate SOAEL values for each transport mode.

Using the approximate conversion to express LAeq,16h levels to Lden values i.e., Lden ≈ LAeq,16h + 2 dB [EEA, 2010], it is

possible to establish the percentage of the population that is highly annoyed (%HA) which corresponds to the NEC

A/B and NEC B/C boundary levels based on the EU noise exposure-response relationships for %HA referred to in

the report (see Chapter 4.7) for each transport mode. The following Table 1.2 shows the %HA corresponding to

each boundary level for each transport mode.

Table 1.2 %HA corresponding to NEC boundary levels for each transport mode

Source

NEC A/B Boundary NEC B/C Boundary

LAeq,16h Lden %HA

(± 95% Levels) LAeq,16h Lden

%HA

(± 95% Levels)

Road 55 57 7.8

(10.0 - 6.0) 63 65

16.2

(20.0 – 14.0)

Rail 55 57 3.2

(4.5 – 2.0) 66 68

11.8

(16.5 – 9.8)

Air 57 59 15.9

(20.0 – 11.8) 66 68

32.6

(38.0 – 30.0)

Average %HA

(Range)

9.0

(11.5 – 6.6)

Average %HA

(Range)

20.2

(24.8 – 17.9)


This shows that the NEC A/B and B/C boundary levels are not equivalent in terms of the effect of the noise

exposure on the highly annoyed response associated with different transport modes. In order to manage the effect

of noise on health and well-being which is central to the NPSE, it could be argued that there should be equivalence

across the transport modes and this should be reflected when establishing appropriate LOAEL and SOAEL values.

A possible way forward is to determine the average effect in terms of %HA across all transport modes at both

boundary transitions and use this as a basis for determining the appropriate LOAEL and SOAEL value for each

mode of transport. These values are 9% and 20%HA, respectively, as shown in Table 1.2, together with the 95%

confidence interval ranges. Using the appropriate EU exposure-response relationship [EU, 2002b], the Lden levels

corresponding to 9% and 20%HA can be derived for each transport mode to obtain the corresponding LOAEL and

SOAEL values as shown in Table 1.1 after converting to LAeq,16h. The LOAEL and SOAEL values for rail are

significantly higher than for road and air because the noise from trains has been found to be less annoying than

other transport modes at a given exposure level1.

Amplified Music

There is insufficient evidence to provide indicative LOAEL and SOAEL values for assessing significance of noise

impacts from amplified music. The significance of adverse effects based on a quantitative and qualitative

assessment using current guidance such as that published by the Noise Council Code of Practice [Noise Council

1995] are required to be undertaken on a case by case basis.

Neighbour

The NPSE focus on effects of noise rather than absolute levels has interesting parallels with the definition of

statutory noise nuisance as defined in the Environmental Protection Act 1990. The issue of SOAEL in relation to

noise from neighbours and sound insulation, or lack thereof, is to some extent related to the concept of nuisance.

However, whilst the statutory control of nuisance is well defined there is no objectively measured level at which

nuisance does, or does not exist. The issue of noise nuisance in relation to sound insulation is discussed in the

main text of the report (Chapter 5).

Without very extensive studies of sound insulation of different types of properties and accompanying

social/attitudinal surveys to determine a robust community exposure-response relationship for different house types

it is not, as yet, possible to determine what could be considered as a LOAEL. The possible link between LOAEL and

the Buildings Regulations is also considered in the main text of the report (see Chapter 5).

1 This response is true for conventional railways


As explained in the main text of the report unless and until there is more robust evidence SOAEL is likely to remain

related to the concept of nuisance, in that existence of established nuisance does indicate a SOAEL but a SOAEL

does not necessarily equate to nuisance. SOAEL can also be related to exceedances of any levels as set out in

legislation such as the Noise Act 1996 and the Clean Neighbourhoods and Environment Act 2005.

Industrial

Industrial noise is variable in nature and it has always been recognised that noise characteristics and levels can vary

substantially according to their source and the type of activity involved. Also, previous guidance in respect of

planning and noise has highlighted that the nature of this type of noise, and local circumstances, may necessitate

individual assessment (DETR, 1994). Given that there is insufficient robust information on people's response to

industrial noise it is not possible to derive a LOAEL or SOEAL for industrial sources. Therefore, a quantitative and

qualitative assessment will always be required to be undertaken to assess the significance of the impact of any

change to be brought about by the introduction of new industrial/commercial source, a change to an existing

industrial/commercial noise source or indeed the introduction of a new noise sensitive receptor in the vicinity of

existing industrial/commercial noise sources.2.

Sleep

Transport Sources

A similar approach as that described above for annoyance from transport sources has been used to derive

appropriate LOAEL and SOAEL values for sleep disturbance using the EU exposure-response relationships [EU,

2004] for the percentage of the population who feel they are highly disturbed sleep (%HSD) and the LAeq,8h or Lnight

values at the NEC A/B and B/C boundary levels. Table 1.3 shows the %HSD corresponding to each boundary level

for each transport mode, together with the 95% confidence interval ranges.

2 Between the completion of this report and publication, British Standard 4142:2014 “Methods for rating and assessing industrial and commercial sound” was published. In that, advice is given as to what noise conditions might be an indication of a significant adverse impact.


Table 1.3: %HSD corresponding to NEC boundary levels for each transport mode

Source


LAeq,8h / Lnight %HSD

(± 95% Levels) LAeq,8h / Lnight

%HSD

(± 95% Levels)

Road 45 3.6

(5.9 to 3.1) 57

9.2

(13.6 to 6.9)

Rail 45 1.9

(3.7 to 1.4) 59

5.3

(10.0 to 2.8)

Air 48 6.4

(10.4 to 4.8) 57

11.8

(18.6 to 7.9)

Average %HSD

(Range)

4.0

(6.6 to 3.1)

Average %HSD

(Range) 8.8

(14.1 to 5.9)

Table 1.3 shows that the average %HSD across all transport modes is 4% and 9%HSD for the A/B and B/C

boundaries respectively. Using the EU exposure-response relationships for %HSD the corresponding LOAEL and

SOAEL values were derived as shown in Table 1.1. Again it is noticeable that the LOAEL and SOAEL values for rail

are significantly higher than for road and air because the evidence shows that noise from trains causes less self-

reported sleep disturbance than other transport modes at a given exposure level3.

The WHO Night Noise Guidelines [WHO, 2009] quote a value of Lnight of 40 dB as being a LOAEL and state that

above 55 dB, the ‘situation is increasingly dangerous for public health’. The noise exposure range between the

LOAEL and SOAEL values for all three transport sources shown in Table 1.1 do fall broadly within this range. A

further consideration is that the WHO guideline values are based on a number of effects on sleep including body

movements, arousal and awakenings as well as self-reported sleep disturbance. Deriving LOAEL and SOAEL

values for sleep effects based purely on self-reported sleep disturbance may not reflect all the potential night noise

impacts on health and quality of life.

For sources relating to amplified music, neighbour and industrial noise the relevant sections described above for

annoyance also apply to the assessment of sleep disturbance.

3 This response is true for conventional railways


Stress

As annoyance can be a precursor for stress as explained in the report with reference to the Noise →Annoyance

→Health pathway model, an assessment for the impact of noise exposure on health due to stress could be based

on health impacts related to annoyance, and the associated LOAEL and SOAEL values adopted.

Cardiovascular

Transport sources

The literature review identified strong evidence linking noise exposure to myocardial infarction (heart attacks) and

other cardiovascular effects. This evidence and the associated exposure-response relationship only relate to

exposure from road traffic and may not be applicable to other modes of transport4. In addition, it is recognised that

statistically there is uncertainty in these relationships due to potential other confounding factors such as air pollution

which may have been included and yet not directly linked with noise exposure. However, despite these uncertainties

and given the importance of the potential noise impacts on health, possible values for LOAEL and SOAEL for road

traffic noise and cardiovascular effects have been derived in line with the “precautionary principle” as followed by the

Interdepartmental Group on Costs and Benefits Noise Subject Group (IGCB(N)) in their report “Noise & Health –

Valuing the Human Health Impacts of Environmental Noise Exposure” published in 20105.

The EEA “Good practice guide on noise exposure and potential health effects” published in 2010 [EEA, 2010]

indicates a threshold value for road traffic noise of 60 dB Lden (equivalent to 58 dB LAeq,16h) which the main report

suggests as a candidate for LOAEL. This LOAEL value is within the range derived for LOAEL for annoyance. It may

therefore be possible to infer that the SOAEL for cardiovascular effects for road traffic noise is in the same range as

for annoyance.

For other modes of transport and other noise sources there are no adequate exposure-response relationships

available for deducing LOAEL and SOAEL values at the present time [but see footnote (4)].

Quality of Life (QoL)

As is explained in the main body of the report there is considerable uncertainty about what is meant by QoL, with

different meanings being used for the concept by different researchers. The research for this report did not identify

descriptors or metrics which could be used as “threshold” for the effects on QoL. The QoL generic descriptor can be

viewed as a possible effect-modifying or mediating variable in the Noise →Annoyance →Health pathway.

4 The evidence in this field is evolving quickly and reference should be made to relevant current research for up-to-date information 5 A further report has been published: Environmental Noise: Valuing impacts on sleep disturbance, annoyance, hypertension, productivity and quiet [Defra, 2014]


To assist in identifying possible QoL effects it is recommended that until further relevant research becomes available

the issue is considered in terms of a qualitative assessment. In effect this means considering whether or not the

change in noise environment is likely to result in a change in established behavioural modes. A qualitative noise

change may be described in various ways. Typically, a useful qualitative guide when assessing noise impacts is

whether or not there are likely to be changes in behaviour as a consequence of the noise generated by, associated

with, or potentially impacting upon the proposed development, for example, will changes in the noise climate be

such that it causes people to change their behaviour by closing windows, raising their voice or not using their

gardens as before. The impacts can also be positive. An example of such considerations is set out in Table 1.4.

Table 1.4: Example of Assigning Descriptors for Qualitative Impacts from Noise on Residential Properties6

Perception Criteria of Description for residential dwellings Descriptor for qualitative

impact

Noticeable (Disruptive)

Significant changes in behaviour and/or an inability to mitigate the effects of noise leading to psychological stress or physiological effects, e.g. regular sleep disturbance; loss of appetite, significant medically definable harm.

Major

Noticeable

(Intrusive)

Causes an important change in behaviour and/or attitude e.g., the avoidance of certain activities during periods of intrusion. Potential for possible sleep disturbance that may result in difficulty in getting to sleep, premature awakening and possible difficulty in getting back to sleep. Quality of life diminished due to change in character of the area.

Moderate

Noticeable

(Mildly intrusive)

Noise can be heard and may cause small changes in behaviour and/or attitude eg. turning up the television’s volume; speaking more loudly; closing windows more often. Potential for non-awakening sleep disturbance. Can slightly affect the character of the area but not such that there is a perceived change in the quality of life.

Minor

6 Other versions of this table can be found in Table 2.5 of the Technical Advice Note “Assessment of Noise” to Planning Advice Note 1/2011[Scottish Government, 2011]; Planning Practice Guidance (Noise) – found here: http://planningguidance.planningportal.gov.uk/blog/guidance/noise/noise-guidance/ and in “Guidelines for Environmental Noise Impact Assessment [IEMA 2014]


Performance and cognitive mental health

The literature review only identified a possible LOAEL candidate for assessing the impact from aircraft noise on the

cognitive impairment of schoolchildren of 50 LAeq,T where T is a normal school day. There is insufficient evidence to

identify other LOAEL values or SOAEL values for other sources of noise in this context.

Conclusion

It is clear from Table 1.1 that there are currently many situations where there is no LOAEL or indeed SOAEL that

can be readily identified from available research. The established basic principle of any noise impact assessment is

to assess the change in the acoustic environment that will be brought about by the proposed development or

change in the nature of the noise source. It is important to appreciate that the assessment of change can, and

should be, both qualitative and quantitative, taking into account the local context of the noise impact.

Where a possible quantitative change in noise level is to be assessed, it is essential to ensure that the most

appropriate noise metrics, sampling periods and survey duration are used. For example, it would be inappropriate to

assess the level of change in noise likely to occur following the introduction of a bus depot into a suburban area by

comparing the predicted LA10,18h with existing LA10,18h noise levels; when the main noise level changes are likely to

arise due to large numbers of buses leaving, or returning, to the depot over shorter periods of time outside the

standard 06:00 to 24:00 time period.

The essential elements required in understanding a project and its context in terms of a noise assessment are set

out in the main body of the report together with examples of how the extent of the impact might be determined.


2.1 The United Kingdom Department for Environment, Food and Rural Affairs (Defra) commissioned AECOM

Ltd to carry out a programme of research to provide, where possible, robust and well supported information

that might be used to define SOAELs and LOAELs for the more commonly encountered noise sources and

related health effects that will assist in the implementation of the NPSE. To assist in carrying out this work

Dr Bernard Berry from Berry Environmental Ltd together with Dr Anna Hansell and Dr Helga Lazslo from

Imperial College have been sub-contracted to the project by AECOM. Dr Rohko Kim from the World Health

Organisation European Centre for Environmental Health (WHO ECEH) was a special advisor to the project.

2.2 This chapter describes our understanding of the brief together with our interpretation of the background to

the need for the work.

2.3 The Noise Policy Statement for England (NPSE) sets out the long term vision of Government noise policy

for the effective management and control of noise from environmental, neighbour and neighbourhood

sources within the context of sustainable development [Defra, 2010]. The aims of the policy are to:



• where possible, contribute to the improvement of health and quality of life.

2.4 Given the complex nature in the way different noise sources can impact on health and quality of life,

establishing what constitutes a ‘significant adverse impact’ or ‘adverse impact’ is not straight forward. To

assist in developing a consistent framework for assessing noise impacts, the NPSE has adopted the

following concepts from toxicology that are currently used by the World Health Organisation (WHO) in

dealing with noise assessment:

• NOEL – No Observed Effect Level: This is the level below which no effect can be detected. In simple

terms, below this level, there is no detectable effect on health and quality of life due to the noise.

• LOAEL – Lowest Observed Adverse Effect Level: This is the level above which adverse effects on

health and quality of life can be detected.

2.5 The NPSE has extended these concepts to include:

• SOAEL – Significant Observed Adverse Effect Level: This is the level above which significant adverse

effects on health and quality of life occur.

2.6 A paper by Turner and Grimwood, at the ICBEN 2011 Conference in London [Turner and Grimwood, 2011]

provides some insight and background on the philosophy behind the Noise Policy Statement for England. It

points out that it is the management of the effects of noise on people (primarily) that is at the heart of noise

policy, and that any noise policy should concentrate on the effects of noise rather than simply the level of

2 Introduction to Issues


noise or noise exposure. The paper goes on to point out that, in Europe, environmental noise management

is set out in Directive 2002/49/EC, the Environmental Noise Directive (END) [EU, 2002a]. Close examination

of the END indicates the following underpinning policy theme:

The aim of this Directive shall be to define a common approach intended to avoid, prevent or reduce on a

prioritised basis the harmful effects, including annoyance, due to exposure to environmental noise.

2.7 Thus the policy aims are not only to “reduce” the harmful effects of noise but also to “avoid” or “prevent” any

harmful effects due to noise.

2.8 Turner and Grimwood note that the END appears to treat noise in isolation so that it can be perceived that

there is no sense of balance in the ultimate aim, which makes it more difficult for policy makers to promote.

They go on to explain how, in England, a balance has been included in the Noise Action Plans established

by implementation of the END.

2.9 The Noise Action Plans contains the following aim:

The Government intends that the END Action Plans will assist the management of environmental noise in

the context of Government policy on sustainable development. Within this policy context, this Noise Action

Plan aims to promote good health and good quality of life.7

2.10 The above statement demonstrates the focus on the effects of noise rather than stating that a particular

noise level or noise exposure has to be achieved. The Turner and Grimwood paper goes on to restate the

long term vision of Government noise policy and the associated aims. It notes that the vision is “.... the

ultimate policy objective; effectively no adverse effects on health and quality of life as a result of noise

exposure, not dissimilar from the END policy”. The paper notes however that the stated aims of the policy

reflect the reality of today’s society, which includes:

1. Some noise making activities are essential for society to function. At present, we cannot remove all

adverse impacts of noise.

2. Some significant adverse impacts may still be unavoidable.

3. Some adverse impacts may still be unavoidable

4. Good management can facilitate improvements to health and quality of life.

2.11 The preceding text therefore provides some background on the use, in the NPSE of the phrases, “significant

adverse” and “adverse” and indicates that their interpretation can be assisted by considering established

concepts from toxicology that are currently being applied to noise impacts, for example, by the World Health

Organisation.

7 In January 2014, updated action plans for Roads, including major roads; railways including major railways and agglomerations were published. The overall policy aim has remained unchanged.


2.12 It is not possible to have a single objective noise-based measure that defines SOAEL that is applicable to all

sources of noise in all situations. Consequently, the SOAEL is likely to be different for different noise

sources, for different receptors, at different times and possibly under different modes of operation.

However, the first aim of the NPSE requires that significant adverse impacts should be avoided, and the

threshold for such impacts is effectively the SOAEL.

2.13 The second aim of the NPSE refers to the situation where the impact lies somewhere between SOAEL and

LOAEL. It effectively requires that all reasonable steps should be taken to mitigate and minimise adverse

effects on health and quality of life while also taking into account the guiding principles of sustainable

development. This does not mean that such adverse effects cannot occur.

2.14 It is interesting to consider practical specific examples of usage of these concepts in publications on noise.

In 2009 the WHO published the Night Noise Guidelines (NNG) [WHO, 2009]. This was the result of the

WHO Regional Office for Europe working group of experts set up in 2006 which provided scientific advice to

the Member States for the development of future legislation and policy action in the area of assessment and

control of night noise exposure. The working group reviewed available scientific evidence on the health

effects of night noise, and derived health-based guideline values.

2.15 The key table from the NNG report is reproduced below in Table 2.1.

Table 2.1. Effects of different levels of night noise on the population’s health

Average night noise level over a year Lnight, outside

Health effects observed in the population

Up to 30 dB

Although individual sensitivities and circumstances may differ, it appears that up to this level no substantial biological effects are observed. Lnight, outside of 30 dB is equivalent to the NOEL for night noise.

30 to 40 dB

A number of effects on sleep are observed from this range: body movements, awakening, self-reported sleep disturbance, arousals. The intensity of the effect depends on the nature of the source and the number of events. Vulnerable groups (for example children, chronically ill and the elderly) are more susceptible. However, even in the worst cases the effects seem modest. Lnight, outside of 40 dB equivalent to the LOAEL for night noise.

40 to 55 dB Adverse health effects are observed among the exposed population. Many people have to adapt their lives to cope with the noise at night. Vulnerable groups are more severely affected.

Above 55 dB

The situation is considered increasingly dangerous for public health. Adverse effects occur frequently, a sizable proportion of the population is highly annoyed and sleep-disturbed. There is evidence that the risk of cardiovascular disease increases.

2.16 It is clear that, notwithstanding the implied emphasis in Government noise policy on managing the effects of

noise rather than simply the level of noise or noise exposure, a fundamental element in the process of


defining NOELs and LOAELs and therefore ultimately SOAELs is the use of exposure-response

relationships.

2.17 The NNG report makes use of two exposure-response relationships. The first of these is for awakenings and

the second is for self-reported sleep disturbance, shown below.

Figure 2.1 Relationship between number of awakenings per year and night noise Lnight

Figure 2.2. Relationship between percentage of the population highly disturbed (%HSD) and night

noise Lnight


2.18 Whilst the process of deriving the values of Lnight = 30dB for the NOEL and Lnight =40 dB for the LOAEL is not

totally transparent, the values do derive from a consideration of these curves.

2.19 In 2010 the European Environment Agency (EEA) published Good practice guide on noise exposure and

potential health effects [EEA, 2010] (http://www.eea.europa.eu/publications/good-practice-guide-on-

noise. The guide was developed by the Expert Panel on Noise (EPoN), a working group that supports the

European Environment Agency and European Commission with the implementation and development of an

effective noise policy for Europe. The group’s aim is to build upon tasks delivered by previous working

groups, particularly regarding Directive 2002/49/EC relating to the assessment and management of

environmental noise, the Environmental Noise Directive (END).

2.20 This good practice guide is intended to assist policymakers, competent authorities and any other interested

parties in understanding and fulfilling the requirements of the directive by making recommendations on

linking action planning to recent evidence relating to the health impacts of environmental noise and, among

others, the Night Noise Guidelines for Europe as recently presented by the World Health Organisation. The

emphasis of the report is to provide end users with practical and validated tools to calculate health impacts

of noise in all kinds of strategic noise studies such as the action plans required by the Environmental Noise

Directive (END) or any environmental impact statements. The basis of this is a number of recent reviews

carried out by well-known institutions like WHO, National Health and Environment departments and

professional organisations [WHO, 2009; EU, 2002b].

2.21 Section 5 of the EEA Guide deals with “Quality targets” and provides a review across 14 EU Member States

of relevant limit values in force or under preparation as requested by the END Article. 5.4. In commenting on

how the distribution of these limit values compares with values promoted by WHO it notes the following,

which simply restates the WHO text;

“The recently issued WHO Night Noise Guidelines expanded the Community guidelines of 2000 on the

issue of sleep disturbance, and concluded that although biological effects kick in as low as Lnight = 30

dB, Lnight = 40 dB should be an adequate health protection value, but also recommends an 'interim

target' of 55 Lnight. An Lnight, outdoor of 30 dB is considered as LOEL8 (lowest observed effect level) and an

Lnight, outdoor of 40 dB as LOAEL (lowest observed adverse effect level).”

2.22 The EEA Guide is also highly relevant to the present work since it includes the following thresholds, shown

in Table 2.2, defined as “level above which effects start to occur or start to rise from the background.” These

could be regarded as LOAELs, although they are not referred to in that context.

8 The WHO actually describe this as a NOEL


Table 2.2: Effects of noise on health and well-being with sufficient evidence

Effect

Dimension Acoustic indicator *

Threshold ** Time domain

Annoyance disturbance

Psychosocial, quality of life

Lden 42 Chronic

Self-reported sleep disturbance

Quality of life, somatic health

Lnight 42 Chronic

Learning, memory Performance Leq 50 Acute, chronic

Stress hormones Stress indicator

Lmax Leq

NA Acute, chronic

Sleep (polysomnographic)

Arousal, motility, sleep quality

Lmax, indoors 32 Acute, chronic

Reported awakening

Sleep SELindoors 53 Acute

Reported health Well-being clinical health

Lden 50 Chronic

Hypertension Physiology somatic health

Lden 50 Chronic

Ischaemic heart diseases

Clinical health Lden 60 Chronic

Note: * Lden and Lnight are defined as outside levels. Lmax may be either internal or external as indicated. ** Level above which effects start to occur or start to rise above background.

2.23 In 2011 the World Health Organisation published the “Burden of disease from environmental noise -

Quantification of healthy life years lost in Europe” (EBD) [WHO, 2011]. This publication was prepared by

experts in working groups convened by the WHO Regional Office for Europe to provide technical support to

policy-makers and their advisers in the quantitative risk assessment of environmental noise, using evidence

and data available in Europe. It contains a summary of synthesized reviews of evidence on the relationship

between environmental noise and specific health effects, including cardiovascular disease, cognitive

impairment, sleep disturbance and tinnitus. A chapter on annoyance is also included.

2.24 For each outcome, the environmental burden of disease methodology, based on exposure–response

relationship, exposure distribution, background prevalence of disease and disability weights of the outcome,

is applied to calculate the burden of disease in terms of disability-adjusted life-years (DALYs).

2.25 The EBD report is organised for each of the main health effects under consideration;

• Cardiovascular disease

• Cognitive impairment

• Sleep disturbance

• Tinnitus


• Annoyance

2.26 Information is then presented in a common format on the following:

• A definition of the health outcome

• A synthesised review of evidence linking noise with that outcome

• A single exposure-response relationship between noise exposure and the health outcome

• A calculation of the “environmental burden of disease” using standard methods

• Discussion of “Uncertainties, limitations and challenges”.

Of relevance to this project is that there are no uses of the concepts of NOEL or LOAEL in the EBD

concerned with environmental noise effects.

2.27 It is possible to conclude from the above discussion that in fact the use by WHO of the NOEL and LOAEL

concepts as such in relation to environmental noise is somewhat limited to the summary table by WHO

(NNG) for sleep disturbance effects, although there remains the question of the use of the term “observed

effect threshold” which is abbreviated simply to “threshold”.

2.28 The current project is also concerned with consideration of the issue of significance and “significant adverse

effects”, as set out in the concept of Significant Observed Adverse Effect Level (SOAEL) which is the level

above which significant adverse effects on health and quality of life occur. This clearly leads to the question

of how it is decided when an observed effect becomes significant.

2.29 Given a robust exposure-response relationship, the task of defining the NOEL and LOAEL is relatively

straightforward since it relates to the process of fitting a mathematical curve to the data being analysed

(assuming robust underlying detail). Defining SOAEL is a more complex matter.

2.30 The NPSE itself notes;

“It is acknowledged that further research is required to increase our understanding of what may constitute a

significant adverse impact on health and quality of life from noise.”

The aim of this report is to contribute to the further understanding by reviewing the relevant research and

identifying possible options for the identification of SOAEL and LOAEL in support of the NPSE.

2.31 The main summary table for night noise effects in the NNG report, Table 2.1 above, sets out the health

effects observed when levels of Lnight exceed the LOAEL of 40dB.

2.32 The effects described could be termed “multi-factor” descriptive criteria, which combine aspects from

different health effects, including cardiovascular effects. Vulnerable groups are mentioned as well as

frequency of occurrence of adverse effects. It is not simply a case of following a single exposure-response


curve for a single specific effect and moving from, say, the exposure relating to 10% highly sleep disturbed

to the exposure relating to 50% highly sleep disturbed and regarding that value as “significant”.

2.33 It is also relevant to consider the “pyramid of effects” first applied to noise by Babisch but also included in

the EEA Guide, and reproduced at Figure 2.3.

Figure 2.3. Pyramid of effects relating severity of effect with number of people affected

2.34 This diagram is intended to illustrate how the less severe effects apply to a greater number of people, and

as the severity increases, the number affected decreases. This feature has to be borne in mind in

considering significance.

2.35 It is already clear from previous experience of research in this area, for example “Estimating Dose-

Response Relationships between Noise Exposure and Human Health Impacts in the UK” [Berry and

Flindell, 2009], that the level of knowledge about the effects of noise on health, and associated exposure-

response relationships, varies considerably for different noise sources and therefore between the various

situations covered by the current project. There are also differences in the extent of knowledge about

different effects. This has resulted in a situation where an exposure-response relationship developed for a

particular noise source and a particular effect is sometimes used beyond the boundaries of the conditions

for which it was developed. An example is the well-known Babisch curve for myocardial infarction and Lday

which was originally developed from studies of road traffic. Babisch himself has argued that in the absence

of such a relationship for aircraft noise, because of the lack of research studies on that noise source, the

same curve could be used when doing risk assessments or more significantly, when defining policy

[Babisch, 2006].


2.36 Similarly, Babisch has argued that although the original curve was developed from health data on the

specific case of myocardial infarction [heart attack], it could be applied to the more general case of ischemic

heart disease which includes a wider range of medical symptoms. A thorough understanding of the origin of

such exposure-response relationships and the assumptions underlying their practical use is therefore vital in

considering the issue of significance and significant adverse effects.

Figure 2.4. Road traffic noise and incidence of myocardial infarction and length of exposure.

2.37 For some adverse health outcomes, for example cardiovascular effects, the significance will depend not

only on noise exposure in terms of noise level, but also on length of exposure. Babisch in his 2006 review

report [Babisch, 2006] discusses “residence time” as an effect modifier. He shows various examples

including a sensitivity analysis of his studies on road traffic noise and the incidence of myocardial infarction

in Berlin. Figure 2.4 above shows there are stronger effects for those with longer residence time.

2.38 Another factor which will have implications for the significance of adverse effects is whether the situation

being assessed is steady-state, i.e. having been in existence for some time, or is one of change, with a new

or modified noise source being introduced or there is a major change of operation of a noise source, such

as a new airport runway. The response to these changes can be quite varied and even conflicting. For

example:


• The change in noise can result in an overreaction, i.e. the person’s response to the noise alters

dramatically;

• Over reaction occurs followed by evidence of adaptation in the short term;

• Over reaction occurs and there is no evidence of adaptation even in the long term;

• Change in the noise does not result in large changes in response (no overreaction);

• Reduction in noise exposure results in small reduction in noise response; and

• A noise response associated with the expectation of change was greater than the actual response

when change occurred.

2.39 In addition to the above there is the question of the robustness of the noise data used in developing an

exposure-response relationship. Generally, reliance on exposure levels derived from noise maps is

becoming more attractive, given the availability of the data. But with it there are the associated errors,

including in categorising exposure levels with a 5 dB(A) bandwidth. Furthermore, exposure levels are

normally derived for the most exposed facades and may not be representative of the noise outside the

rooms where people spend most of their time when at home or take into account variations in exposure due

to sound insulation.

2.40 Whilst considering the possible range of situations to be considered in terms of NPSE and SOAEL, it is

important to take into account the fact that, in some of these situations, the definition of what constitutes a

SOAEL may depend on a comparison of the level of the noise being considered relative to an existing

background noise level. Such an example would be industrial noise, where the convention is to use the

principles of BS4142.

In consideration of all of the above the United Kingdom Department for Environment, Food and Rural Affairs

(Defra) has commissioned AECOM Ltd to carry out a programme of research to provide, where possible,

robust and well supported information that may define SOAELs and LOAELs for the more commonly

encountered noise sources and related health effects that will assist in the implementation of the NPSE.


3.1 The objective of this project was to establish, where possible, threshold levels for LOAEL and SOAEL for a

range of noise source/effects based on strong scientific evidence. Following on from the background to the

project as set out in Chapter 2 there were five project phases which are briefly described in the following

paragraphs.

Project Phases:

Phase 1: Literature Review

3.2 Three tasks were identified within Phase 1 of the project as follows:

Phase 1: Task 1: Identification of noise effects on health

3.3 Prior to the commencement of the literature review the scope of the noise effects on health was agreed with

Defra at the inception meeting and included.

• Annoyance;

• Cardiovascular;

• Sleep;

• Stress;

• Quality of Life (QoL) well-being and general health; and

• Performance, cognitive and mental health.

Phase 1: Task 2: Literature review

3.4 A comprehensive literature review was carried out to identify and collect primary studies, review papers

including results from meta-analyses studies, which would provide the scientific evidence that could

underpin the development of appropriate threshold levels for the LOAELs and SOAELs.

Phase 1: Task 3: E-mail Questionnaire Survey

3.5 To supplement the literature review, an e-mail questionnaire survey was circulated to relevant stakeholders

to augment the literature review. The recipients included: key research experts in the field to capture any

additional research that were about to be published or was under peer-review; policy advisors/consultants in

European and non-European countries to provide information on standards and guideline noise levels

relevant to this project and a global network of acousticians within AECOM who have experience in

assessing noise impacts in many different countries.

3.6 Details of the literature review including the methodology and the results from the various searches carried

out together with the responses from the e-mail questionnaire are described in the Appendices of this report.

3 Objectives


Phase 2: Synthesis of relevant research, standards and other guidance

3.7 The principle objective of this synthesis phase was to identify the optimum exposure-response relationships

for the various sources and effects based on a combination of existing knowledge from reviews combined

with any newer material from more recent primary studies. From examining these relationships, the basis for

the identification of potential LOAELs has been sought.

3.8 A key task was then to consider, for each effect, what might constitute a Significant Observed Adverse

Effect Level. During this phase of the project, a number of international experts were consulted on what

criteria they would use to determine when an adverse effect might become a SOAEL.

3.9 A detailed description of the work undertaken for Phase 2 of the project including the methodology for

synthesising the information from Phase 1 of the project is described in the Appendices of this report.

Phase 3: Identification of Potential LOAELs and SOAELs

3.10 The objective of Phase 3 was to establish from Phase 2 (Synthesis of relevant research, standards and

other guidance) potential relevant LOAELs and SOAELs for a number of source/effect scenarios and to

show the result of using such measures on exposed populations where sufficiently robust evidence has

been established to support the relevant exposure-response relationship.

3.11 The various scenarios examined under Phase 3 of the project are described in Chapter 7 of this report.

Phase 4: Case Study

3.12 A case study is described concerning a previous planning application submitted by BAA for the so-called

Stansted Generation 2 Project. Noise impact assessments for various source/effects are included to

illustrate the application of the potential relevant LOAELs and SOAELs that have been identified from the

previous phases of the project.

3.13 The case study is described in Chapter 8 of this report.

Phase 5: Reports and Presentations

3.14 The final phase of the project concerned the dissemination of the project outputs. The main output is this

final project report but this will potentially be augmented by two presentations to the relevant stakeholders.

3.15 Chapter 9 of this report includes a discussion of the outcomes from the various phases of the project and

which considers the identification of possible LOAELs and SOAELs in the context of the NPSE. A summary

and conclusion from this report is contained in Chapter 10.


4.1 Details of the literature review are described in Appendix 1.

4.2 In total 332 studies, journal papers and grey9 literature were considered for this research (references to

these documents are included in Appendix 3). Of these, the majority (278) were identified in a systematic

literature search, described in Appendix 1 and the remainder through hand searches of conference

proceedings, through Google web search, expert recommendations or through the survey described in

paragraph 3.5.

4.3 Figure 4.1 shows the number of studies identified from the systematic literature search.

Figure 4.1: Number of studies identified in the systematic literature search

4.4 Given the lack of papers identified in relation to neighbourhood noise and entertainment noise these sources

are considered separately in Chapter 5.

4.5 Given the large numbers of papers identified from the review, those identifying exposure-response

relationships available from meta-analyses and authoritative reviews were selected for further analysis as

these would provide the most robust evidence to identify possible SOAELs and LOAELs.

4.6 For the following five outcomes, the current exposure-response relationships were identified:

9 Grey literature is academic literature that has not been formally published.

4 Phase 1: Literature Review


(i) Annoyance in relation to transportation noise [aircraft/road/railway noise, EU 2002b; aircraft post-

1990, Janssen and Vos, 2009];

(ii) Sleep disturbance in relation to transportation noise [aircraft/road/railway noise, EU 2004; aircraft

post-1990, Janssen and Vos, 2009]

(iii) Hypertension in relation to transportation noise [aircraft, Babisch & Kamp, 2009; road traffic noise,

Van Kempen and Babisch, 2012]

(iv) Cardiovascular disease and road traffic noise, [Babisch, 2008]

These relationships are detailed below.

4.7 (i) Annoyance in relation to transportation noise.

Air, road and rail [EU 2002b]

Figure 4.2. The percentage highly annoyed persons (%HA) as a function of the noise exposure

outside of the dwelling (Lden). The solid lines are the estimated curves and the dashed lines are the

polynomial approximations. The 95% confidence intervals are shown dotted.


The polynomial approximations are as follows:

Air: %HA= -9.199*10-5(Lden-42)3 + 3.932*10-2(Lden-42)2 + 0.2939*(Lden -42)

Road: %HA= 9.868*10-4(Lden-42)3 – 1.436*10-2(Lden-42)2 + 0.5118*(Lden -42)

Rail: %HA= 7.239*10-4(Lden-42)3 – 7.851*10-3(Lden-42)2 + 0.1695*(Lden -42)

Comparing these exposure relationships shows that for a given noise exposure, the percentage of people

highly annoyed (%HA) is greater for aircraft noise than compared with other transport modes whereas the

%HA from rail noise is the least. These differences in %HA between transport modes increase as the noise

exposure increases.

Air post-1990 [Janssen and Vos, 2009]

Figure 4.3. The percentage highly annoyed persons (%HA) as a function of the noise exposure

outside of the dwelling (Lden) from aircraft derived from post-1990 studies (upper red lines). The

lower blue lines are from the EU 2002b paper shown above in Figure 4.2. The solid lines are the

estimated curves and the 95% confidence intervals are shown dotted.

Figure 4.3 shows that for aircraft noise, the post-1990 exposure-response relationship is higher than

previous estimates, particularly as noise Lden increases.

The polynomial regression equation:

%HA= -1.8*10-3(Lden)3 + 0.3389*(Lden)

2 – 18.653*(Lden) + 326.2


The authors of this study stress that these more recent curves are based on a limited number of surveys and

can therefore only be viewed as very preliminary estimates of updated exposure-response relationships.

However, they do confirm that exposure-response relationships can change and highlight the importance of

the necessity to continually monitor such exposure relationships. Interestingly, similar recent studies for both

road and rail showed no similar trends.

4.8 (ii) Sleep disturbance in relation to transportation noise.

Air, road and rail [EU, 2004]

Figure 4.4. Percentage of highly sleep disturbed (%HSD)

when exposed to air, road and rail noise (Lnight,outside)

Air: %HSD = 18.147 – 0.956 (Lnight) + 0.01482(Lnight)

2

Road: %HSD = 20.8 – 1.05 (Lnight) + 0.01486(Lnight)2

Rail: %HSD = 11.3 – 0.55(Lnight) + 0.00759(Lnight)2

The above relations represent the current best estimates of the influence of Lnight, outside on self-reported sleep

disturbance for air, road and rail. As with annoyance, comparing these exposure relationships shows that for

a given noise exposure in terms of Lnight, the percentage of people highly sleep disturbed (%HSD) is greater

for aircraft noise than compared with other transport modes whereas the %HSD from rail noise is the least.

These differences in %HSD between transport modes increases as the noise exposure increases. With

regard to the relation for aircraft noise it should be noted that the variance in the response is large compared

to the variance found for road and rail. As the uncertainty regarding the response for night-time aircraft noise


is large, such responses can be considered as indicative only. Suggested reasons for this might be different

time patterns of noise exposure around different airports; sleep disturbance questionnaires for aircraft noise

generally show large variations and recent studies have shown higher levels of disturbance at the same

noise Lnight exposure, a trend which is illustrated in the next section.

Aircraft Noise - post-1990 [Janssen and Vos, 2009]

Figure 4.5.

The percentage highly sleep disturbed (%HSD) as a function of the noise exposure

outside of the dwelling (Lnight) from aircraft post-1990 upper red lines.

The lower blue lines are from the EU 2004 paper shown above in Figure 4.4.

The solid lines are the estimated curves and the 95% confidence intervals are shown dotted.

Figure 4.5 shows that for aircraft noise, the post-1990 exposure-response relationship is higher than

previous estimates, particularly at lower noise levels where the 95% confidence limits do not overlap.


However, the variance of the post-1990 relationship is large and therefore any estimated sleep disturbance

based on this relationship should be treated with caution.

The polynomial regression equation is:

%HSD = 1.04*10-2(Lnight)2 - 0.1258(Lnight) + 1.1836

Again, the authors of this recent study stress that the recent curves are based on a limited number of

surveys and can therefore only be viewed as very preliminary estimates of updated exposure-response

relationships. As with annoyance, exposure-response relationships can change and highlight the importance

of the necessity to continually monitor such exposure relationships.

4.9 (iii) Hypertension in relation to transportation noise.

For aircraft noise, although a positive relationship has been found, the findings from the literature review has

been heterogeneous due to variations in the quality and design of the epidemiological studies [Babisch and

Kamp, 2009]. No reliable exposure-response relationship has been identified10.

For road traffic noise the most recent meta-analysis showed a significant positive association with

hypertension [Van Kempen and Babisch, 2012]. Data revealed an odds ratio (OR) of 1.034 per 5 dB(A)

increase (LAeq,16h) in the range 45 to 75 dB(A) i.e an increase in risk of 3.4% per 5 dB(A) increase in noise.

Important sources of heterogeneity were;

• the age and sex of the population (lower OR with increase in age; men higher OR compared with

women);

• the way the exposure was ascertained (noise mapping /measurement problems associated with

misclassification);

• noise reference level used (assumptions regarding to the cut off noise level below which it is

assumed no effect).

4.10 (iv) Cardiovascular disease and road traffic noise.

Studies on the association between community noise exposure and cardiovascular risk when subjected to a

meta-analysis for deriving a common exposure-response curve provide the following findings when the

diagnosis was limited to myocardial infarction [Babisch, 2008).

10 Subsequent reviews have identified a relationship that might be used for this type of analysis – e.g. Berry 2013


Figure 4.6 shows the relationship between the odds ratio (OR) and noise exposure for myocardial infarction

and traffic noise derived from cohort and cross-sectional studies. (The source paper shows that although

the exposure appears to be described in terms of Lday the exposure was actually in terms of LAeq,16h)

Figure 4.6: Polynomial fits of the exposure-response relationship between road traffic noise and myocardial infarction. The left graph (3a) refers case-control or cohort studies (analytic studies), (3b) to cross-sectional, case-control or cohort studies (descriptive and analytic studies) [Babisch, 2008]

The graph (3a) shows results from cohort studies from which the following quadratic regression equation

was derived:

OR = 1.63 – 6.13*10-4(LAeq,16h)2 + 7.357*10-6(LAeq,16h).

The graph (3b) includes cross-sectional studies and shows that the same function is a reasonable fit for

both study types.

A linear trend revealed an odds ratio per 10 dB LAeq,16h of 1.17 i.e. an increase in risk of 17% per 10 dB

increase in noise.


5.1 The literature survey did not identify any research in relation to neighbour noise and entertainment noise

therefore a further supplementary survey was undertaken based on the research teams experience and

knowledge of the history of these subject areas.

Neighbour Noise

5.2 As highlighted in Chapter 2, the paper by Turner and Grimwood at the ICBEN 2011 Conference in London

[1] provides some insight and background on the philosophy behind the NPSE. It points out that it is the

management of the effects of noise on people (primarily) that is at the heart of noise policy, and that any

noise policy should concentrate on the effects of noise rather than simply the level of noise or noise

exposure. When considered in terms of neighbour noise from adjoining residential properties the focus on

effects of noise rather than absolute levels has interesting parallels with the definition of statutory noise

nuisance as defined in the Environmental Protection Act 1990.

5.3 The issue of SOAEL in relation to noise from neighbours and sound insulation is to some extent related to

the concept of nuisance in that if it is accepted that a nuisance exists, then it is not unreasonable to

conclude that there has been at the very least a significant adverse effect. However, whilst the statutory

control of nuisance is well defined there is no objectively measured level at which nuisance does, or does

not exist. The establishment of statutory nuisance is covered by Part III of the Environmental Protection Act

1990 (EPA). Section 79(1) creates a ‘two limbs’ test; ‘prejudicial to health’ or ‘nuisance’.

5.4 As with any noise complaint the Environmental Health Practitioner must assess the noise and judge whether

or not, in his/her opinion, it constitutes a statutory nuisance. He/she therefore needs to carry out a subjective

assessment based on the principles established in common law to determine whether or not a statutory

nuisance exists. The principles established in common law include:

• Material interference property or personal comfort; behaviour must be unusual, excessive,

unreasonable or serious;

• Locality principle; the character of the area is significant as the standards of amenity and comfort

expectations are not fixed;

• Duration, intensity and frequency of occurrence;

• Time of Day; noise at night more likely to be considered a nuisance than during the day;

• Sensitivity; the law will only protect the average person with average sensitivity to noise; and

• Fault; (in Scotland it is necessary to show that the defender was in some way to blame for the noise).

5.5 What is clear is that statutory nuisance is in relation to the protection of the individual as an occupier of

premises. Statutory nuisance is limited to ‘the ordinary person’ i.e. someone who is not unusually sensitive.

5.6 The issue of sound insulation and potential nuisance is complicated. The cause of the disturbance which

might be the source of a complaint could arise from either unreasonable behaviour by the neighbour or from

inherently poor sound insulation between the two properties. Legal cases have made it difficult to address

5 Neighbour and Entertainment (Amplified Music) Noise


the latter situation, for example, the decision of the House of Lords in London Borough of Southwark -v-

Mills and another, and Baxter -v- Mayor etc., of the London Borough of Camden (‘Mills and Baxter’) on 21

October 1999.

5.7 In Mills & Baxter, the House of Lords held that there was no authority for the proposition that the normal and

ordinary use of a property ‘in a way which shows as much consideration for the neighbours as can

reasonably be expected, can be an actionable nuisance’. Accordingly, if neighbours were not acting

unreasonably, they cannot be committing a nuisance. The tenants in Mills & Baxter accepted that their

neighbours were not ‘unreasonably noisy’ and ‘for the most part’ were behaving ‘quite normally’. The issue

was that properties had very poor sound insulation, resulting in them being able to hear normal living noises.

5.8 This means that the ‘nuisance’ limb of EPA Sec 79(1) has to some extent been removed in the case of poor

sound insulation it then leaves the prejudicial to health limb, which brings us back to the aims of the NPSE

and one of its aims of avoiding significant adverse impacts on health and quality of life. It is not

unreasonable to assume that if an occupant can clearly hear all or most of their neighbour’s daily living

noises that there is a significant adverse effect on health and quality of life. This is clearly illustrated in the

“pyramid of effects” shown section 2.33. Although not previously applied to noise of a domestic origin, noise

is the stressor and therefore the pattern is similar.

5.9 Another approach to assessing an allegedly intrusive noise from neighbours would be through evaluation of

the sound insulation of the party wall or party floor. The sound insulation requirements are set out in the

Buildings Regulations. Can the minimum standard of sound insulation legislated for be related to SOAEL?

The level of sound insulation offered to occupiers has evolved over the last half century or so. In the late

40’s and 50’s the Building Research Station (now the Building Research Establishment, BRE) undertook

research which resulted in a grading system: Party Wall Grade and Grade I and Grade II for floors. The

Party Wall Grade was based on the performance of a single 9” brick party wall and it reduced noise from

neighbours to a level that was just acceptable to the majority. The Grade I floor was based on a concrete

floor construction with a floating layer on its surface. This was found to result in only minor disturbance from

neighbours and was found to be no more of an issue than other disadvantages associated with living in

flats. Grade II floors were found to be seriously disturbing to fewer than half the tenants who took part in the

studies.

5.10 In the intervening years construction types have changed, behaviour modes of the general population have

changed; there is general evidence to support the view that people generally do not exhibit the same level of

respect for neighbours rights; thus the introduction of anti-social behaviour legislation, noise sources within

the home have changed; surround sound television (in fact during the 40’s and 50’s basic TVs were not that

common) and there is now the extensive use of powered domestic appliances etc. However, what is

interesting is that the level of sound insulation afforded to occupants of flatted units, terrace, semi-detached

and townhouse properties is clearly based more on a community response, i.e. a standard that the majority

of people are content with. This is contrary to the nuisance provisions which are geared towards protection

of the individual.


5.11 It is not unreasonable to assume that the minimum level of sound insulation set down in the relevant

buildings regulations will be such that compliance should, given normal noise generating behaviour of

neighbours, be a good indicator of avoidance of a SOAEL. However, it is not quite as simple as that

because there is not a common building standard; the standards for airborne and impact sound vary by the

type of property, i.e. conversions have a less onerous standard than a new build property. The variation in

required performance standards in relation to converted properties is more aligned to economic implications

than to that of avoiding no significant adverse effect for occupants. This does align with the policy in the

NPSE.

5.12 The interpretation of a LOAEL in this type of situation is even less clear. The effect of neighbour noise from

people living in vertically or horizontally adjacent dwellings depends on, amongst many other factors, the

relationship between the noise to the background noise level and this latter level will change depending on

the location of the property relative to external noise sources. Also occupants bring very different

expectations to such properties. Therefore, without very extensive studies of sound insulation of different

types of properties and accompanying social/attitudinal surveys to determine a robust community exposure-

response relationship for different house types it is not, as yet, possible to determine what could be

considered as a LOAEL with respect to neighbour noise.

5.13 In summary, if it is assumed that establishing adverse effect levels can be based on a community response

then it can be argued that SOAEL can be aligned to the minimum standard as set out in the Building

Regulations.

Entertainment Noise

5.14 In reviewing the literature on the impact of entertainment noise on communities, the main focus of attention

has been to consider the impact from events involving high powered amplified music which is one of the

main sources of complaints relating to entertainment noise by residents in their homes. Although other

sources of entertainment noise have not been reviewed here, such as noise from sporting events, the

arguments for establishing possible LOAELs or SOAELs are equally likely to apply.

5.15 Unlike other noise sources such as transportation, the literature review found no evidence that the noise

from high powered amplified music has any adverse effects other than that associated with annoyance.

However, this should not be viewed as meaning that the noise impact from amplified music is less important

than that from other environmental sources because, as illustrated above, depending on the severity of the

noise impact, the stress associated with annoyance/disturbance can have implications on health.

5.16 In discussing the possible way forward to establishing possible LOAELs or SOAELs with regard to

annoyance from amplified music on residents, it is perhaps convenient to look at the various types of

venues from where amplified music can cause disturbance. These can be divided into two groups:

• Venues which are limited in duration and frequency of occurrence such as open-air concerts/festivals;


• Venues which are permanent such as public houses, clubs/discotheques, concert halls and cinemas

which are either detached from the nearby residential properties or form part of the same structure

containing residential properties, where the primary transmission is through the walls and floors of the

building.

Open-air concerts

5.17 Since 1995, the environmental control and management of noise from open-air concerts in the UK has been

based on the recommendations published by a Working Party of the Noise Council which included

specialists with experience in issues associated with noise impacts from such events.

5.18 These recommendations resulted in a Code of Practice which included various guidelines and criteria aimed

at minimising the disturbance caused by large music events involving high powered amplification held in

sporting stadia, arenas and other sites within lightweight buildings.

5.19 The code is not designed to address the question of environmental noise arising from discotheques, clubs

and public houses.

5.20 The recommended noise limits contained within the Code of Practice for events held between the hours of

09:00 and 23:00 hours vary depending on the type of venue and the number of event days per year and are

summarised in Table 5.1 below.

Table 5.1: Concert Guideline Noise Limits

Concert days per

calendar year, per venue Venue Category Guidelines

1 to 3 Urban Stadia and Arenas The MNL1 should not exceed 75dB(A) over a 15-minute period

1 to 3 Other Urban and Rural Venues The MNL should not exceed 65dB(A) over a 15-minute period

4 to 12 All Venues

The MNL should not exceed the background noise level2 by more than 15dB(A) over a 15-minute period

1The Music Noise Level (MNL) value is the LAeq,15min due to music/vocals/sound checks measured at a distance of 1 metre from the

facade of any noise sensitive premises and not affected by other local noise sources. 2The background noise level is the prevailing sound level at the location where the MNL is assessed, measured in terms of the noise index LA90T measured on an equivalent day and at an equivalent time when no concert or sound checks are taking place. The value should be the arithmetic average of the hourly LA90,1h measured over the last four hours of the proposed music event or over the entire period of the proposed music event if scheduled to last less than four hours.

5.21 For events continuing or held between the hours 23:00 and 09:00 the noise from music should not be

audible within noise-sensitive premises with windows open in a typical manner for ventilation.

5.22 Between 2010 and 2011 Defra and the Devolved Administrations commissioned research to assist in a

future review of the Noise Council’s Code of Practice. This research included carrying out noise surveys at

positions representative of the residential areas in the vicinity of 10 event venues that took place throughout

the UK during 2010. An attitude survey of residents living in the vicinity of each concert was also

undertaken.


5.23 Nine of the concert venues fell within the scope of the Code of Practice i.e. urban stadia or other open-air

urban area and therefore had associated MNL guideline values as indicated in the table above. One venue

was an indoor venue which had no MNL guideline values as this venue was outside the scope of Code of

Practice.

5.24 One of the aims of this work was to examine the correlation between the subjective responses of the

residents to the noise from each event and the noise levels estimated at each respondent location based on

a noise model developed from the noise survey.

5.25 Analysis of the exposure-response relationship between the percentage of the population fairly or very

annoyed and the estimated Music Noise Level, LAeq,15min dB for the nine venues that fell within the scope of

the Code of Practice is shown in Figure 5.2.

Figure 5.2: Exposure-response Relationship for Open-Air Concerts

5.26 The results of this analysis shows that there is a link between music noise levels and levels of annoyance

for residents living in the vicinity of venues used for music events which could be used to inform the

development of possible LOAELs and SOAELs for this type of source. For example, a MNL value above

about 40 LAeq,15min could be used as an indicator of an LOAEL whereas, if a definition of SOAEL was set at

where the percentage of those fairly or very annoyed exceeding 20%, the above exposure-response

relationship would indicate a SOAEL at a MNL of about 65 LAeq,15min.


5.27 However, an important finding from the research described above was that there was a significant

percentage of the population where subjective annoyance was not related to the music noise level but

influenced by a number of other factors such as: prior knowledge of the event, musical taste and previous

experience of noise from such events etc.

5.28 The importance of this finding is that whether or not an adverse effect or significant adverse effect is

occurring depends not just on the noise level but also on other factors.

5.29 A further consideration which is important when establishing adverse noise impacts is the frequency of

occurrence. Unlike other noise sources such as transport which has the potential to cause an effect on a

daily basis, the consequence of causing an adverse effect from other types of sources which occur less

frequently such as noise from music venues will depend on how often such effects occur.

Pubs, clubs/discotheques and concert halls etc.

5.30 Until the introduction of the Clean Neighbourhoods and Environment Act 2005, there was no specific

legislation in the UK to control the noise from licensed premises. However, despite this power allowing local

authorities to control noise from licensed premises there is no agreed method or code of practice which sets

out how the noise from this type of source should be assessed.

5.31 To address this problem, Defra commissioned research to develop a suitable assessment method that

would allow noise criteria to be determined that would represent a clearly unacceptable situation (Defra,

2006).

5.32 Under laboratory conditions, the results from this research identified several methods and criteria which

gave reasonable correlation with subjective response. The noise metric which gave the best overall

prediction of subjective ratings by ordinary members of the public of all the entertainment noise types tested

was the absolute LAeq,5min metric measured inside the test room. It was also established that under

laboratory conditions, the criterion of unacceptability was in the range LAeq,5min 34 to 37 dB However, it was

realised that setting a criteria level which was comparable with ambient noise levels may require additional

qualification. It was therefore recommended that a subjective rating to determine whether the noise was

audible should also be included in the criteria to establish unacceptability.

5.33 Clearly further work is required to establish whether the findings from this work are sufficiently robust to be

adopted as a standard method for assessing noise from licensed premises for the purposes of the Act.

5.34 Until such work is carried out, the establishment of any adverse exposure level based on a well-established

community response relationship for this type of noise source is not possible.


6.1 The principal objective of this synthesis phase was to identify the optimum exposure-response relationships

for the various effects based on a combination of existing knowledge arising in earlier phases of the project,

including:

• Material from more recent primary research studies.

• Reviews and meta-analyses

• Information from the email survey, including publications supplied.

6.2 It is essential to have such exposure-response relationships, with a sufficient degree of statistical

robustness, in order to be able to identify possible LOAELs, and to be able to consider, for each health

effect, what might constitute a Significant Observed Adverse Effect level, or SOAEL. The health effects

considered were agreed with Defra and set out in Section 4.1 namely annoyance, cardiovascular, sleep,

stress, quality of life, well-being and general health, and performance, cognitive, mental health.

6.3 Based on the extensive work done in Phase 1, it is clear that the number of epidemiological studies that

provide the basis for an exposure-response curve from which possible LOAEL and SOAELs might be

identified is limited, as is the number of candidate curves. Furthermore. findings have been heterogeneous,

in part due to variations in quality and design of the epidemiological studies.

6.4 Papers and reports on annoyance, sleep disturbance, cognitive effects etc., have been reviewed to

determine whether or not there is any important new material available on exposure-response relationships

which might add to, or alter the current guidance given in documents such as the EEA Good Practice Guide

of 2010, or WHO publications such as the Night Noise Guidelines [2,3]. It is concluded that the current

guidance documents still represent the best available information.

6.5 It should be noted that the WHO Regional Office in Bonn are at the early stages of preparation for a revision

of the existing WHO Community Noise Guidelines11.

6.6 Exposure-response relationships, of sufficient quality which have been identified in the guidance documents

relate to:

• Annoyance in relation to transport noise (road, aircraft and railway noise, EU 2002)

• Sleep disturbance (aircraft, WHO 2009; rail & traffic, EU 2004)

The exposure-response curves for these effects were shown in the literature review paragraph 4.7.

6.7 Analysis of the output from the literature review described earlier has mainly been concerned with

cardiovascular effects, in particular hypertension and ischemic heart disease including myocardial infarction.

11 It is understood that some information on these revised guidelines will be available in 2015.

6 Phase 2: Synthesis of Relevant Research, Standards and Guidance


The research findings from a recent comprehensive meta-analysis study by van Kemp and Babisch which

examined the relationship between hypertension and exposure to traffic noise was published recently (van

Kemp and Babisch, 2012). The paper indicates that road traffic noise was positively and significantly

associated with hypertension and a quantitative relationship was derived for the purpose of assessing health

impacts. Data aggregation revealed an odds ratio (OR) of 1.034 ([95% confidence interval (CI) 1.011–1.056)

per 5 dB(A) increase of the 16-hour average road traffic noise level (LAeq16h) in the range 45–75 dB(A).

Important sources of heterogeneity were the age and sex of the population under study, the way exposure

was ascertained, and the noise reference level used. Also the way noise was treated in the statistical model

and the minimum years of residence of the population under study, gave an explanation of the observed

heterogeneity. However, the paper concludes that the results are consistent with a slight increase of

cardiovascular disease risk in population exposed to transportation noise and that no definite conclusions

can be drawn about the threshold value for the relationship between road traffic noise and the prevalence of

hypertension.

6.8 The current evidence for other cardiovascular effects does not provide evidence that can be used to define

possible SOAELs or LOAELs, which require a well characterised exposure-response curve similar to those

developed for annoyance where exposure is expressed over a continuous range of values and the response

is expressed in terms of the percentage of the population affected. The published studies most often

consider noise in categories, with reference or baseline categories often defined somewhere between

<50dB and <60dB, where by definition the relative risk is 1. Where risks are expressed in categories

relative to that baseline, it is not possible to comment on possible health effects of noise at levels below

baseline. Where results are expressed in terms of a linear (e.g. per 10dB) or other exposure-response, this

is often when a trend has been fitted through the median levels of categories rather than derived from

continuous values. Extending the linear trend outside the range of categories in the original data provides

an indication only i.e. it is not possible to know whether a noise exposure-response function calculated

against a reference category of <50dB is valid if applied to people exposed to 40-45dB.

6.9 Research work in this area is continuing to occur, the results for which might alter the conclusions drawn.

However, it is concluded that the best available information on possible LOAELs for the various effects is

that given in the EEA Good Practice Guide of 2010, (see Table 6.1 below).

Approaches to defining possible LOAELs and SOAELs

LOAELs

6.10 As has been discussed in Chapter 4 of this Report, there are various key review reports which include

tables of threshold values in relation to noise-related health effects. Some of these, for example as

published in the EEA Good Practice Guide of 2011 are summarised in Table 6.1 below. It is understood that

they were derived from analysis of exposure-response relationships by the expert groups involved. The

origin of some of the threshold values is not always clear in published reports. However, there is

consistency across these documents that thresholds can be defined for annoyance and sleep, but evidence

is less clear for other outcomes.


Table 6.1 Summary of Evidence and Threshold Levels from literature review

Effect

Passhier W-W (2000) Babisch (2004, 2006, 2009)

WHO (2009) EEA (2010)

Noise Index

Threshold Evidence Evidence Noise Index

Threshold Evidence Noise Index

Threshold Evidence

Annoyance Ldn 42 sufficient - Lden sufficient Lden 42 sufficient

Hyper- tension

Ldn 70 sufficient

(inadequate) /limited

/sufficient (aircraft)

Lnight, outside 50 limited Lden 50 sufficient

Cardio- vascular disease (inc. ischemic heart disease and myocardial infarction)

Ldn 70 sufficient (limited)

/sufficient

LAeq,16h, Lnight, outside

(myocard)

50 (myocard)

limited Lden 60 sufficient


LAeq,

night 40 sufficient - Lnight, outside 42 sufficient Lnight 42 sufficient

Awakening SEL 55 sufficient - LAmax, inside 42 sufficient SELindo

ors 53 sufficient

Sleep (arousal, motility, sleep quality)

(LAeq,

night), SEL

(<60), 35 sufficient - LAmax, inside,

Lnight, outside 35, 42 sufficient

LAmax,

indoors 32 sufficient

Heart rate, body movements during sleep

SEL 40 sufficient - sufficient -

Hormonal changes during sleep

limited limited limited -

Performance, fatigue next day

limited - limited -

Stress hormones

limited - limited LAmax, LAeq

NA sufficient

Learning, memory, performance

LAeq,

school 70 sufficient - - LAeq 50 sufficient

Immune effect

limited - - -

Birth weight limited - - -

Well-being limited - limited Lden 50 sufficient

6.11 It is also important to note the variety of ways of expressing “thresholds”. For example, the EEA Good

Practice Guide, as has been noted previously, includes a table of Thresholds, defined as “level above which

effects start to occur or start to rise from the background.” These thresholds could be regarded as LOAELs,


although they are not described in that way. Although the term “background” is not defined in the EAA

guide, this term generally refers to the noise which is prevalent for most of the time over a given period.

6.12 A more rigorous approach to defining thresholds would be a statistical approach based on the uncertainties

associated with the exposure-response curves. Information on statistical uncertainties is not always given in

the publications. Another important issue is that individual research studies are often limited in the range of

noise exposures used, so that they do not include low enough noise levels to enable a full assessment of

possible thresholds. This is an issue of the robustness of the noise data given that many of the of studies

refer to noise mapping which has generally produced results on the basis of a 10m grid at a height of 4m.

The availability of operator choice in noise models setting has a potentially very significant impact on the

noise band into which receptors fall in certain circumstances

6.13 At present therefore, it is concluded that the best available information on potential LOAELs for the various

effects is that given in the EEA Good Practice Guide of 2010.

6.14 The possible use of uncertainty information in defining potential SOAELs is also discussed in the next part

of this section.

SOAELs

6.15 Possible approaches to defining SOAELs include:

• criteria based on moving up a given exposure-response curve e.g. going from an outcome of, say,

10% highly annoyed to 50% highly annoyed;

• tracking the severity of medical outcomes, for example from hypertension to actual Myocardial

Infarction;

• a statistical approach which makes use of information about the various uncertainties in the exposure-

response relationship;

• using an approach based on economic evaluation of health effects as described in the BEL Report to

Defra in 2009 [Berry and Flindell, 2009];

• the point at which the number of people affected by the health outcome in question attributable to the

exposure becomes unacceptable (this concept is used, for example, for regulation of chemicals in

food where increased risks of cancer above 1 per million are unacceptable).

6.16 The first option noted above is seen as involving an arbitrary choice of % highly annoyed. The second is not

considered to be a practical option, in view of the complexities of the underlying medical conditions. The

fourth and fifth are likely to introduce even further uncertainties, over and above those involved in the

exposure-response relationships on which such methods depend.

6.17 It would seem that the optimum approach, given the above considerations, is to develop a method of

defining potential SOAELs based on the uncertainties in the relevant exposure-response relationships i.e.


taking account of confidence intervals etc. However, such a method could only be developed for outcomes

and for noise sources where sufficient statistical information is available.

6.18 In the case of annoyance for example, information has recently become available from within the ISO

Working Group currently revising ISO 1996-1: 2003 “Acoustics: Description, Measurement and Assessment

of Environmental Noise”.

6.19 This relates to the approach being used in the ongoing revision of Annex D of ISO 1996-1 to define

confidence intervals around the exposure-response curves for annoyance arising from exposure to air, road

and rail transport, see for example the exposure-response relationship for the percentage of the population

highly annoyed from aircraft noise, Figure 6.1 below.

Figure 6.1 Exposure-response relationship for aircraft noise and

percentage of the population highly annoyed12

6.20 Each data point shown in Figure 6.1 represents the mean exposure level and corresponding mean

percentage of the population highly annoyed from attitudinal surveys on exposure from aircraft noise. The

centre line represents the best fit regression line drawn through the data points which was found to be a

cubic expression of the form y = a + bx3 and was found to explain about 48% of the variance in the

percentage of the population highly annoyed by aircraft noise. The two lines closest to the regression line,

define the 95% confidence interval of the population mean i.e. there is a probability of 1 in 20 that the true

value of y (percentage highly annoyed) lies outside the confidence range for a particular x value (noise

exposure level, DNL). The two lines furthest from the regression line define the 95% prediction interval and

are relevant when using the regression line to predict the mean percentage highly annoyed for a particular

community when the average exposure level, DNL, is known.

12 DNL is an indicator used in the USA and represents the Day-Night Level, where day is the 15 hours from 0700 – 2200 and night is 2200 – 0700. The night time exposure is weighted by adding 10 dB to its level before it is combined with the day value to obtain DNL

AIRCRAFTRank 2 Eqn 7 y=a+bx3

r2=0.47942693 DF Adj r2=0.47620357 FitStdErr=15.250806 Fstat=298.39101

a=-5.7302402

b=0.0001157798

30 50 70 90DNL (dB)

0

20

40

60

80

100

Per

cent

Hig

hly

Ann

oyed

(%

)

AIRCRAFT

Y=a+bx3


6.21 A possible way of using this statistical information is illustrated in Figure 6.1. At a noise exposure level DNL

of 70dB, the mean %HA from the regression line is 34% and the upper 95% prediction interval is 59.2%.

From the regression line the noise exposure level which would correspond to a mean %HA of 59.2% is

found to be at 82.5 dB constituting a change in exposure of 12.5 dB. Statistically it could be argued that

increasing the noise exposure level from 70 dB to 82.5 dB has caused a significant shift in the mean %HA

and constitutes a significant change in exposure. An alternative way of expressing this is to look at the

change in the %HA. In this case, the upper 95% prediction interval corresponds roughly with an increase of

about 25% in the %HA, and that could be considered as constituting a significant change in the %HA.

Looking at the whole distribution it is clear that the upper 95% prediction interval is fairly parallel to the

regression line over the range 30 to 90 dB and therefore generally a 25% increase in the %HA would

constitute a significant change in response.

6.22 However, it should be noted that even with this additional, and sometimes complex statistical information,

the definition of what constitutes a significant effect in the case of an existing steady state situation, would

still be an arbitrary one. A choice of a change of 20%HA, or 30%HA as defining significant would involve a

judgement of the implications of making such a choice in terms of the impact on the population affected, or

potentially affected.


7.1 The objective of Phase 3 was to establish from Phase 2 (Synthesis of relevant research, standards and

other guidance) relevant possible LOAELs and SOAELs for a range of different sources and effects.

7.2 Although no LOAELs and SOAELs have yet been finalised the following paragraphs provide some

examples of threshold levels or criteria levels that have been proposed in the literature and reviewed under

Phase 1 and 2 of the project.

7.3 The first example examines the threshold levels proposed by the European Environment Agency (EEA,

2010) which reviewed the current knowledge on the health effects of noise. Threshold levels are defined in

the EEA document as “level above which effects start to occur or start to rise above background’ and as

mentioned in Para 6.11 above, these values could be regarded as LOAELs. Only those threshold levels

where there is sufficient evidence to support the exposure-response relationship for different health effects

have been included.

The second example looks at the evaluation criteria for aircraft noise in protecting communities in the vicinity

of airports proposed by Griefahn (Griefahn et al, 2004). Evaluation criteria are proposed protection goals to

prevent adverse effects on health and are defined as follows:

Critical loads: Any excess of these loads forces establishment of noise abatement measures on the

grounds of a health hazard. These loads shall be tolerated only as an exception during a limited time.

Protection guides: Excess of these noise loads gives reasons for counter measures. Non-exceedance is

expected to exclude health hazards for the average person whereas impairments may be still observed in

sensitive groups.

Threshold values: Cause significant effects that do not bear a pathogenic risk in the long run.

Nevertheless, to increase the quality of life these values constitute a long-term goal.

Based on these descriptions, it could be inferred from this that the Critical load is equivalent to a SOAEL at

65 dB LAeq,16h.

7.4 Example 1: Threshold levels proposed by European Environment Agency applied to 1st

round END

strategic noise maps for agglomerations in England.

Figure 7.1. shows the threshold levels proposed by the EEA for the onset of annoyance (42 dB Lden),

hypertension (50 dB Lden) and cardiovascular (60 dB Lden) applied to the percentage of the population

exposed to noise from road and rail within all the 23 agglomerations within England. The percentage of the

population exposed to noise levels in terms of Lden in the range 55 to 75 dB were derived from data obtained

from the Noise Observation and Information Service for Europe (NOISE) website:

http://noise.eionet.europa.eu/. Figure 7.2 shows the equivalent results for self reported sleep disturbance

7 Phase 3 Identification of Possible LOAELs and SOAELs


Figure 7.1 Threshold levels and the percentage of the population exposed

to noise levels (Lden) for agglomerations in England

Figure 7.2 shows the corresponding relationship for the threshold levels

proposed by the EEA for self-reported sleep disturbance (42 dB Lnight).

0

10

20

30

40

50

60

70

80

40 45 50 55 60 65 70 75 80

Pe

rce

nta

ge o

f th

e p

op

ula

tio

n e

xp

ose

d t

o n

ois

e le

vel e

xce

ed

ed

(%

)

Noise level Lden exceeded (dB)

Road Rail

Threshold Levels (EEA 2010)

Annoyance

Hypertension

Cardiovascular

0

10

20

30

40

50

60

40 45 50 55 60 65 70 75 80

Perce ntage of the populati on ex posed to noise level exceede d (%)

Noise level, Lnight exceeded (dB)

Road Rail

Threshold Levels (EEA 2010)

Self Reported Sleep Disturbance


Table 7.1 (below) shows the results of the percentage of people within the agglomerations in England that

exceed the threshold levels from road and rail sources for all the health effects shown in Figures 7.1 and

7.2.

Table 7.1 Percentage of people within agglomerations in England exceeding threshold levels

from road and rail sources for a range of health effects (EEA, 2010)

Source Percentage of population exceeding threshold levels for different effects (%)

Annoyance Hypertension Cardiovascular Disease Self-reported sleep disturbance

Road > 71 > 71 49 > 54

Rail >3 >3 1.7 >2

For health effects relating to annoyance, hypertension and self-reported sleep disturbance the threshold

levels fall well below the lower values required to be reported for noise mapping i.e. 55 dB for Lden and 50 dB

for Lnight. However, it is clear that in terms of noise from road traffic the majority of the population in

agglomerations in England (total population about 23,000,00013) exceed the EEA threshold levels (potential

LOAELS) for annoyance, hypertension and self-reported sleep disturbance. For railway noise, again the

threshold levels (potential LOAELs) for annoyance, hypertension and self-reported sleep disturbance are all

well below the lower range required for noise mapping, however because the noise from railways is much

less ubiquitous compared with road sources the percentage of the population exposed to the corresponding

threshold levels is very much lower.

For cardiovascular disease the EEA threshold level falls within the range required for noise mapping. For

road sources, 49% of the population within agglomerations exceed the threshold level (potential LOAEL)

(about a total population of 11,000,000) whereas for railway sources, 1.7% of the population within

agglomerations exceed the threshold level (potential LOAEL) (a total population of about 39,000).

7.5 Example 2: Evaluation Criteria proposed by Griefahn applied to Heathrow Airport.

Figure 7.3 shows the relationship between the evaluation criteria proposed by Griefahn for high annoyance

and the percentage of the population exposed to various noise levels, LAeq,16h within the 55 LAeq,16h contour at

Heathrow Airport [Griefahn et al, 2004]. For high annoyance, the evaluation criteria proposed by Griefahn

are:

Threshold value: 55 dB LAeq,16h

Protection guide: 62 dB LAeq,16h

Critical load: 65 dB LAeq,16h

The percentage of the population exposed to noise levels in terms of LAeq,16h values in the range 55 to 75 dB

were derived from data obtained from the Civil Aviation Authority (Monkman and McMahon, 2007).

13 Round 1 data


Figure 7.3 Evaluation criteria proposed by Griefahn, based on high annoyance, for the population

within the 55 dB, LAeq,16h contour at Heathrow Airport (2007)

Table 7.2 shows the results of the percentage of the population within the 55 LAeq,16h contour and the

number of people exposed above each of the evaluation criteria with respect to aircraft noise from

operations at Heathrow airport.

Table 7.2 Percentage of the population within the 55 LAeq,16h contour at Heathrow Airport exposed to

noise above evaluation criteria for high annoyance (Griefahn et al, 2004)

Evaluation Criteria Percentage of the population within

the 55 dB LAeq,16h contour above evaluation criteria

Number of people above evaluation criteria

Threshold Level 100 480200

Protection Guide 11 52800

Critical Load 4.8 23200

The results show that applying the evaluation criteria proposed by Griefahn to noise exposure from aircraft

at Heathrow in 2007, about 480,200 people were above the threshold level criteria, 11% (52,822 people)

were above the protection guide criteria and 4.8% (23,200 people) were above the critical load criteria.

0

10

20

30

40

50

60

70

80

90

100

40 45 50 55 60 65 70 75 80

Pe

rce

nta

ge

of

the

po

pu

lati

on

ex

po

sed

to

no

ise

lev

el e

xce

ed

ed

(%

)

Noise level LAeq,16h exceeded (dB)

Heathrow Airport

Evaluation Criteria (Griefahn et al, 2004)

Threshold Level

Protection Guide

Critical Load


7.6 The above examples demonstrate how the identification of potential LOAELs and SOAELs can be

determined from the literature. However, the extent to which this can be achieved will depend on several

factors and include the following;

• The noise metric in defining the respective LOAELs and SOAELs for different sources and effects must

correspond with that used for defining the exposure of the target population.

• The range of the exposure levels for the target population must adequately extend to include the

relevant thresholds so that a quantitative assessment of the impact can be derived.

• The robustness of the underlying data. Much of the Europe wide data on which the analysis in the

literature has been based are strategic noise maps. This means that there is uncertainty about the

precise values of exposure at particular locations where a health or annoyance outcome has been

identified as part of the research studies. So caution does need to be exercised when using these

relationships to determine potential LOAELs and SOAELs.


Introduction

8.1 The objective of this Case Study is to provide an opportunity to investigate the application of some of the

ideas and approaches which have been developed in the previous phases of the project. The Case Study

relates to the British Airport Authority (BAA) planning application that had been made in 2008 for a second

runway at Stansted Airport, the so-called Stansted Generation 2 Project, referred to as the G2 Project.

8.2 An overall description is given of the proposed development at London Stansted Airport followed by the data

that had been produced relating to the noise exposure and the population distribution within each noise

contour band.

8.3 The Case Study has not been used to look at potential LOAELs since the available data on noise exposure

from the specific case did not extend to low noise levels.

8.4 Two health effects are examined in detail in this Case Study;

• Annoyance, an analysis is given of the implications, within the context of the population in question, of

setting different possible noise exposures as being SOAELs. This has been done because it was clear

from the previous phases of the work that the evidence on various health effects, including annoyance,

sleep, cardiovascular effects etc, and the related exposure-response relationships, does not in itself

give a clear definition of what constitutes a significant effect. The Case Study is therefore used to look

at the implications of using different definitions for SOAEL on the results of assessments of the

impacts; and

• Self-reported sleep disturbance

8.5 For Cardiovascular effects, a careful assessment has been made of the data from the Stansted G2

project. In an unpublished BEL Technical Report prepared for BAA in 2008 [Berry, 2008], the calculations of

Population Attributable Risk indicated that, in view of the low number of people in the relevant higher-level

noise contour areas, in all of the future scenarios that were being assessed, the analysis indicated that no

cases of Acute Myocardial Infarction AMI, or deaths from AMI would result from exposure to aircraft noise.

This meant that the data from Stansted G2 could not be used to explore the issue of potential SOAELs for

Cardiovascular effect.

Stansted Airport – Generation 2: General description of the proposal

8.6 In 2008, BAA submitted a planning application to Uttlesford District Council for the Stansted Generation 2

(G2) Project.

8.7 The G2 Airport Project comprised the expansion of the present Airport to provide a wide-spaced second

runway and associated facilities; stopping up and diversion of local roads; provision of environmental off-

setting and compensation measures; the provision of off-site utilities infrastructure; changes to airspace

patterns and routes to accommodate aircraft movements to and from the expanded Airport.

8 Phase 4: Case Study


8.8 An Environmental Impact Assessment [EIA] and a Health Impact Assessment [HIA] were published in 2008

and 2009, as part of the Planning application [Taylor, 2008; ERM, 2009]. This was in preparation for a

Public Inquiry, expected to be in September 2009. In April 2009, however, BAA withdrew the Application, as

a consequence of a decision by the Competition Commission that BAA should sell one of its airports. Most

of the relevant technical documents and background data files relating to the Application have remianed

available. These include data prepared by the CAA on noise contours, including ground noise, noise at

various schools, and populations within various noise level bands across the whole of the area affected by

this redistribution of noise.

8.9 The G2 project involved a complex change situation. It would not have involved a sudden change, but one

which, if it had been approved would have meant some gradual changes in exposure over a period of at

least 12 to 18 months from start of construction.

8.10 The EIA and the HIA looked at two future years, 2015, the projected year of runway opening, and the year

2030. For each of those years, estimates were made of the impact of the airport for two scenarios, Base

case, i.e. no new runway, and Development case, with new runway.

8.11 Thus there were four sets of assessment scenarios – see Table 8.1 below

Table 8.1: Scenarios considered for the EIA and HIA Stansted G2 Project

Year 2015 2030

Scenario Base case.

No new runway

Development case with G2

completed

Base case. No new runway

Development case with G2

completed

Noise exposure data

8.12 Appendix 9 contains the noise contour plots that were produced for the standard Summer Average Day,

LAeq,16h where the 16-hour period extends from 07:00 to 23:00 hours. Figure A9.1 shows the contour plot in

2015 for both the Base case and the Development case. Figure A9.2 shows the corresponding contours for

2030. Corresponding information for an average night were also available.

Population exposure data

8.13 The population exposure data from the G2 HIA of the number of people living within the various contour

bands, under the four scenarios outlined above are shown in Table 8.2 for the 16-hour day period and in

Table 8.3 for the night period.


Table 8.2: Number of people exposed within noise contours, LAeq,16h, for 2015 and 2030 for Base and

Development cases.

Noise Band (LAeq16h dB)

Number of People

(2015 Base case)

Number of People (2015

Development case)

Number of People

(2030 Base case)


Development case)

54-57 4591 7162 4121 10171 57-60 3086 2038 2602 2774 60-63 842 890 778 845 63-66 317 468 269 725 66-69 91 206 89 343 69-72 22 58 10 86 72-75 0 2 0 7 Total 8949 10824 7869 14951

Table 8.3: Number of people exposed within noise contours, Lnight, for 2015 and 2030 for Base and

Development cases.

Noise Band Lnight

dB

Number of People

(2015 Base case)


Development case)

Number of People

(2030 Base case)


Development case)

50-55 4272 5575 3955 2803 55-60 917 1188 826 1092 60-65 122 451 120 326 65-70 0 22 0 22 >70 0 0 0 0

Total 5311 7236 4901 4243

Annoyance assessment

Using exposure-response relationship from the HIA, 2009

8.14 The HIA considered a number of possible exposure-response curves for annoyance, see Appendix 10.

However, the current practice of the Department for Transport (DfT) at that time, for assessing annoyance

was to use curves for community annoyance that take into account the results of the UK CAA ANIS Study [

Brooker et al, 1985]. The equation for the ANIS exposure-response curve is:

Percentage of the Population Highly Annoyed (%HA) = 100/(1+exp(13.2-0.19LAeq,16h))

8.15 Using the above equation, Table 8.4 shows the percentage of the population highly annoyed at the mid-

point for each noise contour band, LAeq,16h, shown in Table 8.2.


Table 8.4: The percentage of the population highly annoyed at the mid-point of the noise contour

bands for the Average Summer Day, LAeq,16h.


Mid-point level (LAeq16h dB)

Percent ‘Highly Annoyed’ (%HA)

54-57 55.5 6.6 57-60 58.5 11.1 60-63 61.5 18.0 63-66 64.5 28.0 66-69 67.5 40.7 69-72 70.5 54.9 72-75 73.5 68.2

8.16 Applying these percentages to the populations given above in Table 8.2 above, provides an estimate of the

number of people likely to be highly annoyed under the different scenarios, as shown in Table 8.5.

Table 8.5: Estimated number of people likely to be highly annoyed in each noise contour band,

LAeq,16h. for 2015 and 2030 for Base and Development cases.


Number of People Highly

annoyed (2015 Base

case)


Annoyed (2015

Development case)


annoyed (2030 Base

case)


annoyed (2030

Development case)

54-57 302 470 271 668 57-60 341 225 288 307 60-63 152 160 140 152 63-66 89 131 75 203 66-69 37 84 36 140 69-72 12 32 5 47 72-75 0 2 0 5 Total 932 1104 815 1522

8.17 Using the results shown in Table 8.5, it is interesting to look, for example, at the implications of assuming

different possible definitions of what constitutes a Significant Observed Adverse Effect Level, SOAEL. As

set out in paragraph 7.3 above, from the Griefahn work, a potential SOAEL is 65 dB(A), LAeq,16.

8.18 Referring back to Table 8.4 – Percentage Highly Annoyed, an LAeq,16h of 64.5 dB(A) (the mid-point of the 63-

66 band) corresponds to 28% Highly Annoyed on the basis of the ANIS curve.

8.19 Using the exposure data shown above in Table 8.5, the implications of this particular “definition” of a SOAEL

is shown in Table 8.6.


Table 8.6: Number of people highly annoyed for 2015 and 2030 for Base and Development cases

based on ANSI exposure-response relationship.



Annoyed (2015 Base

case)


Annoyed (2015

Development case)


Annoyed (2030 Base

case)


Annoyed (2030

Development case)

54-57 302 470 271 668 57-60 341 225 288 307 60-63 152 160 140 152 63-661 89 (59) 131 (87) 75 (50) 203 (135) 66-69 37 84 36 140 69-72 12 32 5 47 72-75 0 2 0 5 Total 933 1104 815 1522

Total above SOAEL=65 108 205 91 327 Total above SOAEL=69 12 34 5 52

1Values in brackets are the number of people exposed above 65 dB LAeq16h assuming linear distribution within noise contour band 63-66 dB.

8.20 Using this particular definition of SOAEL, it can be observed, for example, that for the future year 2030, the

operation of the second runway would involve an increase in the number of people above the SOAEL from

91 to 327 compared with if the second runway was not developed.

8.21 Clearly, changing the definition of SOAEL would alter the outcome in this example.

Using other exposure-response relationships for annoyance

8.22 The previous analysis made use of the information taken directly from the HIA documents prepared for the

Stansted case in 2009. It is possible to use the same input data but with other exposure-response

relationships, such as the Miedema curves in the 2002 EU Position Paper [EU,2002] or the curves currently

being considered as part of the revision of the International Standard ISO 1996 [ Schomer, 2011].

8.23 It is understood that two curves are currently being included in the proposed revision. These are the curves

of Miedema and Oudshoorn [Miedema and Oudshoorn, 2001], and the functions given by Fidell et al. in a

paper from 2011 [Fidell et al, 2011].

8.24 These two curves are very similar but not identical. The Miedema and Oudshoorn curve for aircraft noise is

represented by the equation:

% HA = – 9.199 x 10–5 (Lden – 42)3 + 3.932 x 10–2 (Lden – 42)2 + 0.2939 (Lden – 42)

whereas the Fidell et al curve is;

% HA = 100 x exp (-(1/((10^((( Lden – 0.6) – Lct +5.306)/10))0.3)))

where, for aircraft, Lct = 73.3 dB

Both relationships are shown in Figure 8.1.


Figure 8.1: Prevalence of high annoyance to aircraft noise, Lden. Solid line (Miedema and Oudshoorn,

2001). Long dashed line including data points (circles) and 95% prediction intervals (short dashed

line) (Fidell et al. (2011))

8.25 Values of the percentage of the population highly annoyed (%HA) are derived from the equation above for

the Miedema and Oudshoorn curve and are shown below in Table 8.7, along with 95% confidence limits [i.e.

there is a 95% chance that the %HA lies within the upper and lower limit values]. Noise levels in LAeq,16h

have been converted to Lden by the addition of 2 dB [EAA, 2010].

Table 8.7: Percentage of people highly annoyed (%HA) at the mid-point noise contour bands using

Miedema-Oudshoorn exposure-response relationship including 95% confidence limits.

Noise Band

LAeq,16h

dB

Mid-point LAeq,16h

dB

Estimated Lden, (LAeq,16h + 2)

dB

Miedema and Oudshoorn

%HA

Upper 95% Confidence Limit

%HA

Lower 95% Confidence

Limit

%HA

54-57 55.5 57.5 14.5 63.7 2.6 57-60 58.5 60.5 19.1 70.3 3.9 60-63 61.5 63.5 24.5 76.3 5.6 63-66 64.5 66.5 30.6 81.6 8.0 66-69 67.5 69.5 37.3 86.1 11.1 69-72 70.5 72.5 44.4 89.7 15.0 72-75 73.5 75.5 51.6 92.7 19.6

8.26 Using the values derived for the percentage of people highly annoyed (%HA) at the mid-point of the noise

contour bands shown in Table 8.7, the number of people highly annoyed in 2015 and 2030 from the

exposure data given in Table 8.2 for both the Base case (without the second runway) and the Development

case (with the second runway) can be calculated. The results are shown in Table 8.8.


Table 8.8: Number of people highly annoyed for 2015 and 2030 for Base and Development cases

based on Miedema and Oudshoorn exposure-response relationship.

Noise Band

(LAeq,16h dB)

Estimated Lden,

(LAeq,16h + 2) dB


Annoyed (2015 Base

case)


Annoyed (2015

Development case)


Annoyed (2030 Base

case)


Annoyed (2030

Development case)

54-57 57.5 666 1038 598 1475 57-60 60.5 589 389 497 530 60-63 63.5 206 218 191 207

63-661 66.5 97(65) 143(95) 82(55) 222(148) 66-69 69.5 34 77 33 128 69-72 72.5 10 26 4 38 72-75 75.5 0 1 0 4 Total 1602 1892 1405 2604

Total above SOAEL=65

Equivalent SOAEL=67 109 199 92 318

1Values in brackets are the number of people exposed above 65 dB LAeq16h assuming linear distribution within noise contour band 63-66 dB

8.27 Again, defining the SOAEL as 65 dB LAeq16h has an equivalent value of 67 dB Lden (using the conversion in

the EEA report (EEA 2010). The number of people above the SOAEL in 2030 with the second runway

operational is 318 compared with 92 if the second runway was not built. In this case, the results based on

the Miedema and Oudshoorn exposure-response relationship are very similar to that obtained using the

ANIS relationship (327 with the second runway and 91 without the second runway for 2030).

8.28 There are other exposure-response curves for annoyance which could be used, and from which an

assessment of how many people might be significantly affected might be different. A notable example has

been shown in a previous section of this report and comes from the EEA report [EAA, 2010]. In that report,

the difference between the results of annoyance surveys conducted pre- and post- 1990 are discussed. The

Guide comments, “Although it is recommended to use the post-1990 data in impact assessment, one should

be aware that the exact values might change under the influence of further studies. Using the old values in

the context of the END would be formally valid, but leads to a conservative approach.” The exposure-

response relationships from these studies are shown in Figure 8.2.


Figure 8.2: Exposure-response relationship, EAA Guide 2010. Upper curves post-1990 surveys.

Lower curves pre-1990 surveys.

8.29 It is clear, even from simple visual inspection of these curves that the use of the upper, post-1990 survey

curve would result in a very much higher number of people highly annoyed. Therefore, a SOAEL of 67 dB

Lden, equivalent to 65 LAeq16h dB the corresponding percentage Highly Annoyed for the upper curve is about

60%.

8.30 Rather than defining the SOAEL with reference to an exposure level, SOAEL could relate to a certain

percentage highly annoyed. For example, an LAeq,16h of 65 dB corresponds to 30% Highly Annoyed

according to the equation shown in paragraph 8.14 above. The corresponding exposure to 30% highly

annoyed for the other dose-response curves are: 67 dB, Lden (Miedema & Oudshoorn); 66 dB (Fidell); and

56 Lden (post-1990 studies). As mentioned above, it is essential that the dose-response relationships used

in this type of analysis are robust.

Sleep disturbance

8.31 For sleep disturbance, the relationship between Lnight and self-reported sleep disturbance (in terms of %

highly sleep disturbed) was used for the Stansted G2 project. The data on the distribution of the exposed

population in various noise exposure bands in terms of Lnight was shown earlier in Table 8.3. The dose-

response relationship used was that set out in the 2004 EU Position Paper [EU, 2004] and that was also

shown in the EEA Good Practice Guide 2010 [EEA,2010].

8.32 The relevant equation is:


Percentage of people Highly Sleep Disturbed, %HSD = 18.147 - 0.956 Lnight + 0.01482(Lnight) 2

Table 8.10 shows the number of people that might be highly sleep disturbed within each noise band contour

estimated from the %HSD at the mid-point noise contour within each band.

Table 8.10: Number of people that might be highly sleep disturbed within each noise contour band Lnight for

2015 and 2030 for both the Base and Development cases

Noise Band

Lnight

dB

Percentage Highly Sleep

Disturbed

%HSD

Number of People

Highly Sleep Disturbed

(2015 Base case)

Number of People


(2015 Development

case)

Number of People


(2030 Base case)


Sleep Disturbed (2030

Development case)

50-55 8.8 376 491 348 247 55-60 12.2 112 145 101 133 60-65 16.3 20 73 20 53 65-70 21.1 0 5 0 5 >70 -

Total 508 714 469 438

8.33 For sleep disturbance, a possible way forward in defining a SOAEL could be based on the published WHO

report on guidelines for night noise [WHO, 2009]. Table 8.11 shows the effects of exposure to various levels

of Lnight.

Table 8.11: Extract from WHO 2009

Average night noise level over a year Lnight, outside

Health effects observed in the population

Up to 30 dB Although individual sensitivities and circumstances may differ, it appears that up to this level no substantial biological effects are observed. Lnight, outside of 30 dB is equivalent to the NOEL for night noise.

30 to 40 dB A number of effects on sleep are observed from this range: body movements, awakening, self-reported sleep disturbance, arousals. The intensity of the effect depends on the nature of the source and the number of events. Vulnerable groups (for example children, chronically ill and the elderly) are more susceptible. However, even in the worst cases the effects seem modest. Lnight, outside of 40 dB equivalent to the LOAEL for night noise.

40 to 55 dB Adverse health effects are observed among the exposed population. Many people have to adapt their lives to cope with the noise at night. Vulnerable groups are more severely affected.

Above 55 dB The situation is considered increasingly dangerous for public health. Adverse effects occur frequently, a sizable proportion of the population is highly annoyed and sleep-disturbed. There is evidence that the risk of cardiovascular disease increases.


8.34 Night noise levels above 55 dB Lnight are “considered increasingly dangerous for public health” and may

therefore be regarded as having a significant adverse effect on health. The implications of defining SOAEL

at 55 dB Lnight for the Stansted G2 project are illustrated in Table 8.12.

Table 8.12: Number of people highly sleep disturbed for 2015 and 2030 for Base and Development cases based on EU position paper[EU,2004].

Noise Band Lnight

dB

Percentage Highly Sleep

Disturbed

%HSD

Number of People


(2015 Base case)

Number of People


(2015 Development

case)

Number of People


(2030 Base case)


Sleep Disturbed

(2030 Development

case)

50-55 8.8 376 491 348 247 55-60 12.2 112 145 101 133 60-65 16.3 20 73 20 53 65-70 21.1 0 5 0 5 >70 -

Total 508 714 469 438 Total above SOAEL=55 132 223 121 191

8.35 This Case Study has provided an example of how a value of SOAEL might be defined and how that

definition translates into determining the number of people that might have been significantly affected had

the project proceeded. Clearly the result is dependent on how SOAEL is defined and the dose-response

relationship used to determine the effects. This section has outlined some of the issues involved.


9.1 The aim of this discussion is to consider how the implementation of the Noise Policy Statement for England

might be related to the findings from the literature review of the effects of noise on health described in

Chapter 3 of this report.

9.2 The underlying concept of the NPSE is to protect communities from the effects of noise on health and

quality of life. Unlike many other pollutants where an accumulation of the pollutant builds-up in the body to

cause adverse effects above a certain threshold level, the effects of noise on health is more complex and

depends not only on biological effects but on how the noise is perceived which includes not only individual

sensitivity to noise but also on perceived relationships between the recipient and the noise producer,

amongst other confounding influences.

9.3 Despite this difference in the way noise affects health compared with other pollutants, concepts which are

normally associated with toxicology have been adopted within the NPSE to assist in the effective

management of noise. These concepts have been interpreted as follows (Turner and Grimwood, 2011):

• Is there, or is there likely to be, a significant adverse impact on health or quality of life (well-being) for

the community in general? If yes, can this be avoided in the context of Government Policy on

sustainable development?

• Is there, or is there likely to be, an adverse impact on health or quality of life (well-being)? If yes, to

what extent can this be mitigated or minimized in the context of Government Policy on sustainable

development?

9.4 Associated with these concepts, it is anticipated that a quantitative assessment of a noise impact can

eventually be determined which will enable impacts to be differentiated as either having a significantly

adverse impact or an adverse impact on health or quality of life. Such a quantitative assessment may be

based not only on the setting of a threshold level, above which the impact would be regarded as significantly

adverse but may include additional criteria such as an associated specified change in noise level.

9.5 The first essential aspect of this approach is to understand what is meant by “adverse” effects. The World

Health Organisation defines an “adverse effect” as follows (WHO, 1994):

“Change in morphology, physiology, growth, development or life span of an organism, which results in

impairment of the functional capacity to compensate for additional stress, or increase in susceptibility to the

harmful effect of other environmental influences”

9.6 To place this definition in the context of noise, the following illustration provides a useful interpretation for

differentiating where the effect of noise on health becomes “adverse” (Babisch, 2002).

9 General Discussion


Figure 9.1 Severity of noise effects on the population exposed

9.7 Figure 9.1 shows the severity of noise effects on the population exposed. As noise impact increases (the

vertical axis), the numbers so affected reduces but the severity of the noise impact on health increases. If it

is accepted that, in terms of quality of life, experiencing annoyance is an adverse effect, the base of the

“severity triangle” represents the threshold for LOAEL. Where the effects are such as to cause pathological

disorders, leading to morbidity, that boundary, shown by the bold line in Figure 9.1, is possibly the SOAEL

threshold.

9.8 Chapter 6 considered possible threshold values that might be used as a basis for arriving at LOAELs for

certain source/effect combinations, but at present, because there is no internationally accepted definition of

what constitutes a significant adverse effect, SOAELs cannot be defined.

9.9 To reach a consensus on establishing potential SOAELs for different source/effects would most likely

require a panel of experts to review the available evidence which could take several years with no

guarantee of a successful outcome. The existing evidence relating noise sources with health effects such as

hypertension and cardiovascular disease have limitations with regard to high and low exposures as

explained in the paper by Laszlo at InterNoise (Laszlo, 2012). In addition, the categorisation of noise

exposure based on noise maps will be likely to lead to inconsistencies as no single common approach to

noise mapping is currently followed. A further concern in relying on noise maps for identifying exposure

levels is that they were produced for strategic purposes and not with the aim of establishing the exact

exposure at any particular location.

9.10 In the meantime, a possible way forward could be to adopt a statistical approach similar to that described in

paragraph 6.19 to 6.21 using established exposure-response relationships for different source/effects where

they exist.


9.11 For this approach SOAEL could be determined from the exposure-response relationship by calculating the

exposure level which corresponds to the upper 95% prediction interval drawn through the regression line at

the LOAEL as illustrated in Figure 9.2.

Figure 9.2 Example for possibly estimating SOAEL based on exposure-response relationship

9.12 The example, illustrated in Figure 9.2, shows how the SOAEL might be derived for transport noise and

annoyance. The LOAEL of 42 dB Lden is based on the threshold level from the EAA 2010 value shown in

Table 6.1. At 42 dB Lden the %HA at the upper 95% predicted interval is about 28% which corresponds to

about 66.5 dB Lden on the exposure curve. Noise levels exceeding the 95% predicted level at the LOAEL

could be argued statistically to be significantly above the LOAEL and therefore represent the SOAEL which

in this example would be 66.5 dB Lden.

9.13 Consequently, LOAEL represents the noise exposure level at which adverse effects can start to occur:

SOAEL, using this approach, is the level above the LOAEL which constitutes a statistically significant

change in the adverse impact on health (and quality of life).

9.14 The above approach could be applied to those adverse effects which have robust exposure-response

relationships such as annoyance and sleep disturbance based on steady state conditions.

Alternative approach for deriving LOAEL and SOAEL for transportation noise

9.15 For transportation noise sources, air, road and rail, robust exposure-response relationships for annoyance

and self-reported sleep disturbance have been found in the literature and are described in Chapter 4 of this

report.

9.16 To assist in deriving possible LOAEL and SOAEL values for these source/effects, the Noise Exposure

Categories (NEC) as defined in previous planning policy may provide a way forward [DETR, 1994]. Table

9.1 shows the noise levels associated for each NEC for each noise source at different times of the day.

0

10

20

30

40

50

60

70

80

90

100

30 40 50 60 70 80 90

% P

op

ula

tio

n H

igh

ly A

nn

oye

d (%

HA

)

Lden dB

Regression Line Upper 95% Prediction Interval

LOAEL

42 dB

Lden SOAEL

66.5 dB

Lden


Table 9.1. Former Noise Exposure Categories and noise levels for air, road and rail

Noise Source

Time of day

Noise Levels corresponding to the Noise Exposure Category

A B C D

Road

07:00 – 23:00 <55 55-63 63-72 >72

23:00 – 07:00 <45 45-57 57-66 >66

Rail

07:00 – 23:00 <55 55-66 66-74 >74

23:00 – 07:00 <45 45-59 59-66 >66

Air

07:00 – 23:00 <57 57-66 66-72 >72

23:00 – 07:00 <48 45-57 57-66 >66

9.17 The NEC A/B boundary defines the noise level for a particular mode as the criteria above which noise

should be taken into consideration with regard to former planning policy and therefore could be viewed as a

candidate for deriving appropriate LOAEL values for each transport mode. Similarly, the NEC B/C boundary

defines the noise level for a particular mode as the criteria above which planning permission would not have

normally been granted due to noise impact and therefore could be viewed as a candidate for deriving

appropriate SOAEL values for each transport mode.

9.18 Using the approximate conversion to express LAeq,16h levels to Lden values i.e. Lden ≈ LAeq,16h + 2 dB [EEA,

2010], it is possible to establish the percentage of the population that is highly annoyed (%HA) which

corresponds to the NEC A/B and NEC B/C boundary levels based on the EU noise exposure-response

relationships for %HA described previously in this report (Chapter 4) for each transport mode. The following

Table 9.2 shows the %HA corresponding to each boundary level for each transport mode.


Table 9.2 %HA corresponding to NEC boundary levels for each transport mode

Source


LAeq,16h Lden %HA

(± 95% Levels) LAeq,16h Lden

%HA

(± 95% Levels)

Road 55 57 7.8

(10.0 - 6.0) 63 65

16.2

(20.0 – 14.0)

Rail 55 57 3.2

(4.5 – 2.0) 66 68

11.8

(16.5 – 9.8)

Air 57 59 15.9

(20.0 – 11.8) 66 68

32.6

(38.0 – 30.0)

Average %HA

(Range)

9.0

(11.5 – 6.6)

Average %HA

(Range)

20.2

(24.8 – 17.9)

9.19 This shows that the NEC A/B and B/C boundary levels are not equivalent in terms of the corresponding

%HA for the different transport modes. It can be argued that there should ideally be equivalence across the

transport modes when establishing the potential LOAEL and SOAEL values using this approach. A possible

way forward is to determine the average effect in terms of %HA across all transport modes at both boundary

transitions and use this as a basis for determining the possible LOAEL and SOAEL values for each mode of

transport, i.e. 9% and 20%HA, respectively, as shown in Table 9.2. However, given the inherent uncertainty

in the relevant dose-response relationships, the corresponding values for the 95% levels have also been

shown, leading to a range of results14.

9.20 Using the appropriate EU exposure-response relationship [EU, 2002b], the Lden levels corresponding to

range of %HA values can be derived for each transport mode to obtain the corresponding LOAEL and

SOAEL values as shown in Table 9.3 after converting to LAeq,16h. The LOAEL and SOAEL values for rail are

significantly higher than for road and air because the dose response relationship for noise from trains shows

them to be less annoying than other transport modes at a given exposure level.

14 For the average %HA, the 95% CI levels have also just been averaged. An alternative approach would be to take the upper and lower bound across the three sources. This would result, however, in a potentially impracticable range of values.


Table 9.3 LOAEL and SOAEL for annoyance from transportation noise

Source

LOAEL and SOAEL for Annoyance

(Range in Values)

dB LAeq,16h

LOAEL SOAEL

Road 56

(53 to 59)

66

(64 to 68)

Rail 63

(61 to 66)

72

(70 to 74)

Air 52

(50 to 54)

60

(58 to 62)

9.21 A similar approach can be used to derive possible LOAEL and SOAEL values for sleep disturbance. This

approach would use the EU exposure-response relationships {EU, 2004] for the percentage of the

population highly sleep disturbed (%HSD) and the LAeq,8h or Lnight values at the NEC A/B and B/C boundary

levels. Table 9.4 shows the range of %HSD corresponding to each boundary level for each transport mode.

Table 9.4: %HSD corresponding to NEC boundary levels for each transport mode

Source


LAeq,8h/Lnight %HSD LAeq,8h/Lnight %HSD

Road 45 3.6 57 9.2

Rail 45 1.9 59 5.3

Air 48 6.4 57 11.8

Average %HSD 4.0

Average %HSD 8.8

Table 9.5 shows the corresponding 95% levels for %HSD for each of the transport modes.


Table 9.5 %HSD corresponding to NEC boundary levels for each transport mode

Source


LAeq,8h / Lnight %HSD

(± 95% Levels) LAeq,8h / Lnight

%HSD

(± 95% Levels)

Road 45 3.6

(5.9 to 3.1) 57

9.2

(13.6 to 6.9)

Rail 45 1.9

(3.7 to 1.4) 59

5.3

(10.0 to 2.8)

Air 48 6.4

(10.4 to 4.8) 57

11.8

(18.6 to 7.9)

Average %HSD

(Range)

4.0

(6.6 to 3.1)

Average %HSD

(Range) 8.8

(14.1 to 5.9)

9.22 Using the EU exposure-response relationships for %HSD the corresponding LOAEL and SOAEL values

were derived as shown in Table 9.6.

Table 9.6: LOAEL and SOAEL for sleep disturbance from transportation noise

Source

LOAEL and SOAEL for Sleep Disturbance

(Range in Values)1

dB LAeq,8h

LOAEL SOAEL

Road 46

(43 to 52)

56

(51 to 64)

Rail 55

(52 to 63)

68

(61 to 77)

Air 41

(40 to 49)

53

(47 to 60)

9.23 Again it is noticeable that the LOAEL and SOAEL values for rail are significantly higher than for road and air

because the noise from trains causes less self-reported sleep disturbance than other transport modes at a

given exposure level.

9.24 The WHO Night Noise Guideline value of Lnight between 40 to 55 dB is recognised as where adverse health

effects are observed among the exposed population and the noise range between the LOAEL and SOAEL

values for both road and air as derived in Table 9.6 do fall primarily within this range. However, for rail

transport the LOAEL/SOAEL range falls significantly above this range i.e. 52 to 77 dB Lnight, again reflecting

the difference in self-reporting sleep disturbance compared with other transport modes. A further

consideration is that the WHO guideline values are based on a number of effects on sleep including body

movements, arousal and awakenings as well as self-reported sleep disturbance. Deriving LOAEL and


SOAEL values for sleep effects based purely on self-reported sleep disturbance may not fully reflect the

impacts on health and quality of life.


10.1 The objective of this project was to establish how potential threshold levels for Lowest Observed Adverse

Effect Level (LOAEL) and Significant Observed Adverse Effect Level (SOAEL) might be defined for a range

of noise source/effects. In some cases, there is strong scientific evidence that can provide robust and well

supported information that may define SOAELs and LOAELs for the more commonly encountered noise

sources. The ultimate aim of this work is to assist in the implementation of the Government’s policy on noise

which is described in the Noise Policy Statement for England (NPSE). The effects considered as part of this

project were agreed by Defra and are as follows; annoyance, cardiovascular, sleep, stress, quality of life,

well-being and general health, and performance, cognitive mental health.

10.2 The project research highlighted the stated aims of the NPSE as set out in a paper by Turner and Grimwood

[Turner and Grimwood, 2011] and how the policy reflects the reality of today’s society, which includes:

• Some noise making activities are essential for society to function. At present, we cannot remove all

adverse impacts of noise;

• Some significant adverse impacts may still be unavoidable;

• Some adverse impacts may still be unavoidable;

• Good management can facilitate improvements to health and quality of life.

10.3 The research work highlighted that, a fundamental element in the process of defining potential LOAELs and

therefore ultimately SOAELs is the use of exposure-response relationships. It therefore follows that it is

essential to have such exposure-response relationships, with a sufficient degree of statistical robustness in

order to be able to identify LOAELs, and to be able to consider, for each adverse effect of relevance to this

project, what might constitute a SOAEL.

10.4 In pursuit of the stated objective the research work was divided into five project phases:

• Phase 1: Literature Review

o Task 1: Identification of noise effects on health

o Task 2: Literature review

o Task 3: E-mail Questionnaire Survey

• Phase 2: Synthesis of relevant research, standards and other guidance

• Phase 3: Identification of possible LOAELs and SOAELs

• Phase 4: Case Study

• Phase 5: Reports and Presentations

10 Summary and Conclusions


10.5 A very extensive literature review was undertaken involving 332 papers. Detailed analysis was undertaken

on the studies which identified exposure-response relationships available from meta-analyses because of

the greater potential to provide the most robust evidence to identify possible SOAELs and LOAELs. The

literature survey did not identify any equivalent research in relation to neighbour noise and entertainment

noise. Consequently, a further supplementary survey was undertaken based on the research teams

experience and knowledge of the history of the subject areas under consideration, specifically neighbour

noise and amplified music noise. Exposure - response relationships were identified as listed below:

(i) Annoyance in relation to transportation noise [aircraft/road/railway noise, EU 2002b; aircraft post-1990:

Janssen and Vos, 2009];

(ii) Sleep disturbance in relation to transportation noise [aircraft/road/railway noise, EU 2004; aircraft post-

1990, Janssen and Vos, 2009]

(iii) Hypertension in relation to transportation noise (aircraft, Babisch & Kamp, 2009; road traffic noise, [Van

Kempen and Babisch, 2012]

(iv) Cardiovascular disease and road traffic noise, [Babisch, 2008]

10.6 The literature revealed that the number of epidemiological studies that could provide the basis for exposure-

response curves from which possible LOAELs and SOAELs might be identified was limited, as was the

number of potential curves. Papers and reports on annoyance, sleep disturbance, cognitive effects etc, were

reviewed to determine whether or not there was any important new material available on exposure-response

relationships which might add to, or alter the current guidance given in documents such as the EEA Good

Practice Guide of 2010, or WHO publications such as the Night Noise Guidelines [EAA,2010; WHO,2009].

10.7 It was concluded that the current guidance documents still represent the best available information.

Furthermore, the findings were heterogeneous, in part due to variations in quality and design of

epidemiological studies. Exposure-response relationships, of sufficient quality, identified in such guidance

documents relate to:

• Annoyance in relation to traffic noise [road, aircraft and railway noise, EU 2002]

• Sleep disturbance (aircraft, WHO 2009; rail & traffic, EU 2004)

10.8 For amplified music, there was insufficient evidence to provide even indicative LOAEL and SOAEL values

for assessing effects from amplified music. It was concluded that the significance of adverse effects would

have to be based on a quantitative and qualitative assessment using current guidance such as that

presented in the Noise Council Code of Practice and undertaken on a case by case basis.

10.9 Noise from neighbours and the setting of any values for LOAEL/SOAEL is to some extent related to the

concept of noise nuisance. However, whilst the statutory control of nuisance is well defined there is no

objectively measured level at which nuisance does, or does not exist. The issue of noise nuisance in

relation to sound insulation is discussed in the main text of the report (Chapter 5). Without very extensive

studies of sound insulation of different types of properties and accompanying social/attitudinal surveys to

determine a robust community exposure-response relationship for different house types it is not, as yet,

possible to determine what could be considered as a LOAEL in this situation.


10.10 Industrial noise is variable in nature and it has always been recognised that noise characteristics and levels

can vary substantially according to their source and the type of activity involved. Given that there is

insufficient information on people's response to industrial noise it is not possible to derive potential LOAEL or

SOAEL for industrial sources. Therefore, a quantitative and qualitative assessment will always be required to

be undertaken to assess the significance of the impact of any change to be brought about by the introduction

of new industrial/commercial source, a change to an existing industrial/commercial noise source or indeed

the introduction of a new noise sensitive receptor in the vicinity of existing industrial/commercial noise

sources. 15

10.11 So whilst the research established that, for transportation noise sources, air, road and rail, robust exposure-

response relationships for annoyance and self-reported sleep disturbance have been found in the literature,

the current evidence for cardiovascular effects was not sufficiently robust to facilitate a possible definition of

SOAEL or LOAEL.,

10.12 This led to a further consideration of defining possible LOAELs and SOAELs examples of threshold levels or

criteria curves that had been reviewed in Phase 1 and 2 of the project were considered. The examples

considered the threshold levels proposed by the European Environment Agency (EEA, 2010), which

reviewed the current knowledge on the health effects of noise, and the evaluation criteria for aircraft noise in

protecting communities in the vicinity of airports proposed by Griefahn (Griefahn et al, 2004). It was

concluded that several factors limited the usefulness of such approaches including the following:

• The noise metric in defining the respective LOAELs and SOAELs for different sources and effects

needed to correspond with that of the exposure levels available for the target population.

• The range of the exposure levels for the target population adequately extended to include the

respective criteria level so that a quantitative assessment of the impact can be derived.

• The underlying exposure data for road and rail had to be sufficiently robust. The strategic noise maps

on which much of the research analysis is based were not designed to provide accurate results at

every specific location, but instead to enable an estimate of the overall impact to be determined. .

Consequently, the exposure data associated with a particular outcome at a specific location may not be

sufficiently accurate.

10.13 The difficulties in defining potential SOAELs have been identified as is the need for further work required to

develop some of the identified approaches further.

10.14 To examine the issues further a Case Study based on a previous planning application for the expansion of

Stansted Airport was examined. The main conclusion that can be drawn from the Case Study is that the

conclusions drawn about the impact of a specific proposal is dependent on several factors, including the

basis used for the definition of SOAEL and which dose-response relationship is used.

10.15 As part of this research an international survey was undertaken and the results endorsed the finding of the

literature review in that there is no internationally accepted definition of what constitutes a significant adverse

effect. However, to assist in understanding what is actually meant by adverse effects the definition promoted

15 Between the completion of this report and publication, British Standard 4142:2014 “Methods for rating and assessing industrial and commercial sound” was published. In that, advice is given as to what noise conditions might be an indication of a significant adverse impact.


by the World Health Organisation in 1994 was considered. This was developed by examining the concept of

the severity of noise effects on the population exposed as developed by Babisch through the pyramid of

effects [Babisch 2002]. This approach provided the basis for a possible statistical approach using well

established exposure-response relationships for different source/effects where they exist.

10.16 This approach seems to lead to a definition of SOAEL as the level which is statistically significantly higher

than LOAEL.

10.17 The research suggests that such an approach could be applied to those effects which have robust exposure-

response relationships such as annoyance and sleep disturbance based on steady state conditions and sets

out an approach for deriving possible LOAEL and SOAEL values for transportation sources using the Noise

Exposure Categories (NEC) as defined in previous planning policy [DETR, 1994].

10.18 The various NEC category boundaries were associated with LOAEL and SOAEL. A standard approximate

conversion to relate two noise exposure indicators was used and a range of values for the percentage of the

population that is highly annoyed (%HA) which corresponds to the relevant NEC boundary levels was

derived, based on the EU noise exposure-response relationships for %HA for each transport mode.

AECOM Identification of SOAEL and LOAEL in Support of the NPSE – Draft Final Report 68

Babisch (2006). Transportation Noise and Cardiovascular Risk. A review and synthesis of epidemiological

studies. Dose-effect and risk estimation. Federal Environmental Agency, Berlin, 2006.

Babisch (2008). Road traffic noise and cardiovascular risk. Noise and Health 10:27 -33, 2008.

Babisch and Kamp (2009). Exposure-response relationship of the association between aircraft noise and

the risk of hypertension. Noise and Health 11:161-8 2009.

Berry (2008). Stansted G2 – Cardiovascular effects of noise: Review, methodology, assessment.

BEL Technical Report 2008-007. October 2008.

Berry (2013). Review of Recent research on Noise and Hypertension, BEL Technical report 2013 - 003

Berry and Flindell (2009). Estimating Dose-Response Relationships between Noise Exposure and Human

Health Impacts in the UK. BEL Technical Report BEL 2009-2.16

Brooker et al (1985). United Kingdom Aircraft Noise Index Study. DR Report 840217

Clark, Martin, van Kempen and Alfred (2006). Exposure-effect relations between aircraft and road traffic

noise exposure at school and reading comprehension. THE RANCH project. American Journal of

Epidemiology, 163(1),27-37, 2006.

Defra (2010). Noise Policy Statement for England (NPSE). Department for Environment Food and Rural

Affairs, March 2010.

DETR (1994). Planning Policy Guidance PPG24: Planning and Noise. Department of the Environment,

Transport and the Regions, September 1994.

EEA (2010). Good practice guide on noise exposure and potential health effects. EEA Technical Report No

11/2010.European Environmental Agency. Copenhagen, Denmark. October 2010.

ERM (2009). Health Impact Assessment. Stansted Airport Generation 2. Final Report EU (2002a). Relating to the assessment and management of environmental noise Directive 2002/49/EC.

Official Journal of the European Communities, L 189/12. 2002.

EU (2002b). Position paper on dose response relationship between transportation noise and annoyance.

Working Group on Dose-Effect Relations. European Commission, 2002.

EU (2004). Position paper on dose-effect relationships for night time noise. European Commission Working

Group on Health and Socio-Economic Aspects. 2004.

16 http://archive.defra.gov.uk/environment/quality/noise/igcb/publications/healthreport.htm 17 http://www.caa.co.uk/application.aspx?catid=33&pagetype=65&appid=11&mode=detail&id=1441

11 References


Fidell, V. Mestre, P. Schomer, B. F. Berry, T. Gjestland, M. Vallet, T. Reid (2011). A theory-based model

for estimating the prevalence of annoyance with aircraft noise exposure. J. Acoust. Soc. Am., 130(2), 791-

806.18

Griefahn B, Scheuch K, Jansen G and Spreng M (2004). Protection goals for residents in the vicinity of

civil airports. Noise and Health Vol.6 Issue 24 pp 51-62. 2004.

IEMA (2014) Guidelines for Environmental Noise Impact Assessment Institute of Environmental

Management and Assessment 2014

Janssen and Vos (2009). Comparison of recent surveys to aircraft noise exposure-response relationships.

TNO report TNO-034-DTM-2009-01799, April 2009.

Miedema and Oudshoorn. (2001). Annoyance from Transportation Noise: Relationships with Exposure

Metrics DNL and DENL and Their Confidence Intervals. Environmental Health 109, pp. 409-416.

Monkman and McMahon (2007). Strategic Noise Maps 2006. London Heathrow Airport. ERCD Report

0706. Environmental Research and Consultancy Department. Civil Aviation Authority. December 2007.

Noise Council (1995) Code of Practice on Environmental Noise Control at Concerts. Noise Council 1995.

Schomer (2011). ISO WG45 working paper. Community Uncertainty.

Scottish Government (2011) Technical Advice Note “Assessment of Noise” to Planning Advice Note

1/2011, Planning and Noise. Scottish Government 2011

Taylor (2008). Stansted G2 Airport Project Environmental Statement Volume 3: Air Noise Part 1 of 1 – Main

Text and Appendix 1 to Appendix 5 Date: March 2008.

Turner and Grimwood (2011). The importance of clear policy objectives when managing noise. 10th

International Congress on Noise as a Public Health Problem (ICBEN) London UK, 2011.

Van Kempen and Babisch (2012). The quantitative relationship between road traffic noise and

hypertension: meta – analysis. Journal of Hypertension 30:1075-1086, 2012.

WHO (2009). Night Noise Guidelines for Europe, World Health Organisation, Regional Office, Denmark,

2009.

WHO (2011). Burden of diseases from environmental health. World Health Organisation, Regional Office,

Denmark, 2011.

WHO (2012). Cardiovascular diseases (CVDs). Fact sheet No: 317, September 2012.

18 http://asadl.org/jasa/resource/1/jasman/v130/i2/p791_s1?isAuthorized=no


Appendix 1 - Details of Literature Review

Identification of noise effects on health

The following effects were identified at the inception meeting with Defra prior to the commencement of the

project:

• Annoyance,

• Cardiovascular,

• Sleep,

• Stress,

• Quality of Life, well-being and general health, and

• Performance, cognitive, mental health.

Much of the previous work relating to health effects of noise has focussed on annoyance, sleep disturbance

and quality of life. More recent work has suggested links with disease, especially cardiovascular disease.

This is of public health relevance as cardiovascular disease is a major cause of mortality and morbidity.

Studies have also suggested that environmental noise may impact on children’s cognitive development.

(WHO, 2011)

A literature search for all of the above effects was led by the team from the MRC-HPA Centre for

Environment and Health at Imperial College London. Given that the focus of the review was to identify

potential SOAELs and LOAELs for a wide range of source/effects and the limited time-frame of the project,

the search concentrated on effects for which exposure-response curves were available. It also drew on

previous work reviewing literature synthesising evidence on environmental noise and health as part of the

European Network for Noise and Health (ENNAH) project (http://www.ennah.eu/) which was carried out by

the team from Imperial College.

Identify and collect primary studies, reviews and meta-analyses

Search strategy

A systematic search was conducted on environmental and neighbourhood noise in relation to various health

outcomes including cardiovascular disease, annoyance, sleep disturbance, stress, hormonal changes, mood

and performance, cognitive development and quality of life both in steady state and changing noise

conditions. Web of Science, PubMed and Embase electronic databases were searched for papers published

between 2000 and January 2012. Studies were also screened in the reference list of relevant review papers

and reports. In addition, hand searching was used for acoustical conference proceedings (InterNoise,

Euronoise, ICBEN). Web searches using Google and suggestions from experts were used to identify

relevant grey literature. No language restriction was applied. Combined search terms included noise, health,

adverse effect, well-being, quality of life, LOAEL, limit, exposure, threshold, exposure-response. All types of

publications in the initial search i.e. original studies as well as reviews were included. However, particular

interest was in identifying systematic reviews (reviews that had made rigorous attempts to identify all


available literature) that either included meta-analysis (a quantitative synthesis of results from all available

studies that met pre-specified quality and design inclusion criteria to provide exposure-response curves) or

provided a good narrative review (where papers were too heterogeneous for results to be used in meta-

analyses, but where a useful description of the evidence was provided).

Study selection

In selecting the relevant studies, four inclusion criteria were defined. Studies were included if:

a. it described noise exposure (objective/subjective assessment);

b. the source of noise was either environmental (road traffic, railway or aircraft noise) or neighbourhood

noise19;

c. the study investigated the following outcomes: cardiovascular disease including hypertension,

annoyance, sleep disturbance, stress, hormonal changes, mood and performance, cognitive

development and quality of life, and

d. the paper examined a direct relationship between the above health outcomes and noise exposure.

Data extraction for original research papers

For data collection, data extraction sheets were developed with the following headings:

• Reference

• Study design (number of participants)

• Noise exposure assessment (M- measured, C-calculated)

• Noise source

• Noise exposure (DI - dichotomous, CA-categorical, CO - continuous)

• Noise level (dB(A))

• Reference category (dB(A))

• Type of outcome (O-objectively measured, S-subjective)

• Effect size (DI - noise given as dichotomous variable, CA - noise given as categorical variable, CO -

noise given as continuous variable)

• Statistics

• Exposure-response curve (Y-yes, N-no)

• Threshold identified (Y-yes, N-no)

• Confounding factors (Y-yes, N-no)

• Conclusions

19Neighbourhood noise as defined by Defra ‘noise arising from within the community such as industrial and entertainment premises, trade and business premises, construction sites and noise in the street). It does not include general transport noise, which falls under the definition of environmental noise’, http://www.defra.gov.uk/environment/quality/noise/neighbourhood/ ,


Data extraction for review papers

The data extraction sheet contained the following information:

• Review title;

• Date;

• Noise Source(s)

• Outcome – Health Effects

• Thresholds

• Exposure-response

• Comments

Quality assessment of documents

For review papers we used the quality assessment tool developed within the ENNAH project

(www.ennah.eu):

• Following a web based search (The Cochrane Collaboration, Web of Science for related papers) and

hand search (epidemiology related books) for quality assessment of general review papers, it was

concluded that quality assessments were mainly focused on systematic reviews and meta-analyses.

The criteria for assessing scientific quality of general research reviews for the current work is based

on the combination of AMSTAR measurement tool that is used to assess the methodological quality

of systematic reviews (http://www.springerlink.com/content/qj5073804n1227x6/), the Critical

Appraisal Skills Programme (CASP) crib sheet for a systematic review (http://www.casp-

birmingham.org/) and a quality assessment tool for review papers that is presented in Appendix C of

Chou R, Norris S, Carson S, Chan BKS. Drug Class Review on Drugs for Neuropathic Pain. 2007,

(http://www.ncbi.nlm.nih.gov/books/NBK10597/). Furthermore, two additional questions were

included concerning the type of the review and numbers cited that is based on the record shown in

Web of Science as of 1st March 2012.

• No tool was available for assessing the quality of grey literature; therefore, only two distinctions could

be made:

• Institutional and governmental reports including WHO and other national/international organisation

reports and

• Thesis, conference proceedings and other grey literature.

The criteria for judging the quality of review papers is described in Appendix 2

For original research papers the quality assessment tool for quantitative studies developed by the Effective

Public Health Practice Project was identified (http://www.ephpp.ca/Tools.html).


Document sharing

Using the web-based Mendeley system (www.mendeley.com) a searchable database of papers and reports

has been developed. One ‘library’ contains the papers from peer-reviewed journals, the other the “grey

literature” including Government reports, WHO publications etc.

However, copyright issues affect the dissemination of the results. Consequently, many of the identified

studies on noise and health could not be freely circulated in full among the project partners (access rights

differed between partners) nor published for wider consumption. According to copyright law, redistributing

the articles contained in PubMed Central (PMC) needs the permission of the copyright holder, except for

PMC articles in the open access subset. Even the circulation of journals with ‘free access’ documents

depend on the open access agreement associated with the article (e.g. creative commons license).

Circulating a copy on behalf of the author is not allowed, unless circulating a copy to peers is included in the

copyright transfer agreement. Web reports such as those from the WHO and (UK) Health Protection

Agency20 are often subject to copyright, where permission must be sought for non-commercial redistribution,

so only links can be provided but the reports are free to download. As a conclusion, a publications list, the

citation and a link to the publication on the publisher’s website but not the full article is provided. Access to

the full-text will then be available to those with permitted access.

Results from literature review

General issues

In total 332 studies, journal papers and grey literature were considered for this report (references to these

documents are included in Appendix 3), of which the majority (278) were identified in a systematic literature

search (see below) and the remainder through hand searches of conference proceedings, through Google

web search, expert recommendations and through the survey described in paragraph 3.5.

Of the 332 documents considered, 98 documents were review papers and meta-analyses (38 of these from

grey literature) and 234 were primary studies (39 grey literature including conference proceedings and a PhD

thesis).

The systematic literature search selected 278 studies from 5901 records identified as of possible interest;

selection was based on the inclusion criteria described in Appendix 2. Since many studies investigated more

than one noise source, the studies were grouped by health outcomes or other criteria in order to minimise

the overlap within the groups (see Figure A1.1 below). The main noise sources were road traffic noise,

aircraft noise and railway noise. No study was found which investigated health effects of neighbourhood

noise including entertainment noise other than annoyance/disturbance (Note: the ‘Other’ category covers

exposure assessment (11 papers), health impact assessment (2 papers) and exposure to personal audio

device noise (1 paper).

Given the lack of papers identified in relation to neighbourhood noise and entertainment noise these issues

are considered separately in Chapter 5.

20 Now Public Health England


Figure A1.1: Number of studies identified in the systematic literature search

There was only one paper (study) identified in the literature search relating to personal audio devices, 13

papers on wind farms (focussing on low frequency noise) and one paper (study) on industrial noise relating

to annoyance as endpoint.

The quality of review papers published in peer-reviewed journals varied greatly (see Appendix 2). Most of the

review papers were of narrative type, in part because studies were too heterogeneous to permit a statistical

synthesis of results in a meta-analysis. Although narrative reviews are considered lower quality compared to

systematic reviews and meta-analyses they can contain useful information. However, for risk assessment,

high quality meta-analysis is preferred as this contains the most detail on exposure-response. It is worth

noting that the quality assessment used for articles in peer-reviewed journals also included the number of

citations (i.e., an indicator of the influence and perceived usefulness by the scientific community). However,

the number of citations may not necessarily be a direct indicator of quality and therefore highly cited papers

which have lower scores on other quality criteria would lead to a below average score.

Identifying health end-points with exposure-response curves

Given the large number of papers selected from the review (332) those identifying exposure-response

relationships available from meta-analyses and authoritative reviews were selected for further analysis as

these would provide the most robust evidence to identify possible SOAELs and LOAELs. Resources were

focused on cardiovascular disease given its public health importance and because it was several years since

the most recent meta-analysis on this outcome was published [Babisch, 2008]. Furthermore, the

aforementioned meta-analysis did not give useful information on impact of noise exposure below 60 dB. A

more detailed search on papers dealing with the quality of life as one of the outcomes of interest was also

included (as agreed by Defra) for which exposure-response curves were not available.

For the following five outcomes, the current exposure-response relationships were identified:


(i) Annoyance in relation to transportation noise (aircraft/road/railway noise, EU 2002b; aircraft post-

1990: Janssen and Vos, 2009);

(ii) Sleep disturbance in relation to transportation noise (aircraft/road/railway noise, EU 2004; aircraft

post-1990, Janssen and Vos, 2009);

(iii) Hypertension (aircraft, Babisch & Kamp, 2009; road traffic noise, van Kempen & Babisch, 2012);

(iv) Ischemic heart disease road traffic noise, Babisch, 2008);

(v) Reading scores (aircraft noise, Clark et al, 2006).

The exposure-response curves for these outcomes are shown in Figures A1.2 to A1.8 below. It should be

noted that the exposure-response curve for reading scores is derived from a single study and the ischemic

heart disease exposure-response curves, although widely quoted and used, are derived from a small

number of studies (five) and have wide confidence intervals around the curves. Furthermore, the Babisch

and Kamp [2009] meta-analysis relating aircraft noise to hypertension showed heterogeneity (different

studies gave different estimates for the exposure-response relationship) so the exact shape of the exposure-

response relationship, and any LOAEL, cannot be defined.

(i) Annoyance in relation to transportation noise (road, aircraft and railway noise, [EU 2002])

Figure A1.2: The percentage of highly annoyed persons (%HA) as a function of the noise exposure at the most exposed facade of the dwelling (Lden). The solid lines are the estimated curves, and the dashed lines are the polynomial approximations. The figure also shows the 95% confidence intervals (dotted lines) [EU, 2002].

(ii) Sleep disturbance (aircraft, WHO 2009; rail & road traffic, [EU 2004])

Exposure-response relations have been set for three sleep disturbance indicators: awakening, motility-

aircraft noise and self-reported sleep disturbance.


Figure A1.3: Worst case prediction of noise-induced behavioural awakenings [WHO, 2009].

Figure A1.4: Probability of (aircraft) noise-induced motility (m) at the 15- second interval in which the indoor maximum sound level occurs (solid line) and the 95% confidence interval, as a function of LAmax, inside bedroom [WHO, 2009].

Figure A1.5: Percentages of highly sleep disturbed when exposed to rail and road traffic noise [EU, 2004]


(iii) Hypertension (Aircraft; Babisch & Kamp, 2009, Road traffic noise; [van Kempen &

Babisch, 2012]

Figure A1.6 Association between aircraft noise level and the prevalence or incidence of hypertension [Babisch & Kamp, 2009]

Hypertension – road traffic noise [van Kempen & Babisch, 2012]

OR per 5 dB LAeq,16h = 1.034 [96% Cl 1.011-1.056]

(iv) Ischemic heart disease – road traffic noise [Babisch, 2008]

OR per 10 dB(A)= 1.17 (0.87-1.57) in a range ~55-75 dB(A)

Figure A1.8: Polynomial fits of the exposure-response relationship between road traffic noise and myocardial infarction. The left graph (3a) refers case-control or cohort studies (analytic studies), (3b) to cross-sectional, case-control or cohort studies (descriptive and analytic studies) [Babisch, 2008]

Exposure-response function:

OR = 1.63 – 6.13*10-4

(LAeq,16h)2 + 7.357*10

-6(LAeq,16h).


(v) Reading scores and aircraft noise [Clark 2006]

Figure A1.9: Adjusted mean reading z scores and 95% confidence intervals for 5-dB(A) bands of aircraft noise at school (adjusted for age, gender, and country), the RANCH project, 2001–2003. [Clark et al. 2006]

For most health endpoints, the number of epidemiological studies is limited; therefore, the basis for a

exposure-response curve is limited. Furthermore, findings have been heterogeneous in part due to variations

in quality and design of epidemiological studies. The quality of reviews is also very heterogeneous therefore

the findings need to be interpreted with caution.

Initial summary of review papers and reports

Several documents (EEA, 2010; WHO, 2009) listed thresholds in relation to noise induced health effects.

Table A1.1 summarises those review papers that contain threshold NOEL/LOAEL levels that are used with

the scientific community. The hyperlinks allow the reader to look at key extracts concerning Thresholds etc.

The extracts are found in Appendix 4 of this report.

Table A1.1: Summary of review papers and reports with threshold/LOAEL levels

Ref. No. Review Title Date Noise Source(s)

Outcomes, Health Effects

Thresholds Exposure-

response Comments

1 WHO Burden of Disease from Environmental Noise

2011 various

Cardiovascular disease

Cognitive impairment

Sleep disturbance Tinnitus Annoyance

Refers to WHO NNG 2009 (see below)

Yes – for all effects included

Mainly concerned with DALYs etc. See Also: Kim R, Berg M. 2010 Summary of night noise guidelines for Europe. Noise Health 2010: 12:61-3

2

K Hume 2011. Overview of research into sleep disturbance due to noise in the last three years ICBEN 2011

2011

Road Rail Air Wind Turbine

Sleep Strokes

Lists WHO NNG values

No

Refers to Berry 2009 Jones 2009 USA FAA Partner Program review 2010

3 H Davies and I van Kamp. 2011. Noise and cardiovascular disease:

2011 Road traffic Railways Aircraft

Cardiovascular disease, Coronary heart

Yes. LOEL Link1

Yes - HYENA Lists other reviews e.g. Babisch and van Kempen 2009





response Comments

a review of the literature 2008-2011. ICBEN 2011

Occupational

disease, Ischemic heart disease,

Myocardial infarction,

Hypertension, Stroke

Babisch 2011 The country-specific reviews in N&H 2011

4

C Clark 2011. 3-year update on research on effects of noise on health and behaviour. ICBEN 2011

2011 Aircraft

Children’s cognitive performance (field studies),

Role of sleep

No No RANCH discussed but no other D-R

5

S. Pirrera. 2010. Nocturnal road traffic noise: A review on its assessment and consequences on sleep and health

2011 Road traffic

Sleep Disturbance, Sleep Quality Secondary and long term Effects

WHO NNG restated

No -

6

A Review of the Literature Related to Potential Health Effects of Aircraft Noise. US FAA Partner Project

2010 Aircraft

Sleep, Cardiovascular, Some on

annoyance

No No Focuses on Mechanisms for cardiovascular

7

EEA 2010. Good practice guide on noise exposure and potential health effects. EEA Technical Report 11/2010

2010 Road Rail Air

Annoyance, Sleep disturbance, Cardiovascular, Cognitive

Link 2 Link 3

Yes For all four effects

Additional information on aircraft noise surveys pre- and post-1990 Section 5. Quality targets

8

Environmental Noise and Health: A Review. ERCD REPORT 0907. February 2010.

2010 Aircraft

Annoyance, Mental health, Cardiovascular and Physiological effects,

Performance, Night-time effects, Noise and children, Foetal effects

Link 4 Link 5

No -

9

WHO Night noise guidelines for Europe,

2009 All sources

Sleep related effects,

Cardiovascular, Long term health

Link 6 Yes. Babisch curve MI

Comment – NOAEL not useful concept

10

Babisch W, van Kamp I (2009). Exposure-response relationship of the association between aircraft noise and the risk of hypertension. Noise & Health 11(44): 161-168.

2009 Aircraft Hypertension

“No answer can be given regarding possible effect thresholds” But Lden 55 mentioned

Yes Meta-analysis

11 Berry and Flindell BEL Report for Defra

July 2009

Air Road Rail

Not specifically

Yes Babisch MI EU Position Paper D-R for sleep

Criteria related to use of exposure-response in economic valuation

12 HPA Report Environmental noise and health in the UK

2009 All sources

Annoyance, Sleep, Cardiovascular, Cognitive, Performance, Mental health

Link 7 Various referred to, e.g. Miedema





response Comments

13

Transportation noise and cardiovascular risk, Review and synthesis of epidemiological studies, Exposure-effect curve and risk estimation. Babisch 2006

2006 All sources Cardiovascular (links to annoyance)

The effect threshold for an increase in risk of ischaemic heart disease, including myocardial infarction due to road traffic noise, was found to be around 60-65 dB(A) for Lday ≈ Lden. The

effect threshold, if any, for serious annoyance tends to be lower, e.g. 55 dB(A) according to WHO recommendations (WHO 2000).

D-R curve for AMI

But note D-R was developed from road traffic studies. See BEL 2009 report for assumptions etc

14

RIVM report 2005 Selection and evaluation of exposure-effect relationships for health impact assessment in the field of noise and health.

2005 All sources

Annoyance, Sleep, Cardiovascular cognition

Hypertension threshold Lden 70 dBA

Yes Recommends; Annoyance-Miedema Sleep-EU POsitionpaper Cardiovascular – van Kempen 2002

-

15

Protection goals for residents in the vicinity of civil airports. Griefahn et al. Noise and Health Jul-Sep 2004, 6(24), 51-62

2004 Aircraft

Sleep, High annoyance Chronic disease (cardiovascular)

Link 5 No

Text refers to ; “just tolerable limits for the avoidance of adverse effects.”

Summary of quality of life papers

The quality of life (QoL) papers are summarised in Table A1.2. The following observations from examining

these papers are:

• Only three of the papers [Botteldooren 2011, Brink 2011, and Schreckenburg 2010] relate to actual

measurement of QoL in surveys etc;

• Most of the time, in reviews, writers just use the term loosely without defining what it means, and

suggest that, for example, because noise disrupts sleep, it must affect quality of life. But such reviews

give no quantitative information;

• One review, by Seidman and Standring, cites the 2002 Schiphol work by Franssen et al, 2002 from

the National Institute for Public Health, Netherlands (RIVM) as follows: “In several studies the

association between transportation noise, environmental (EQoL) and health-related quality of life

(HQoL) was investigated.” But in fact close inspection of the 2002 paper shows no mention of the

terms EQoL or HQoL by the RIVM team;


Table A1.2 Summary of papers identified examining relationship between noise exposure and “quality of life”

Author/Title/Reference Noise

Source QoL

defined/measured Conclusions

Any threshold data?

A Muzet Environment noise, sleep and health

Sleep Medicine Review (2007) 11, 135-142

Various

No specific measure Simply suggests........ Chronic partial sleep deprivation induces marked tiredness, increases a low vigilance state, and reduces both daytime performance and the overall quality of life.

No threshold data

Franssen, E.A.M.; Staatsen B.A.M.: Lebert, E

Assessing health consequences in an environmental impact assessment. The case of Amsterdam Airport Schipol.

Environ. Impact Assess. Rev. 2002, 22, 633-653

Aircraft

NOTE – cited as reference 18 by Seidman and Standring see above as follows; In several studies the association between transportation noise, environmental (EQoL) was investigated [17-19] INFACT NO MENTION OF QUALITY OF LIFE

No threshold data

Stansfield et al A review of environmental noise and health. Noise and Health, 2000 Volume: 2 Issue: 8 Page: 1-8

Various

Reviews various studies on mental health Refers to the Munich study on children and QoL. Summary of Welsh bypass study; See below

No threshold data

Stephen A. Stansfeld, Mary M. Halnes, Bernard Berry, Michael Burr, 2009 Reduction of road traffic noise and mental health: An Intervention Study Noise & Health, July – September 2009, Volume 11, 169-175

Road traffic noise

Under QoL – “Health functioning” was measured by the SF-36 General health Survey (Ware & Sherborne, 1992) including dimensions of general health status, physical functioning, general mental health and social functioning.

No threshold data no evidence that respondents exposed to higher levels of road traffic noise had worse health functioning than those exposed to lower levels of traffic noise, adjusting for levels of deprivation. There was no reduction in noise annoyance and no change in levels of common mental disorder and quality of life following the introduction of the bypass.

Dick Botteldooren et al. The influence of Traffic Noise on Appreciation of the Living Quality of a Neighbourhood.

Survey Measured-general satisfaction with the quality of life in the neighbourhood. Q1:1 How satisfied are you generally with the quality of life

Direct annoyance pathway the most important.

Multiple logistic regression models



Source QoL


Any threshold data?

Int. J. Environ. Res. Public Health 2011, 8, 777-798

Road traffic

(Safety, child friendliness, environment,) in your neighbourhood? Five point answering scale: very satisfied, satisfied more, less satisfied, not satisfied, not at all satisfied. Also questions on annoyance

Importance of exposure indicators away from the home – trips etc No useful threshold data

M Brink et al Parameters of well-being and subjective health and their relationship with residential traffic noise exposure..a representative evaluation in Switzerland.

. Environmental international. [Online] 37 (4), 723-733 Available from: Doi:10,1016/j.envint 2011.02.011

Road Rail Air

Survey [ 10,000] Swiss Household panel Actually deal\s with “subjective health.” Does not use the term QoL Two questions: “how do you feel right now?” and was answered on a 5 point-scale from “very well (5)” to “not well at all (1)”. The answers on that scale are further referred to as Health Status. Satisfaction with one’s health status (Health Satisfact) was asked in a similar way Also self-reported Sleep disturbances

No useful threshold data

Seidman and Standring Noise and the Quality of Life Int. J. Environ. Res. Public

health, 2010, 7, 3730-3738;

Various

Just reviews a number of health effects studies and quotes links to “quality of life”. The only measure mentioned is the KINDL questionnaire used in one of the reviewed studies on children. [Munich]

Review some fo the recent literature on the physiological and psychological effects from noise and its relationship with quality of life. No useful threshold data

D Schreckenburg et al. Aircraft Noise and Quality of Life around Frankfurt Airport

Int. J. Environ. Res. Public Health 2010, 7, 3382-3405

Aircraft

Survey 2312 residents Face-to-face interviews Environmental QoL (EQoL) Residential satisfaction in total and with regard to infrastructure, quietness, attractiveness

Model proposed which links EQoL, HQoL and other aspects. Environmental (EQoL) and health-related quality of life (HQoL) All in all, for residents living in the vicinity of Frankfurt Airport the results of the correlational analysis indicate that being stressed by aircraft noise lessens the



Source QoL


Any threshold data?

satisfaction with the residential area and, thus, the perceived local environmental quality of life. No useful threshold data

There is considerable uncertainty about what is meant by QoL, with different meanings being used for the

concept by different researchers. Most significantly none of the studies or reviews has information of the kind

which could be used to define any kind of “threshold” for the effects on QoL. The main role of QoL seems to

be as a possible effect-modifying or mediating variable in the Noise >Annoyance >Health pathway.

After careful consideration, and bearing in mind that the main focus of the project is to inform the possible

definition of SOAELs and LOAELs it was concluded that, whilst the QoL topic may be worthy of further

research, resources in the present project should focus only on specific well defined health outcomes.

Summary of cardiovascular papers published after 2006

As mentioned previously, the most recent meta-analysis of associations between noise and ischemic heart

disease relates to studies identified up to 2006. This provides an exposure-response curve in relation to

myocardial infarction (‘heart attack’ in lay terms, a subset of ischemic heart disease) originally published by

Babisch (2006) and 2008 (Babisch 2008a). Using this curve, it is estimated that approximately 1.8 % of

myocardial infarctions could be attributable to road traffic noise (WHO 2011).

Although this curve was based on best-available evidence at the time and has been widely quoted and used,

not least in the WHO Burden of Disease from Environmental Noise (WHO 2011), there are several

limitations to this estimate. Sixty-one studies were identified, but because of quality and design issues only

five analytic and two cross-sectional studies were suitable for use in the meta-analysis. The studies were

based in Berlin, Bristol and Caerphilly which may limit generalisation to other geographical areas. The

studies only sampled men; some studies have suggested potential differences in noise effects on health

between men and women. For example, the HYENA study which looked at hypertension (Jarup et al 2008)

and a Berlin study which looked at myocardial infarction (Willich et al, 2006) both showed differences

between men and women.

The studies on ischemic heart disease relate to road traffic noise. There were no suitable studies to be able

to conduct a meta-analysis in relation to other environmental noise sources. The polynomial curve used in

burden of disease calculations (see Figure A1.8 above) was fitted through categorical (grouped) noise levels

in 5dB steps rather than directly estimated from continuous data. The reference categories for daytime noise

were <60dB for the five analytic studies and <55 dB for the two cross-sectional studies. By definition, the

reference category is a chosen baseline or ‘no-effect’ level against which all higher noise levels are

compared in a statistical model, therefore no comments can be made about the association with noise below

these levels and this cannot be taken to indicate a NOEL. Finally, if the meta-analysis using original

categories is presented (Figure A1.10 below), it can be seen that statistical confidence intervals are wide and


while an exposure-response relationship is suggested visually, the figure is also consistent with there being

no clearly causal effect of noise on myocardial infarction.

Figure A1.10: Pooled effect estimates from meta-analyses of the association between road traffic

noise and myocardial infarction for prevalence (left) and incidence (right) showing ORs and 95%

confidence intervals. [WHO, 2011]

One potential reason for the wide confidence limits is the small number of studies available. More studies

may help to improve the association between noise and heart disease. It was decided to identify from the

systematic literature search the papers that had been published since 2006, i.e. subsequent to those used to

derive the exposure-response curve shown in Figure 4.10 (Babisch, 2008a). Within the systematic search 69

papers were identified in relation to cardiovascular disease published from Jan 2000-Jan 2012, of which 49

papers were published after 2006 (the list of papers is shown in Appendix 3). Data were extracted from 30

original research publications and meta-analyses (grey literature and reviews and the meta-analysis by

Babisch published in 2008 [Babisch 2008] were excluded). The data extraction table is shown in Appendix 6.

Most (23 of 30) of the more recent cardiovascular studies related to blood pressure (measured blood

pressure, hypertension, medication for hypertension), four studies related to ischaemic heart disease or

myocardial infarction, two had information on stroke, two related to the autonomic nervous system (cardiac

sympathetic and parasympathetic tone). Two of the blood pressure papers also investigated heart rate. The

six studies relating to heart disease and stroke are considered in more detail below.

Heart disease:

(i) Huss (Huss et al, 2010) looked at aircraft noise exposure in the Swiss national cohort (4.6 million people

identified through the Census and linked to mortality records 2000-2005); significant associations between

aircraft noise and acute myocardial infarction were only found in a subgroup of the highest exposure group

who had lived at the same residence for at least 15 years (hazard ratio 1.48 (95% confidence intervals 1.01-

1.28) for those exposed to ≥60 dB compared with <45 dB). Huss also considered distance from road and

additionally adjusted for modelled PM10 levels (a traffic-related air pollutant), so this may be considered a

proxy for road traffic noise. Statistically significant associations were seen between living closer to a major

road and risks of death from myocardial infarction or any circulatory disease. In this study, the evidence for


any association with aircraft noise and death from myocardial infarction is limited and while these findings

with respect to distance from road are supportive of an association between road noise exposure and heart

disease, they do not assist with identification of possible SOAEL or LOAEL (as they do not relate to actual

noise exposures).

(ii) Willich (Willich et al. 2006) conducted a case-control study of 4000 individuals in Berlin 1998-2001. The

study examined environmental noise levels at place of residence assessed by Berlin traffic noise maps

(noise metric not stated) for patients admitted to hospital with acute myocardial infarction compared with

patients with diagnoses not thought to be associated with noise (accidents, inguinal hernia, goitre, or colon

disorder). There were statistically significant associations between daytime noise and hospital admission in

men for categories of noise >60dB compared with ≤60 dB, results were positive but not statistically

significant in women. Associations with night-time noise were statistically significant in women for categories

>50dB and for men >60dB compared with ≤50 dB. There was a suggestion of higher associations with night-

time noise in women (adjusted OR 2.73 (95% CI 1.09-6.84) comparing >60dB with ≤50 dB) than in men

(adjusted OR 1.54 (1.04-2.28)) but confidence intervals were wide and statistical tests for interaction with

gender was not formally tested so it is unclear if the differences were due to chance (and smaller numbers of

women as ~75% of the study were male). This study therefore provides evidence for association of road

traffic noise with hospital admission for acute myocardial infarction above the reference categories of ≤50 dB

for night-time and ≤60 dB for daytime traffic noise, but no exposure-response curves are given and results

cannot be used to identify possible SOAEL or, particularly, LOAEL at or below these cut-offs.

(iii) Beelen (Beelen et al, 2009) examined relationships between modelled traffic noise and different

cardiovascular disease mortality in a Dutch cohort of ~120,000 individuals followed up from 1987-1996. The

paper focused on air pollution results and assessed potential for confounding by noise. The main analyses

considered Lden noise levels in 5dB categories with the reference category ≤50 dB. Table 3 in the paper

shows increased risks for highest levels of traffic noise (>65 dB) for all cardiovascular disease and most

subsets of this – ischaemic heart disease, heart failure, cardiac dysrhythmia but not stroke. However, these

are only statistically significant for all cardiovascular disease and heart failure. After adjustment for

background black smoke and traffic intensity on the nearest road the relative risks (RRs) reduced slightly

and became non-significant. The authors interpreted this as no true effect of noise, but an alternative

explanation is that as road noise comes from traffic, including traffic intensity in the statistical model will

reduce the observed association with traffic noise. However, correlations between traffic intensity and

modelled noise were surprisingly low (~0.3). The analyses also considered noise as a continuous variable

(with modelled levels down to 29dB); the paper states that ‘relative risks for traffic noise were essentially

unity when traffic noise was included as a continuous exposure variable’ but do not provide further

information. This study provides limited evidence of any association between road traffic noise and

cardiovascular disease mortality; statistically significant results were only seen in traffic noise >65dB with

suggestion that observed associations may not be due to noise but due to confounding by air pollution.

Exposure-response analyses were conducted but not presented, however were reported as close to unity.

This study does not provide good support for a relationship between road traffic noise and cardiovascular

disease and cannot help with identification of possible SOAEL or LOAEL.

(iv) Selander (Selander et al, 2009) examined associations between first myocardial infarction (assessed by

hospital and death records) in 1992-1994 in Stockholm and a time-weighted average of modelled road traffic


noise (LAeq,24h) based on traffic flows and air pollution at residences from 1970 onwards in a case-control

study involving ~4000 men and women aged 45-70 years. A positive association was seen between MI and

long-term road traffic noise exposure of 50 dBA or higher compared with <50dB (OR 1.12 95% confidence

interval 0.95–1.33) and there was a suggestive exposure-response trend (OR for linear increase over 5 dBA

categories of 1.06, (CI 0.95–1.16). However, results were only statistically significant in subsamples

excluding either or both of persons with hearing loss or exposure to noise from other sources (OR for both

hearing loss and other noise exposures 1.38 (95% confidence intervals 1.11–1.71)), There was no difference

in effect in males and females. This study examined very long-term averages (20 years) of noise exposure

and it is unclear how this might relate to potential SOAELs and LOAELs that would be mainly predicated on

annual average exposure. Further, it provides suggestive but not strong evidence for an effect of traffic noise

on myocardial infarction. Results were analysed in relation to a reference category of <50dB so no

information is given on health effects below this cut-off.

Stroke:

(i) Sørensen (Sørensen et al. 2011a) looked at associations between first hospital admissions for stroke with

road traffic and railway noise in a cohort of 57,000 people in Sweden aged 50-64 in the mid-1990s followed

to 2006. Exposure to noise (Lden) and air pollution at residence were estimated; noise level used in the

analyses was the yearly mean exposure at a residence at a given age. The main analyses used noise as a

continuous exposure with no lower cut-off (a categorical analysis was also conducted with <55dB as the

lowest level). The adjusted relative risk was 1.14 (95% CI: 1.03–1.25) per 10 dB increase in road traffic

noise. Effects were similar in males and females, but older individuals were at higher risks (see Figure A1.11

below). There were no associations seen with railway or aircraft noise, however, exposure to aircraft noise

was limited and only 1% were exposed to aircraft noise >55dB.


(ii)

Figure A1.11: Exposure–response relation between exposure to road traffic noise (Lden) and incidence rate ratio

(IRR) for stroke (Sørensen et al. 2011)

(iii) Huss (Huss et al, 2010) studying relationship between noise and various cardiovascular outcomes in the

Swiss national cohort found no association between aircraft noise and stroke, nor with distance from road.

As there are only two studies to date which have examined the relationship between stroke and

environmental noise with inconsistent findings, identification of possible SOAEL or LOAEL in relation to

environmental noise and stroke is not possible.

Email Questionnaire Survey

The aim of the questionnaire survey was to contact international experts in the field that were already known

to the project team or who were authors of key papers identified from the literature review. The objective was

to establish whether there was any further information, in particular any new or about to be published

research relevant to the project that would not have been identified in the literature review. In addition, the

views from such experts as well as from policy and environmental noise stakeholders in other countries were

also sought with regards to the objective of the project.

The following sections describe the design of the survey questionnaire, the survey method and the survey

response.

Design of the survey

The intention of the survey was to sample a small number of experts and other stakeholders not only in

Europe but also in other parts of the world. The questionnaire was divided into two sections. The first section

dealt with current noise policies and regulations in the recipient’s country relating to guidance on noise levels

and associated adverse effects. The second section dealt with any ongoing research known to the recipient

that may have been relevant to the project.


A request via e-mail was sent to each recipient inviting them to take part in the survey. The e-mails were

sent out on 29th November 2011 to about 35 contacts worldwide. In addition, the e-mail was circulated within

the AECOM global network which included Canada and Australia. Defra also circulated the e-mail to

members on the European Environment Agency’s (EEA) distribution list. In total the email was sent to

recipients in 27 countries including: Australia, Austria, Belgium, Brazil, Canada, Cyprus, Czech Republic,

Denmark, France, Germany, Hungary, Iceland, Italy, Japan, Latvia, Malta, Netherlands, New Zealand,

Norway, Poland, Portugal, Slovakia, Spain, Sweden, Turkey, UK and USA. The deadline for responses was

set at 14th December 2011. The e-mails included the context and background information relating to the

project. Access to the questionnaire was obtained via a link to the SurveyMonkey web system.

A copy of the e-mail together with the questionnaire is shown in Appendix 7.

Survey Response

In total there were 22 respondents to the survey questionnaire from 12 countries. The responses received to

each question can be viewed via the SurveyMonkey web site.

http://www.surveymonkey.com/sr.aspx?sm=2piZNo3VJVFDGgkPULvz_2bNn3K4hF7EvCVRPcrxqOeUk_3d.

The link is password protected, the password is noise.

A summary of the replies to each question is shown in Table A1.3 and details of all replies are shown in

Appendix 8.

Table A1.3: Summary of responses to survey questionnaire.

Questions No:

positive replies

Summary

A. CURRENT NOISE POLICIES AND REGULATIONS

Does any Noise Policy, Regulation, or National standard in your country give specific levels of noise that should be avoided for health or quality of life based reasons?

17 There were some detailed responses to this question, in particular to noise limits with regard to land-use planning legislation. Where health effects were mentioned, noise limits were based on annoyance or levels of complaint rather than severe health effects such as cardiovascular disease.

Does any Noise Policy, Regulation, or National standard in your country make use of the concepts of LOAEL and/or SOAEL in the setting of threshold, standard or limit values?

5 Although the concept of LOAEL and/or SOAEL are not used, the setting of threshold or limit values could be translated as having an equivalent meaning e.g. see Appendix 7.

If LOAELs and/or SOAELs are defined in such documents, what is the basis for any defined levels?

5 Some replies indicated that WHO Guidelines informed the process for setting limit values.

If you believe there to be a scientific basis, please can you describe further

0 No responses

B. RESEARCH

Are you aware of any recently published research on the health effects of noise, or on “noise and the quality of life”, which you consider might be relevant to the challenge of defining LOAELs and SOAELs

7 Most refer to WHO Night Noise Guideline and Environmental Burden of Disease.

Are you aware of any ongoing projects which might be relevant?

3 Generally, no useful information of any ongoing projects except in Iceland


where noise impacts on children in schools is being carried out.

Total Number of Responses 22 Total Number of Countries 12 Canada (Ontario), Czech Republic,

Estonia, Iceland, Italy, Netherlands, Norway, Macedonia, New Zealand, Slovak Republic, Turkey, United Arab Emirates,

The main conclusions from the responses received from the survey questionnaire is that the concept of LOAEL

and SOAEL is not used in the setting of threshold noise limits for the purposes of land-use planning legislation, for

example, although some guidance from WHO publications such as the Night Noise Guidelines and the

Environmental Burden of Disease report is recognised.


Appendix 2 - Judging the quality of review papers published in peer review journals

The following criteria were judged or each review paper:

1. Was the research protocol reported?

YES, if review states the research question, inclusion criteria, database used and something about

research terms. (1 point)

2. Was the research comprehensive?

YES, if at least two electronic sources were searched. (1 point)

3. Were there any inclusion/exclusion criteria provided?

For example, including grey literature, language... (1 point)

4. Was selection bias avoided?

YES, if review gives information about the number of identified studies and number of excluded ones

(with reason explanation) (1 point)

5. Was the scientific quality of included studies assessed and reported?

YES, if methodological rigor and scientific quality of identified papers are considered (1 point)

6. What was the type of the review?

Systematic review, meta-analysis (3 points)

Critical review (2 points)

Narrative review (1 point)

7. Number of citations?

For papers published between 1980-1990:

1. 1-20 (1 point)

2. 21-35 (2 points)

3. 35< (3 points)


4. 1-15 (1 point)

5. 16-25 (2 points)

6. 25< (3 points)


7. 1-10 (1 point)

8. 11-20 (2 points)

9. 21< (3 points)

For papers published after 2010:


10. 1-5 (1 point)

11. 6-10 (2 points)

12. 11< (3 points)

1-4 points: Yellow 5-7 points: orange 8-11 points: red

Yellow, orange, red highlights refer to the quality of the review paper published in peer-reviewed journal, with red being the highest quality

Babisch 2003 Babisch 2000 Babisch 2008

Babisch 2004 Miedema & Vos 2003 Babisch 2006b

Belojevic et al. 2003 Muzet 2007 Babisch & van Kamp 2009

Belojevic et al. 2011

Clark et al. 2007

Bluhm & Eriksson 2011 Kaltenbach et al. 2008

Clark & Stansfeld 2007 van Kempen et al. 2002

Finegold 2010 Knopper & Ollson 2011

Griefahn & Spreng 2004 Ndrepepa & Twardella 2011

Guski 2004

Hoeger et al. 2002

Hoffmann et al. 2007

Hume 2010

Ising & Braun 2000

Ising & Kruppa 2004

Ising et al. 1999

Kawada 2004

Kawada 2011

van Kempen 2011

Kohlhuber & Bolte 2011

Lercher 2011

Leventhall (2004)

Marquis-Favre et al. 2005a

Marquis-Favre et al. 2005b

Maschke 2011

Maschke & Hecht 2004

Maschke et al. 2004

Maschke et al. 2000

Mathenson et al. 2005

Michaud et al. 2007

Olaosun et al. 2009

Ouis 2002

Ouis 2001

Ouis 1999

Passchier &Passchier 2000

Paunović et al. 2011

Better quality................


Pirrera et al. 2010

Prasher (2009)

Raschke (2004)

Rylander 2006

Schust (2004)

Seidman & Standring 2010

Spreng (2004)

Stansfeld& Crombie 2011

Stansfeld & Matheson 2003

Stansfeld et al. 2000

Tominsek & Bilban 2011

Zaharna & Guilleminault 2010


Appendix 3 - List of Identified Studies

1. Aasvang, G. & Engdahl, B. (2004) Subjective responses to aircraft noise in an outdoor recreational setting: a combined field and laboratory study. Journal of Sound and Vibration. [Online] 276 (3-5), 981–996. Available from: doi:10.1016/j.jsv.2003.08.042.

2. Aasvang, G., Engdahl, B. & Rothschild, K. (2007) Annoyance and self-reported sleep disturbances due to structurally radiated noise from railway tunnels. Applied Acoustics. [Online] 68 (9), 970–981. Available from: doi:10.1016/j.apacoust.2006.04.013.

3. Aasvang, G.M., Moum, T. & Engdahl, B. (2008) Self-reported sleep disturbances due to railway noise: exposure-response relationships for nighttime equivalent and maximum noise levels. The Journal of the Acoustical Society of America. [Online] 124 (1), 257–268. Available from: doi:10.1121/1.2932074.

4. Aasvang, G.M., Øverland, B., Ursin, R. & Moum, T. (2011) A field study of effects of road traffic and railway noise on polysomnographic sleep parameters. The Journal of the Acoustical Society of America. [Online] 129 (6), 3716–3726. Available from: doi:10.1121/1.3583547.

5. Agarwal, S. & Swami, B.L. (2011) Road traffic noise, annoyance and community health survey - A case study for an Indian city. Noise & health. [Online] 13 (53), 272–276. Available from: doi:10.4103/1463-1741.82959. Alayrac, M., Marquis-Favre, C. & Viollon, S. (2011)

6. Alayrac, M., Marquis-Favre, C. & Viollon, S. (2011) Total annoyance from an industrial noise source with a main spectral component combined with a background noise. The Journal of the Acoustical Society of America. [Online] 130 (1), 189–199. Available from: doi:10.1121/1.3598452.

7. Ali, S. & Tamura, A. (2003) Road traffic noise levels, restrictions and annoyance in Greater Cairo, Egypt. Applied Acoustics. [Online] 64 (8), 815–823. Available from: doi:10.1016/S0003-682X(03)00031-8.

8. Ali, S. (2004) Investigation of the exposure-response relationship for road traffic noise in Assiut, Egypt. Applied Acoustics. [Online] 65 (11), 1113–1120. Available from: doi:10.1016/j.apacoust.2004.06.007.

9. Ali, S. (2005) Railway noise levels, annoyance and countermeasures in Assiut, Egypt. Applied Acoustics. [Online] 66 (1), 105–113. Available from: doi:10.1016/j.apacoust.2004.06.005.

10. Amundsen, A.H. (2007) Effects of facade insulation on annoyance and sleep disturbances. In: Proceedings of the 36th International Congress and Exhibition on Noise Control Engineering. 30 July 2007 Turkey.

11. Ana, G.R.E.E., Shendell, D.G., Brown, G.E. & Sridhar, M.K.C. (2009) Assessment of noise and associated health impacts at selected secondary schools in ibadan, Nigeria. Journal of environmental and public health. [Online] 1–6. Available from: doi:10.1155/2009/739502.

12. Anderson, G.S. & Miller, N.P. (2007) Alternative analysis of sleep-awakening data. Noise Control Engineering Journal. [Online] 55 (2), 224. Available from: doi:10.3397/1.2711617.

13. Anon (2001) Infrasound. Brief Review of Toxicological Literature. p.1–51.

14. Anon (2012) Wind Turbine Health Impact Study: Report of Independent Expert Panel.

15. Asuquo, U.E., Onuu, M.U., Akpan, A.O. & Asuquo, A.U. (2009) Noise and Blood Pressure: a Cross Sectional and Longitudinal Study of the Effects of Exposure to Loud Noise on Residents in Calabar , Cross River State, Nigeria. International Journal of Acoustics and Vibration. 14 (2), 56–69.

16. Aydin, Y. & Kaltenbach, M. (2007) Noise perception, heart rate and blood pressure in relation to aircraft noise in the vicinity of the Frankfurt airport. Clinical research in cardiology: official journal of the German Cardiac Society. [Online] 96 (6), 347–358. Available from: doi:10.1007/s00392-007-0507-y.

17. Babisch, W. & Kamp, I.V. (2009) Exposure-response relationship of the association between aircraft noise and the risk of hypertension. Noise & Health. [Online] 11 (44), 161–168. Available from: doi:10.4103/1463-1741.53363.

18. Babisch, W. (2000) Traffic Noise and Cardiovascular Disease: Epidemiological Review and Synthesis. Noise & Health. 89–32.


19. Babisch, W. (2001) Increased catecholamine levels in urine in subjects exposed to road traffic noise The role of stress hormones in noise research. Environment International. [Online] 26 (7-8), 475–481. Available from: doi:10.1016/S0160-4120(01)00030-7.

20. Babisch, W. (2002) The Noise/Stress Concept, Risk Assessment and Research Needs. Noise & health. 4 (16), 1–11.

21. Babisch, W. (2003) Health status as a potential effect modifier of the relation between noise annoyance and incidence of ischaemic heart disease. Occupational and Environmental Medicine. [Online] 60 (10), 739–745. Available from: doi:10.1136/oem.60.10.739.

22. Babisch, W. (2003) Stress hormones in the research on cardiovascular effects of noise. Noise & health. 5 (18), 1–11.

23. Babisch, W. (2006a) Transportation Noise and Cardiovascular Risk. Review and Synthesis of Epidemiological Studies. Dose-effect Curve and Risk Estimation. p.1–113.

24. Babisch, W. (2006b) Transportation noise and cardiovascular risk: updated review and synthesis of epidemiological studies indicate that the evidence has increased. Noise & Health. 8 (30), 1–29.

25. Babisch, W. (2008a) Road traffic noise and cardiovascular risk. Noise & Health. 10 (38), 27–33.

26. Babisch, W. (2008b) Associations between road traffic noise level, road traffic noise annoyance and high blood pressure in the HYENA study. In: Proceedings of Acoustics’08 Paris. [Online]. 2008 Paris, pp. 3365–3370. Available from: doi:10.1121/1.2934267.

27. Babisch, W. (2010) Noise sensitivity in cardiovascular noise studies. In: Proceedings of the 39th International Congress on Noise Control Engineering. 2010 Lisbon.

28. Babisch, W. (2011) Cardiovascular effects of noise. Noise & health. [Online] 13 (52), 201–204. Available from: doi:10.4103/1463-1741.80148.

29. Babisch, W., Beule, B., Schust, M. & Kersten, N. (2004) The Impact of Annoyance from different Noise Sources on the Risk of Myocardial Infarction – Results from the NaRoMI Study. In: Proceedings of the 33rd International Congress and Exposition on Noise Control Engineering. 2004 Prague,. p.

30. Babisch, W., Beule, B., Schust, M., Kersten, N., et al. (2005) Traffic Noise and Risk of Myocardial Infarction. Epidemiology. [Online] 16 (1), 33–40. Available from: doi:10.1097/01.ede.0000147104.84424.24.

31. Babisch, W., Houthuijs, D., Pershagen, G., Cadum, E., et al. (2009a) Annoyance due to aircraft noise has increased over the years - results of the HYENA study. Environment International. [Online] 35 (8), 1169–1176. Available from: doi:10.1016/j.envint.2009.07.012.

32. Babisch, W., Houthuijs, D., Pershagen, G., Katsouyanni, K., et al. (2008) Hypertension and Exposure to Noise Near Airports: results of the HYENA Study. In: B Griefahn (ed.). Proceedings of the 9th International Congress on Noise as a Public Health Problem. 11 December 2008 Mashantucket.

33. Babisch, W., Houthuijs, D., Velonakis, M., Cadum, E., et al. (2007) Association between noise annoyance and high blood pressure. Preliminary results from the HYENA study. In: Inter-Noise 2007. [Online]. July 2007 Istambul,. pp. 161–161. Available from: doi:10.1260/135101007781447993.

34. Babisch, W., Keil, T., Beule, B., Stallmann, M., et al. (2002) ASSOCIATION BETWEEN ENVIRONMENTAL NOISE ANNOYANCE AND SOUND LEVEL. FIRST RESULTS OF THE “NAROMI” STUDY ( NOISE AND RISK OF MYOCARDIAL INFARCTION ). In: Proceedings of Forum Acusticum. 2002 Sevilla,. p.

35. Babisch, W., Neuhauser, H., Thamm, M. & Seiwert, M. (2009b) Blood pressure of 8 –14 year old children in relation to traffic noise at home — Results of the German Environmental Survey for Children (GerES IV). Science of the Total Environment. [Online] 407 (22), 5839–5843. Available from: doi:10.1016/j.scitotenv.2009.08.016.

36. Banerjee, D., Chakraborty, S.K., Bhattacharyya, S. & Gangopadhyay, A. (2009) Attitudinal response towards road traffic noise in the industrial town of Asansol, India. Environmental monitoring and assessment. [Online] 151 (1-4), 37–44. Available from: doi:10.1007/s10661-008-0247-0.

37. Barnett, A.G., Plonka, K., Seow, W.K., Wilson, L.-A., et al. (2011) Increased traffic exposure and negative birth outcomes: a prospective cohort in Australia. Environmental health. [Online] 10 (26), 1–11. Available from: doi:10.1186/1476-069X-10-26.


38. Barregard, L., Bonde, E. & Ohrström, E. (2009) Risk of hypertension from exposure to road traffic noise in a population-based sample. Occupational and environmental medicine. [Online] 66 (6), 410–415. Available from: doi:10.1136/oem.2008.042804.

39. Barrowcliffe, R., Buroni, A., Philips, C., Purvis, B., et al. (2006) Health Impact Assessment of Stansted Generation 1. p.1–107.

40. Basner M, Samel A, Isermann U. 2006. Aircraft noise effects on sleep: Application of the results of a large polysomnographic field study. The Journal of the Acoustical Society of America 119:2772; doi:10.1121/1.2184247.

41. Basner, M. & Samel, a (2004) Nocturnal aircraft noise effects. Noise & health. 6 (22), 83–93.

42. Basner, M. (2009) Validity of aircraft noise induced awakening predictions. Noise Control Engineering Journal. [Online] 57 (5), 524. Available from: doi:10.3397/1.3202160.

43. Basner, M. (2009.) Nocturnal aircraft noise exposure increases objectively assessed daytime sleepiness. In: 19th Congress of the European-Sleep-Research-Society. Glasgow,. pp. 257–257.

44. Basner, M., Griefahn, B. & Berg, M.V.D. (2010) Aircraft noise effects on sleep: Mechanisms, mitigation and research needs. Noise & health. [Online] 12 (47), 95–109. Available from: doi:10.4103/1463-1741.63210.

45. Basner, M., Müller, U. & Elmenhorst, E.-M. (2011) Single and combined effects of air, road, and rail traffic noise on sleep and recuperation. Sleep. 34 (1), 11–23.

46. Basner, M., Müller, U. & Griefahn, B. (2010) Practical guidance for risk assessment of traffic noise effects on sleep. Applied Acoustics. [Online] 71 (6), 518–522. Available from: doi:10.1016/j.apacoust.2010.01.002.

47. Bassarab, R., Sharp, B. & Robinette, B. (2009) An Updated Catalog of 628 Social Surveys of Residents’ Reaction to Environmental Noise (1943-2008).

48. Beelen, R., Hoek, G., Houthuijs, D., Brandt, P.A.V.D., et al. (2009) The joint association of air pollution and noise from road traffic with cardiovascular mortality in a cohort study. Occupational and Environmental Medicine. [Online] 66243–250. Available from: doi:10.1136/oem.2008.042358.

49. Belojevic, G. & Saric-Tanaskovic, M. (2002) Prevalence of Arterial Hypertension and Myocardial Infarction in Relation to Subjective Ratings of Traffic Noise Exposure. Noise & health. 4 (16), 33–37.

50. Belojević, G. a, Jakovljević, B.D., Stojanov, V.J., Slepcević, V.Z., et al. (2008a) Nighttime road-traffic noise and arterial hypertension in an urban population. Hypertension research: official journal of the Japanese Society of Hypertension. [Online] 31 (4), 775–781. Available from: doi:10.1291/hypres.31.775.

51. Belojevic, G., Jakovljevic, B., Vesna, S., Paunovic, K., et al. (2008b) Urban road-traffic noise and blood pressure and heart rate in preschool children. Environment international. [Online] 34 (2), 226–231. Available from: doi:10.1016/j.envint.2007.08.003.

52. Belojevic, G., Paunovic, K., Jakovljevic, B., Stojanov, V., et al. (2011) Cardiovascular effects of environmental noise: research in Serbia. Noise & health. [Online] 13 (52), 217–220. Available from: doi:10.4103/1463-1741.80156.

53. Belojevic, G., Jakovljevic, B. & Slepcevic, V. (2003) Noise and mental performance: personality attributes and noise sensitivity. Noise & Health. 6 (21), 77–89.

54. Bennett, R.L. & Pearsons, K.S. (1981) Handbook of aircrft noise metrics. NASA Contractor Report 3406.

55. Berglund, B., Lindvall, T. & Schwela, D.H. (1999) Guidelines for community noise. WHO document. p.1–160.

56. Berry, B.F. & Flindell, I.H. (2009a) Estimating Dose-Response Relationships between Noise Exposure and Human Health Impacts in the UK. Technical report. p.1–174.

57. Berry, B.F. & Flindell, I.H. (2009b) Estimating Dose-response Relationships between Noise Exposure and Human Health Impacts in the UK. Final project report BEL 2009-001. p.1–27.

58. Berry, B.F. & Porter, N. (2004) Review and analysis of published research into the adverse effects of industrial noise, in support of the revision of planning guidance. FINAL REPORT. DEFRA Ref. NANR 5. p.1–91.


59. Berry, B.F. (2008a) Technical report effect of noise on physical health risk in London - report on phase 2 – estimates of the numbers of people at risk. p.1–29.

60. Berry, B.F. (2008b) Technical report. Effect of noise on physical health risk in London. Report on phase 1 - review of the topic. p.1–62.

61. Bistrup, M.L., Hygge, S., Keiding, L. & Passchier-Vermeer, W. (2001) Health effects of noise on children - and perception of the risk of noise and perception of the risk of noise. Project report.

62. Bjork, J., Ardo, J., Stroh, E., Lovkvist, H., et al. (2006) Road traffic noise in southern Sweden and its relation to annoyance, disturbance of daily activities and health. Scandinavian journal of work, environment & health. 32 (5), 392–401.

63. Black, D., Black, J., Issarayangyun, T. & Samuels, S. (2007) Aircraft noise exposure and resident’s stress and hypertension: A public health perspective for airport environmental management. Journal of Air Transport Management. [Online] 13 (5), 264–276. Available from: doi:10.1016/j.jairtraman.2007.04.003.

64. Bluhm, G. & Eriksson, C. (2011) Cardiovascular effects of environmental noise: research in Sweden. Noise & health. [Online] 13 (52), 212–216. Available from: doi:10.4103/1463-1741.80152.

65. Bluhm, G., Nordling, E. & Berglind, N. (2004) Road traffic noise and annoyance--an increasing environmental health problem. Noise & Health. 6 (24), 43–49.

66. Bluhm, L.G., Berglind, N., Nordling, E. & Rosenlund, M. (2007) Road traffic noise and hypertension. Occupational and environmental medicine. [Online] 64 (2), 122–126. Available from: doi:10.1136/oem.2005.025866.

67. Bly, S., Vlahovich, S., Mclean, J. & Cakmak, S. (2001) Noise from Civilian Aircraft in the Vicinity of Airports – Implications for Human Health. p.1–17.

68. Bodin, T., Albin, M., Ardö, J., Stroh, E., et al. (2009) Road traffic noise and hypertension: results from a cross-sectional public health survey in southern Sweden. Environmental health: a global access science source. [Online] 838. Available from: doi:10.1186/1476-069X-8-38.

69. Boesch, H.-J., Kahlmeier, S., Sommer, H., van Kempen, E., et al. (2008) Economic valuation of transport- related health effects. Review of methods and development of practical approaches, with specific focus on children. p.1–150.

70. Bolin, K., Bluhm, G., Eriksson, G. & Nilsson, M.E. (2011) Infrasound and low frequency noise from wind turbines: exposure and health effects. Environmental Research Letters. [Online] 6 (3), 035103. Available from: doi:10.1088/1748-9326/6/3/035103.

71. Botteldooren, D., Dekoninck, L. & Gillis, D. (2011) The influence of traffic noise on appreciation of the living quality of a neighbourhood. International journal of environmental research and public health. [Online] 8 (3), 777–798. Available from: doi:10.3390/ijerph8030777.

72. Botteldooren, D., Dekoninck, L., Greve, B.D., De Coensel, B., et al. (2007) Annoyance by combined exposure to noise from road traffic and rail traffic discussed in the framework of the noticing model. In: 19 th International congress on acoustics madrid. 2007 Madrid,. pp. 2–5.

73. Brink, M. (2011) Parameters of well-being and subjective health and their relationship with residential traffic noise exposure--a representative evaluation in Switzerland. Environment international. [Online] 37 (4), 723–733. Available from: doi:10.1016/j.envint.2011.02.011.

74. Brink, M., Omlin, S., Müller, C., Pieren, R., et al. (2011) An event-related analysis of awakening reactions due to nocturnal church bell noise. The Science of the total environment. [Online] 409 (24), 5210–5220. Available from: doi:10.1016/j.scitotenv.2011.09.020.

75. Brink, M., Schreckenberg, D., Thomann, G. & Basner, M. (2010) Aircraft Noise Indexes for Effect Oriented Noise Assessment. Acta Acustica united with Acustica. [Online] 96 (6), 14.

76. Brink, M., Wirth, K.E., Schierz, C., Thomann, G., et al. (2008) Annoyance responses to stable and changing aircraft noise exposure. The Journal of the Acoustical Society of America. [Online] 124 (5), 2930–2941. Available from: doi:10.1121/1.2977680.

77. Bristow, A., Wardman, M., Heaver, C., Murphy, P., et al. (2003) Attitudes towards and values of aircaft annoyance and noise nuisance. Attitudes To Aircraft Annoyance Around Airports (5A) – Survey Report.

78. Brooker, P. (2010) Aircraft noise annoyance estimation: UK time-pattern effects. Applied Acoustics. [Online] 71 (7), 661–667. Available from: doi:10.1016/j.apacoust.2010.01.010.


79. Brown, A.L. & van Kamp, I. (2009) Response to a change in transport noise exposure: a review of evidence of a change effect. The Journal of the Acoustical Society of America. [Online] 125 (5), 3018–3029. Available from: doi:10.1121/1.3095802.

80. Campbell, K. (2010) Event-related potentials as a measure of sleep disturbance: A tutorial review. Noise & Health. [Online] 12 (47), 137–153. Available from: doi:10.4103/1463-1741.63216.

81. Chang, T.-Y., Liu, C.-S., Bao, B.-Y., Li, S.-F., et al. (2010) Characterization of road traffic noise exposure and prevalence of hypertension in central Taiwan. The Science of the total environment. [Online] Available from: doi:10.1016/j.scitotenv.2010.11.039.

82. Chang, T.-yuan, Lai, Y.-an, Hsieh, H.-hui, Lai, J.-shoung, et al. (2009) Effects of environmental noise exposure on ambulatory blood pressure in young adults. Environmental Research. [Online] 109 (7), 900–905. Available from: doi:10.1016/j.envres.2009.05.008.

83. Clark, C., Martin, R., van Kempen, E., Alfred, T., et al. (2006) Exposure-effect relations between aircraft and road traffic noise exposure at school and reading comprehension: The RANCH project. American Journal of Epidemiology. 163 (1), 27–37.

84. Clark, C. & Stansfeld, S.A. (2007) The Effect of Transportation Noise on Health and Cognitive Development: A Review of Recent Evidence. International Journal of Comparative Psychology. 20 (2), 145–158.

85. Clark, C., Myron, R., Stansfeld, S.A. & Candy, B. (2007) A systematic review of the evidence on the effect of the built and physical environment on mental health. Journal of public mental health. 6 (2), 14–27.

86. Colby, D.V., Dobie, R., Leventhall, G., Lipscomb, D.., et al. (2009) Wind Turbine Sound and Health Effects. An Expert Panel Review.

87. Davies, H. & Kamp, I.V. (2008) Environmental noise and cardiovascular disease: Five year review and future directions. In: ICBEN 2008. 2008 Foxwoods.

88. de Kluizenaar, Y., Gansevoort, R.T., Miedema, H.M.E. & de Jong, P.E. (2007) Hypertension and road traffic noise exposure. Journal of occupational and environmental medicine. [Online] 49 (5), 484–492. Available from: doi:10.1097/JOM.0b013e318058a9ff.

89. de Kluizenaar, Y., Janssen, S.A., van Lenthe, F.J., Miedema, H.M.E., et al. (2009) Long-term road traffic noise exposure is associated with an increase in morning tiredness. The Journal of the Acoustical Society of America. [Online] 126 (2), 626–633. Available from: doi:10.1121/1.3158834.

90. de Kluizenaar, Y., Salomons, E.M., Janssen, S. a, van Lenthe, F.J., et al. (2011) Urban road traffic noise and annoyance: the effect of a quiet fac ̧ade. The Journal of the Acoustical Society of America. [Online] 130 (4), 1936–1942. Available from: doi:10.1121/1.3621180.

91. Dekoninck, L. & Botteldooren, D. (2002) Prediction of nosie annoyance due to local traffic using geographic information and traffic modelling. In: Proceedings of the 2002 International Congress and Exposition on Noise Control Engineering. 2002 Dearborn.

92. den Boer, E. & Schroten, A. (2007) Traffic noise reduction in Europe. Health effects, social costs and technical and policy options to reduce road and rail traffic noise.

93. Diaz, J., Ekelund, M., Gothe, R., Huber, M., et al. (2001) Traffic noise pollution. A state of the art review.

94. Dratva, J., Phuleria, H.C., Foraster, M., Gaspoz, J.-M., et al. (2012) Transportation noise and blood pressure in a population-based sample of adults. Environmental health perspectives. [Online] 120 (1), 50–55. Available from: doi:10.1289/ehp.1103448.

95. EEA (2001) Traffic noise : exposure and annoyance.

96. EEA (2010) Good practice guide on noise exposure and potential health effects. EEA Technical report. p.1–40.

97. ERM (2008) HIA of 2nd Runway Development at Stansted Airport Generation 2 - Annex A Literature review.

98. Elmenhorst, E.-M., Elmenhorst, D., Wenzel, J., Quehl, J., et al. (2010) Effects of nocturnal aircraft noise on cognitive performance in the following morning: dose-response relationships in laboratory and field. International archives of occupational and environmental health. [Online] 83 (7), 743–751. Available from: doi:10.1007/s00420-010-0515-5.


99. Eriksson, C., Bluhm, G., Hilding, A., Ostenson, C.-G., et al. (2010) Aircraft noise and incidence of hypertension - Gender specific effects. Environmental research. [Online] 110764–772. Available from: doi:10.1016/j.envres.2010.09.001.

100. Eriksson, C., Rosenlund, M., Pershagen, G., Hilding, A., et al. (2007) Aircraft noise and incidence of hypertension. Epidemiology. [Online] 18 (6), 716–721. Available from: doi:10.1097/EDE.0b013e3181567e77.

101. ERM (2008) HIA of 2nd Runway Development at Stansted Airport Generation 2 - Annex A Literature review.

102. EU (2002) Position paper on dose response relationships between transportation noise and annoyance.

103. EU (2004) Dose-effect relationships for night time noise.

104. Evans, G.W., Lercher, P., Meis, M., Ising, H., et al. (2001) Community noise exposure and stress in children. The Journal of the Acoustical Society of America. [Online] 109 (3), 1023–1027. Available from: doi:10.1121/1.1340642.

105. Fidell, S. & Schomer, P. (2007) Uncertainties in measuring aircraft noise and predicting community response to it. Noise Control Engineering Journal. [Online] 55 (1), 82. Available from: doi:10.3397/1.2402314.

106. Fidell, S. & Silvati, L. (2004) Parsimonious alternatives to regression analysis for characterizing prevalence rates of aircraft noise annoyance. Noise Control Engineering Journal. 52 (2), 56–68.

107. Fidell, S. (2003) The Schultz curve 25 years later: A research perspective. The Journal of the Acoustical Society of America. [Online] 114 (6), 3007–3015. Available from: doi:10.1121/1.1628246.

108. Fidell, S., Mestre, V., Schomer, P., Berry, B., et al. (2011) A first-principles model for estimating the prevalence of annoyance with aircraft noise exposure. The Journal of the Acoustical Society of America. [Online] 130 (2), 791. Available from: doi:10.1121/1.3605673.

109. Fidell, S., Pearsons, K., Tabachnick, B.G. & Howe, R. (2000) Effects on sleep disturbance of changes in aircraft noise near three airports. The Journal of the Acoustical Society of America. 107 (5 Pt 1), 2535–2547.

110. Fidell, S., Silvati, L. & Haboly, E. (2002) Social survey of community response to a step change in aircraft noise exposure. The Journal of the Acoustical Society of America. [Online] 111 (1), 200–209. Available from: doi:10.1121/1.1423927.

111. Fidell, S., Silvati, L., Pearsons, K., Lind, S., et al. (1999) Field study of the annoyance of low-frequency runway sideline noise. The Journal of the Acoustical Society of America. [Online] 106 (3), 1408. Available from: doi:10.1121/1.427175.

112. Fidell, S., Tabachnick, B. & Pearsons, K.S. (2010) The state of the art of predicting noise-induced sleep disturbance in field settings. Noise & health. [Online] 12 (47), 77–87. Available from: doi:10.4103/1463-1741.63207.

113. Finegold, L.S. (2010) Sleep disturbance due to aircraft noise exposure. Noise & health. [Online] 12 (47), 88–94. Available from: doi:10.4103/1463-1741.63208.

114. Floud, S., Vigna-Taglianti, F., Hansell, A., Blangiardo, M., et al. (2010) Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study. Occupational and environmental medicine. [Online] Available from: doi:10.1136/oem.2010.058586.

115. Franco, V., Garraín, D. & Vidal, R. (2010) Methodological proposals for improved assessments of the impact of traffic noise upon human health. The International Journal of Life Cycle Assessment. [Online] 869–882. Available from: doi:10.1007/s11367-010-0213-2.

116. Franssen, E.A.M. (2004) Aircraft noise around a large international airport and its impact on general health and medication use. Occupational and Environmental Medicine. [Online] 61 (5), 405–413. Available from: doi:10.1136/oem.2002.005488.

117. Franssen, E.A.M., Staatsen, B.A.M. & Lebret, E. (2002) Assessing health consequences in an environmental impact assessment The case of Amsterdam Airport Schiphol. Environmental Impact Assessment Review. [Online] 22 (6), 633–653. Available from: doi:10.1016/S0195-9255(02)00015-X.

118. Fyhri, A. & Klæboe, R. (2009) Road traffic noise, sensitivity , annoyance and self-reported health — A structural equation model exercise. Environment International. [Online] 35 (1), 91–97. Available from: doi:10.1016/j.envint.2008.08.006.


119. Gidlof-Gunnarsson, A. & Ohrstrom, E. (2010) Attractive “quiet” courtyards: a potential modifier of urban residents’ responses to road traffic noise? International journal of environmental research and public health. [Online] 7 (9), 3359–3375. Available from: doi:10.3390/ijerph7093359.

120. Goto, K. & Kaneko, T. (2002) Distribution of Blood Pressure Data from People Living Near an Airport. Journal of Sound and Vibration. [Online] 250 (1), 145–149. Available from: doi:10.1006/jsvi.2001.3895.

121. Graham, J.M.A., Janssen, S.A., Vos, H. & Miedema, H.M.E. (2009) Habitual traffic noise at home reduces cardiac parasympathetic tone during sleep. International journal of psychophysiology. [Online] 72 (2), 179–186. Available from: doi:10.1016/j.ijpsycho.2008.12.004.

122. Grazuleviciene, R., Lekaviciute, J., Mozgeris, G., Merkivicus, S., et al. (2004) Traffic Noise Emissions and Myocardial Infarction Risk. Polish Journal of Environmental Studies. 13 (6), 737–741.

123. Greiser, E., Greiser, C. & Janhsen, K. (2007) Night-time aircraft noise increases prevalence of prescriptions of antihypertensive and cardiovascular drugs irrespective of social class—the Cologne-Bonn Airport study. Journal of Public Health. [Online] 15 (5), 327–337. Available from: doi:10.1007/s10389-007-0137-x.

124. Greiser, E., Janhsen, K. & Greiser, C. (2008) Night-time aircraft noise leads to increased prescription volumes of antihypertensive and cardiovascular drugs – the Cologne-Bonn Airport Study.

125. Griefahn, B. & Spreng, M. (2004) Disturbed sleep patterns and limitation of noise. Noise & health. 6 (22), 27–33.

126. Griefahn, B., Schuemer-Kohrs, A., Schuemer, R., Moehler, U., et al. (2000) Physiological, subjective, and behavioural responses during sleep to noise from rail and road traffic. Noise & health. 3 (9), 59–71.

127. Guski, R. (2004) How to forecast community annoyance in planning noisy facilities. Noise & Health. 6 (22), 59–64.

128. Haines, M.M., Stansfeld, S. a, Head, J. & Job, R.F.S. (2002) Multilevel modelling of aircraft noise on performance tests in schools around Heathrow Airport London. Journal of epidemiology and community health. 56 (2), 139–144.

129. Haines, M.M., Stansfeld, S.A., Brentnall, S., Head, J., et al. (2001) The West London Schools Study: the effects of chronic aircraft noise exposure on child health. Psychological Medicine. 31 (8), 1385–1396.

130. Haines, M.M., Stansfeld, S.A., Job, R.F.S., Berglund, B., et al. (2001) Chronic aircraft noise exposure, stress responses mental health and cognitive performance in school children. Psychological Medicine. 31265–277.

131. Haines, M.M., Stansfeld, S.A., Job, R.S., Berglund, B., et al. (2001) A follow-up study of effects of chronic aircraft noise exposure on child stress responses and cognition. International Journal of Epidemiology. 30839–845.

132. Haralabidis, A.S., Dimakopoulou, K., Velonaki, V., Barbaglia, G., et al. (2010) Can exposure to noise affect the 24 h blood pressure profile? Results from the HYENA study. Journal of epidemiology and community health. [Online] 1–7. Available from: doi:10.1136/jech.2009.102954.

133. Haralabidis, A.S., Dimakopoulou, K., Vigna-taglianti, F., Giampaolo, M., et al. (2008) Acute effects of night-time noise exposure on blood pressure in populations living near airports. European Heart Journal. [Online] 29658–664. Available from: doi:10.1093/eurheartj/ehn013.

134. HCE (2004) The Influence of Night-time Noise on Sleep and Health. 2004/14E.

135. Hoeger, R., Schreckenberg, D., Felscher-Suhr, U. & Griefahn, B. (2002) Night-time Noise Annoyance: State of the Art. Noise & Health. 4 (15), 19–25.

136. Hoffmann, B., Moebus, S., Dragano, N., Möhlenkamp, S., et al. (2009) Residential traffic exposure and coronary heart disease: results from the Heinz Nixdorf Recall Study. Biomarkers. [Online] 14 (Suppl 1), 74–78. Available from: doi:10.1080/13547500902965096.

137. Hong, J., Kim, J., Kim, K., Jo, Y., et al. (2009) Annoyance caused by single and combined noise exposure from aircraft and road traffic. Journal of Temporal Design in Architecture and Environment. 9 (1), 137–140.


138. Hong, J., Kim, J., Lim, C., Kim, K., et al. (2010) The effects of long-term exposure to railway and road traffic noise on subjective sleep disturbance. The Journal of the Acoustical Society of America. [Online] 128 (5), 2829–2835. Available from: doi:10.1121/1.3493437.

139. Houthuijs, D., Breugelmans, O. & Kamp, I.V. (2007) Burden of annoyance due to aircraft noise and non-acoustical factors. In: Proceedings of the 33rd International Congress and Exposition on Noise Control Engineering. 2007 Istanbul.

140. HPA (2009) Environmental Noise and Health in the UK. HPA report. Draft for comment. p.1–94.

141. Hume, K., Gregg, M., Thomas, C. & Terranova, D. (2003) Complaints caused by aircraft operations: an assessment of annoyance by noise level and time of day. Journal of Air Transport Management. [Online] 9 (3), 153–160. Available from: doi:10.1016/S0969-6997(02)00079-0.

142. Hume, K. (2010) Sleep disturbance due to noise: Current issues and future research. Noise & Health. [Online] 12 (47), 70–76. Available from: doi:10.4103/1463-1741.63206.

143. Hume, K.I., Morley, H. & Thomas, C. (2004) Community response to a new runway: preliminary results. In: Proceedings of the 33rd International Congress and Exposition on Noise Control Engineering. 2004 Prague.

144. Huss, A., Spoerri, A., Egger, M. & Röösli, M. (2010) Aircraft Noise, Air Pollution, and Mortality From Myocardial Infarction. Epidemiology. [Online] 21 (6), 829–836. Available from: doi:10.1097/EDE.0b013e3181f4e634.

145. Ising, H. & Braun, C. (2000) Acute and chronic endocrine effects of noise: Review of the research conducted at the Institute for Water, Soil and Air Hygiene. Noise & Health. 2 (7), 7–24.

146. Ising, H., Babisch, W. & Kruppa, B. (1999) Noise-Induced Endocrine Effects and Cardiovascular Risk. Noise & health. 1 (4), 37–48.

147. Ising, H., Babisch, W., Guski, R., Kruppa, B., et al. (2004) Exposure and Effect Indicators of Environmental Noise. p.1–28.

148. Ising, H. & Kruppa, B. (2004) Health effects caused by noise: evidence in the literature from the past 25 years. Noise & health. 6 (22), 5–13.

149. Jakovljević, B., Belojević, G., Paunović, K. & Stojanov, V. (2006) Road traffic noise and sleep disturbances in an urban population: cross-sectional study. Croatian medical journal. 47 (1), 125–133.

150. Jakovljevic, B., Paunovic, K. & Belojevic, G. (2009) Road-traffic noise and factors influencing noise annoyance in an urban population. Environment international. [Online] 35 (3), 552–556. Available from: doi:10.1016/j.envint.2008.10.001.

151. Janssen, S.A. & Vos, H. (2009) A comparison of recent surveys to aircraft noise exposure-response relationships. p.1–14.

152. Jarup, L., Babisch, W., Houthuijs, D., Pershagen, G., et al. (2008) Hypertension and exposure to noise near airports: the HYENA study. Environmental health perspectives. [Online] 116 (3), 329–333. Available from: doi:10.1289/ehp.10775.

153. Jarup, L., Babisch, W., Houthuijs, D., Pershagen, G., et al. (2008) Acute and Long-Term Effect On Blood Pressure Of Exposure To Noise Near Airports - The HYENA Study. In: InterNoise 2008. 2008 p.

154. Job, R.F.S. & Hatfield, J. (2001) The impact of soundscape, enviroscape, and psychoscape on reaction to noise: Implications for evaluation and regulation of noise effects. Noise Control Engineering Journal. [Online] 49 (3), 120. Available from: doi:10.3397/1.2839647.

155. Jones, K. (2009) Aircraft Noise and Sleep Disturbance: A Review. ERCD REPORT 0905. p.1–30.

156. Jones, K. (2010a) Environmental Noise and Health: A Review. ERCD REPORT 0907. p.1–46.

157. Jones, K. (2010b) Aircraft Noise and Children’s Learning. ERCD REPORT 0908. p 1-20.

158. Kaku, J., Hiroe, M., Kuwano, S. & Namba, S. (2004) Sleep disturbance by traffic noise: an experimental study in subjects’ own houses using a portable CD player. Journal of Sound and Vibration. [Online] 277 (3), 459–464. Available from: doi:10.1016/j.jsv.2004.03.005.

159. Kaltenbach, M., Maschke, C. & Klinke, R. (2008) Health consequences of aircraft noise. Deutsches Ärzteblatt International. [Online] 105 (31-32), 548–556. Available from: doi:10.3238/arztebl.2008.0548.


160. Kamp, I.V., Houthuijs, D., Wiechen, C.V. & Breugelmans, O. (2007) Environmental noise and mental health: evidence from the Schiphol monitoring program. In: InterNoise 2007, Istanbul.

161. Kaltenbach, M., Maschke, C. & Klinke, R. (2008) Health consequences of aircraft noise. Deutsches Ärzteblatt International. [Online] 105 (31-32), 548–556. Available from: doi:10.3238/arztebl.2008.0548.

162. Kawada, T. (2004) The Effect of Noise on the Health of Children. Journal of Nippon Medical School. 71 (1), 5–10.

163. Kawada, T. (2011) Noise and health: sleep disturbance in adults. Journal of occupational health. 53 (6), 413–416.

164. Kempen, E. van (2011) Cardiovascular effects of environmental noise: research in The Netherlands. Noise & health. [Online] 13 (52), 221–228. Available from: doi:10.4103/1463-1741.80158.

165. King, E. a, Murphy, E. & Rice, H.J. (2011) Implementation of the EU environmental noise directive: lessons from the first phase of strategic noise mapping and action planning in Ireland. Journal of environmental management. [Online] 92 (3), 756–764. Available from: doi:10.1016/j.jenvman.2010.10.034.

166. King, E.A. & Murphy, E. (2011) A critical review of current policy for the assessment of night-time noise in the EU. In: Proceedings of the 11th International Congress on Noise as a Public Health Problem. 2011 London.

167. Klæboe, R. & Bjørnskau, T. (2000) Towards a national indicator for noise exposure and annoyance. Part II: Mapping changes in noise annoyance to monitor the efficacy of nosie reduction efforts.

168. Klæboe, R. (2007) Are adverse impacts of neighbourhood noisy areas the flip side of quiet area benefits? Applied Acoustics. [Online] 68 (5), 557–575. Available from: doi:10.1016/j.apacoust.2005.05.007.

169. Klæboe, R., Amundsen, A.H., Fyhri, A. & Solberg, S. (2004) Road traffic noise - the relationship between noise exposure and noise annoyance in Norway. Applied Acoustics. [Online] 65893–912. Available from: doi:10.1016/j.apacoust.2004.04.001.

170. Kohlhuber, M. & Bolte, G. (2011) Influence of environmental noise on sleep quality and sleeping disorders-implications for health. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. [Online] 54 (12), 1319–1324. Available from: doi:10.1007/s00103-011-1370-6.

171. Knopper, L.D. & Ollson, C. a (2011) Health Effects and Wind Turbines: A Review of the Literature. Environmental health: a global access science source. [Online] 10 (1), 78. Available from: doi:10.1186/1476-069X-10-78.

172. Kristiansen, J., Persson, R., Björk, J., Albin, M., et al. (2011) Work stress, worries, and pain interact synergistically with modelled traffic noise on cross-sectional associations with self-reported sleep problems. International archives of occupational and environmental health. [Online] 84 (2), 211–224. Available from: doi:10.1007/s00420-010-0557-8.

173. Kroesen, M. & Schreckenberg, D. (2011) A measurement model for general noise reaction in response to aircraft noise. The Journal of the Acoustical Society of America. [Online] 129 (1), 200–210. Available from: doi:10.1121/1.3514542.

174. Kroesen, M., Molin, E.J.E., Miedema, H.M.E., Vos, H., et al. (2010) Estimation of the effects of aircraft noise on residential satisfaction. Transportation Research Part D: Transport and Environment. [Online] 15 (3), 144–153. Available from: doi:10.1016/j.trd.2009.12.005.

175. Krog, N.H. & Engdahl, B. (2004) Annoyance with aircraft noise in local recreational areas, contingent on changes in exposure and other context variables. The Journal of the Acoustical Society of America. [Online] 116 (1), 323–333. Available from: doi:10.1121/1.1756162.

176. Kryter, K.D. (2009) Acoustical model and theory for predicting effects of environmental noise on people. The Journal of the Acoustical Society of America. [Online] 125 (6), 3707–3721. Available from: doi:10.1121/1.3125320.

177. La Torre, G., Coniglione, D., Scagliosi, A., Ciocci, G., et al. (2011) [Exposure to noise in the general population and hypertension: results from a pilot case-control study in Rome]. Annali di igiene: medicina preventiva e di comunità. 23 (3), 209–217.


178. Lam, K., Chan, P., Chan, T., Au, W., et al. (2009) Annoyance response to mixed transportation noise in Hong Kong. Applied Acoustics. [Online] 70 (1), 1–10. Available from: doi:10.1016/j.apacoust.2008.02.005.

179. Lee, C.S.Y. & Fleming, G.G. (2002) General health effects of transportation noise. p.1–36.

180. Lee, P.J., Shim, M.H. & Jeon, J.Y. (2010) Effects of different noise combinations on sleep, as assessed by a general questionnaire. Applied Acoustics. [Online] 71 (9), 870–875. Available from: doi:10.1016/j.apacoust.2010.05.004.

181. Lepore, S.J., Shejwal, B., Kim, B.H. & Evans, G.W. (2010) Associations between chronic community noise exposure and blood pressure at rest and during acute noise and non-noise stressors among urban school children in India. International journal of environmental research and public health. [Online] 7 (9), 3457–3466. Available from: doi:10.3390/ijerph7093457.

182. Lercher, P. & Botteldooren, D. (2006) General and / or local assessment of the impact of transportation noise in environmental health impact studies? In: Euronoise 2006. 2006 Tampere. P.

183. Lercher, P. (2007) Soundscape research, quality of life and health: an integrated environmental health viewpoint. In: Proceedings of the 36th International Congress and Exhibition on Noise Control Engineering. 2007 Istambul,. p. Paper No. 033.

184. Lercher, P., Botteldooren, D. & Greve, B.D. (2007) The effects of noise from combined traffic sources on annoyance: the case of interactions between rail and road noise. In: Internoise 2007. 2007 Istanbul.

185. Lercher, P., Botteldooren, D. & Greve, B.D. (2007) The effects of noise from combined traffic sources on annoyance: the case of interactions between rail and road noise. In: Internoise 2007. 2007 Istanbul.

186. Lercher, P., Botteldooren, D., Widmann, U., Uhrner, U., et al. (2011) Cardiovascular effects of environmental noise: Research in Austria. Noise and Health. [Online] 13 (52), 234. Available from: doi:10.4103/1463-1741.80160.

187. Lercher, P., Brink, M., Rudisser, J., Van Renterghem, T., et al. (2010) The effects of railway noise on sleep medication intake: Results from the ALPNAP-study. Noise & health. [Online] 12 (47), 110–119. Available from: doi:10.4103/1463-1741.63211.

188. Lercher, P., Evans, G.W., Meis, M. & Kofler, W.W. (2002) Ambient neighbourhood noise and children’s mental health. Occupational and Environmental Medicine. [Online] 59 (6), 380–386. Available from: doi:10.1136/oem.59.6.380.

189. Lercher, P., Greve, B.D., Botteldooren, D. & Baulac, M. (2008) The effect on annoyance estimation of noise modeling procedures. In: Proceedings of the 9th International Congress on Noise as a Public Health Problem 2008.

190. Lercher, P., Pfeifer, C., Botteldooren, D. & Dekoninck, L. (2005) Traffic noise exposure, education and annoyance: longitudinal experience from cross-sectional surveys over time ( 1989-2004 ) Methods Results : first part. In: Proceedings of Forum Acusticum 2005. 2005 Budapest. pp. 1795–1800.

191. Leventhall, G. (2003) A Review of Published Research on Low Frequency Noise and its Effects. Report for Defra EPG 1/2/50. p.1–88.

192. Leventhall, H.G. (2004) Low frequency noise and annoyance. Noise & Health. 6 (23), 59–72.

193. Li, H.-J., Yu, W.-B., Lu, J.-Q., Zeng, L., et al. (2008) Investigation of road-traffic noise and annoyance in Beijing: A cross-sectional study of 4th Ring Road. Archives of environmental and occupational health. 63 (1), 27–33.

194. Lim, C., Kim, J., Hong, J. & Lee, S. (2006) The relationship between railway noise and community annoyance in Korea. The Journal of the Acoustical Society of America. [Online] 120 (4), 2037. Available from: doi:10.1121/1.2266539.

195. Lim, C., Kim, J., Hong, J., Sun, H., et al. (2005) Community Annoyance from Civil Aircraft Noise in Korea. In: Inter-Noise 2005. Rio de Janeiro.

196. Mahashabde, A., Wolfe, P., Ashok, A., Dorbian, C., et al. (2011) Assessing the environmental impacts of aircraft noise and emissions. Progress in Aerospace Sciences. [Online] 47 (1), 15–52. Available from: doi:10.1016/j.paerosci.2010.04.003.


197. Marks, A., Griefahn, B. & Basner, M. (2008) Event-related awakenings caused by nocturnal transportation noise. Noise Control Engineering Journal. [Online] 56 (1), 52. Available from: doi:10.3397/1.2828211.

198. Marquis-Favre, C., Premat, E. & Aubree, D. (2005a) Noise and its effects - A review on qualitative aspects of sound. Part II: Noise and annoyance. ACTA ACUSTICA UNITED WITH ACUSTICA. 91 (4), 626–642.

199. Marquis-Favre, C., Premat, E., Aubree, D. & Vallet, M. (2005b) Noise and its effects - A review on qualitative aspects of sound. Part 1: Notions and acoustic ratings. ACTA ACUSTICA UNITED WITH ACUSTICA. 91 (4), 613–625.

200. Martin, M., Tarrero, a, Gonzalez, J. & Machimbarrena, M. (2006) Exposure–effect relationships between road traffic noise annoyance and noise cost valuations in Valladolid, Spain. Applied Acoustics. [Online] 67 (10), 945–958. Available from: doi:10.1016/j.apacoust.2006.01.004.

201. Maschke, C. & Hecht, K. (2004) Stress hormones and sleep disturbances - electrophysiological and hormonal aspects. Noise & Health. 6 (22), 49–54.

202. Maschke, C. (2011) Cardiovascular effects of environmental noise: Research in Germany. Noise & health. [Online] 13 (52), 205–211. Available from: doi:10.4103/1463-1741.80150.

203. Maschke, C., Harder, J., Cornelissen, G., Hecht, K., et al. (2003) Chronoecoepidemiology of “strain”: infradian chronomics of urinary cortisol and catecholamines during nightly exposure to noise. Biomedecine & Pharmacotherapy. [Online] 57126–135. Available from: doi:10.1016/j.biopha.2003.08.021.

204. Maschke, C., Hecht, K. & Wolf, U. (2004) Nocturnal awakenings due to aircraft noise. Do wake-up reactions begin at sound level 60 dB(A)? Noise & health. 6 (24), 21–33.

205. Maschke, C. (2002) Epidemiological research on stress caused by road traffic noise and its effects on health- Results for hypertension. In: Proceedings of Forum Acusticum 2002.

206. Maschke, C., Rupp, T. & Hecht, K. (2000) The influence of stressors on biochemical reactions - a review of present scientific findings with noise. International Journal of Hygiene and Environmental Health. 20345–53.

207. Matheson, M.P., Stansfeld, S.A. & Haines, M.M. (2003) The Effects of Chronic Aircraft Noise Exposure on Children’s Cognition and Health: 3 Field Studies. Noise & Health. 5 (19), 31–40.

208. Matheson, M., Clark, C., Martin, R., van Kempen, E., et al. (2010) The effects of road traffic and aircraft noise exposure on children’s episodic memory: the RANCH project. Noise & health. [Online] 12 (49), 244–254. Available from: doi:10.4103/1463-1741.70503.

209. Mathews, R. (2009) The Effect of Community Noise on Health and Well-being. Auckland University of Technology.

210. Matsui, T., Uehara, T., Miyakita, T., Hiramatsu, K., et al. (2004) The Okinawa study: effects of chronic aircraft noise on blood pressure and some other physiological indices. Journal of Sound and Vibration. [Online] 277 (3), 469–470. Available from: doi:10.1016/j.jsv.2004.03.007.

211. Maxwell, L. (2000) The Effects of Noise on Pre-School Children’S Pre-Reading Skills. Journal of Environmental Psychology. [Online] 20 (1), 91–97. Available from: doi:10.1006/jevp.1999.0144.

212. Mestre, V. (2008) ACRP Synthesis 9. Effects of Aircraft Noise: Research Update on Selected Topics. A synthesis of airport practice. p.1–90.

213. Mestre, V., Schomer, P.D., Fidell, S. & Berry, B. (2011) Technical support for day / night average sound level (dnl) replacement metric research. p.1–77.

214. Michaud, D.S., Fidell, S., Pearsons, K., Campbell, K.C., et al. (2007) Review of field studies of aircraft noise-induced sleep disturbance. The Journal of the Acoustical Society of America. [Online] 121 (1), 32–41. Available from: doi:10.1121/1.2400613.

215. Michaud, D.S., Keith, S.E. & McMurchy, D. (2005) Noise annoyance in Canada. Noise & Health. 7 (27), 39–47.

216. Michaud, D.S., Keith, S.E. & McMurchy, D. (2008) Annoyance and disturbance of daily activities from road traffic noise in Canada. The Journal of the Acoustical Society of America. [Online] 123 (2), 784–792. Available from: doi:10.1121/1.2821984.


217. Miedema, H.M. & Oudshoorn, C.G.M. (2001) Annoyance from transportation noise: relationships with exposure metrics DNL and DENL and their confidence intervals. Environmental health perspectives. 109 (4), 409–416.

218. Miedema, H.M.E. & Vos, H. (2004) Noise annoyance from stationary sources: Relationships with exposure metric day–evening–night level (DENL) and their confidence intervals. The Journal of the Acoustical Society of America. [Online] 116 (1), 334–343. Available from: doi:10.1121/1.1755241.

219. Miedema, H.M.E. & Vos, H. (2007) Associations between self-reported sleep disturbance and environmental noise based on reanalyses of pooled data from 24 studies. Behavioral sleep medicine. [Online] 5 (1), 1–20. Available from: doi:10.1207/s15402010bsm0501_1.

220. Miedema, H.M.E. (2007) Annoyance Caused by Environmental Noise: Elements for Evidence-Based Noise Policies. Journal of Social Issues. [Online] 63 (1), 41–57. Available from: doi:10.1111/j.1540-4560.2007.

221. Miedema, H.M.E., Passchier-Vermeer, W. & Vos, H. (2003) Elements for a position paper on night-time transportation noise and sleep disturbance. TNO report 2002-59.

222. Miller, N.P., Nicholas, B., Gardner, R.C. & Anderson, G.S. (2011) Update of an alternative analysis of sleep awakening data. Noise Control Engineering Journal. [Online] 59 (6), 698. Available from: doi:10.3397/1.3630002.

223. Miyakawa, M., Matsui, T., Uchiyama, I., Hiramatsu, K., et al. (2008) Relationship between subjective health and disturbances of daily life due to aircraft noise exposure ― Questionnaire study conducted around Narita International Airport ―. In: 9th International Congress on Noise as a Public Helath Problem. 2008 p.

224. Morihara, T., Sato, T. & Yano, T. (2004) Comparison of dose-response relationships between railway and road traffic noises: the moderating effect of distance. Journal of Sound and Vibration. [Online] 277 (3), 559–565. Available from: doi:10.1016/j.jsv.2004.03.017.

225. Muer, T.D., Botteldooren, D. & Lercher, P. (2005) Event based noise annoyance modeling The notice-event model. In: Forum Acusticum 2005. 2005 pp. 1807–1812.

226. Murphy, E. & King, E. a (2010) Strategic environmental noise mapping: methodological issues concerning the implementation of the EU Environmental Noise Directive and their policy implications. Environment international. [Online] 36 (3), 290–298. Available from: doi:10.1016/j.envint.2009.11.006.

227. Murphy, E. & King, E. a. (2011) Scenario analysis and noise action planning: Modelling the impact of mitigation measures on population exposure. Applied Acoustics. [Online] 72 (8), 487–494. Available from: doi:10.1016/j.apacoust.2010.10.006.

228. Muzet, A. (2007) Environmental noise, sleep and health. Sleep Medicine Reviews. [Online] 11 (2), 135–142. Available from: doi:10.1016/j.smrv.2006.09.001.

229. Nadaraja, B., Wei, Y.X. & Abdullah, R. (2010) Effect of Traffic Noise on Sleep: A Case Study in Serdang Raya, Selangor, Malaysia. Environment Asia. 3149–155.

230. Ndrepepa, A. & Twardella, D. (2011) Relationship between noise annoyance from road traffic noise and cardiovascular diseases: A meta-analysis. Noise & health. [Online] 13 (52), 251–259. Available from: doi:10.4103/1463-1741.80163.

231. Niemann, H. & Maschke, C. (2004) WHO LARES. Final report. Noise effects and morbidity. p.1–20.

232. Nilsson, M.E. & Berglund, B. (2006) Noise annoyance and activity disturbance before and after the erection of a roadside noise barrier. The Journal of the Acoustical Society of America. [Online] 119 (4), 2178–2188. Available from: doi:10.1121/1.2169906.

233. Nilsson, M.E., Andéhn, M. & Leśna, P. (2008) Evaluating roadside noise barriers using an annoyance-reduction criterion. The Journal of the Acoustical Society of America. [Online] 124 (6), 3561–3567. Available from: doi:10.1121/1.2997433.

234. Oftedal, B., Aasvang, G.M., Biswas, R.T., Nafstad, P., et al. (2009) Exposure to long-term traffic noise, noise annoyance and blood pressure. Norsk Epidemiologi. 19 (Suppl 1), 51.

235. Ohrstrom, E. & Skånberg, A. (2004) Sleep disturbances from road traffic and ventilation noise-laboratory and field experiments. Journal of Sound and Vibration. [Online] 271 (1-2), 279–296. Available from: doi:10.1016/S0022-460X(03)00753-3.


236. Ohrstrom, E. (2004) Longitudinal surveys on effects of changes in road traffic noise—annoyance, activity disturbances, and psycho-social well-being. The Journal of the Acoustical Society of America. [Online] 115 (2), 719–729. Available from: doi:10.1121/1.1639333.

237. Ohrstrom, E. (2004) Longitudinal surveys on effects of changes in road traffic noise: effects on sleep assessed by general questionnaires and 3-day sleep logs. Journal of Sound and Vibration. [Online] 276 (3-5), 713–727. Available from: doi:10.1016/j.jsv.2003.08.038.

238. Ohrstrom, E., Barregård, L., Andersson, E., Skånberg, A., et al. (2007) Annoyance due to single and combined sound exposure from railway and road traffic. The Journal of the Acoustical Society of America. [Online] 122 (5), 2642–2652. Available from: doi:10.1121/1.2785809.

239. Öhrström, E., Hadzibajramovic, E., Holmes, M. & Svensson, H. (2006) Effects of road traffic noise on sleep: Studies on children and adults. Journal of Environmental Psychology. [Online] 26 (2), 116–126. Available from: doi:10.1016/j.jenvp.2006.06.004.

240. Ohrstrom, E., Skanberg, A., Svensson, H. & Gidlof-Gunnarsson, A. (2006) Effects of road traffic noise and the benefit of access to quietness. Journal of Sound and Vibration. [Online] 295 (1-2), 40–59. Available from: doi:10.1016/j.jsv.2005.11.034.

241. Olaosun, A.O., Ogundiran, O. & Tobih, J.E. (2009) Health hazards of noise: A review article. Research Journal of Medical Sciences. 3 (3), 115–122.

242. Ouis, D. (1999) Exposure to Nocturnal Road Traffic Noise: Sleep Disturbance and its After Effects. Noise & Health. 1 (4), 11–36.

243. Ouis, D. (2001) Annoyance from Road Traffic Noise: a Review. Journal of Environmental Psychology. [Online] 21 (1), 101–120. Available from: doi:10.1006/jevp.2000.0187.

244. Ouis, D. (2002) Annoyance Caused by Exposure to Road Traffic Noise: An Update. Noise & Health. 4 (15), 69–79.

245. Padungtod, C., Ekpanyaskul, C., Nuchpongsai, P., Laemun, N., et al. (2011) Aircraft Noise Exposure and Its Effects on Quality of Life and Cognitive Function Among Thai Residents. Epidemiology. [Online] 22S259. Available from: doi:10.1097/01.ede.0000392491.90419.d5.

246. Passchier-Vermeer, W. & Passchier, W.F. (2000) Noise exposure and public health. Environmental Health Perspectives. 108 (Supplement 1), 123–131.

247. Passchier-Vermeer, W. & Passchier, W.F. (2005) ENVIRONMENTAL NOISE, ANNOYANCE AND SLEEP DISTURBANCE. In: P Nicolopoulou-Stamati, L Hens, & C V Howard (eds.). Environmental Health Impacts of Transport and Mobility. Dordrecht, Springer. pp. 25–38.

248. Passchier-Vermeer, W., Vos, H., Janssen, S.A. & Miedema, H.M.E. (2007) Sleep and traffic noise.

249. Paunović, K., Stansfeld, S., Clark, C. & Belojević, G. (2011) Epidemiological studies on noise and blood pressure in children: Observations and suggestions. Environment international. [Online] 37 (5), 1030–1041. Available from: doi:10.1016/j.envint.2011.03.017.

250. Pawlaczyk-Luszczyńiska, M., Dudarewicz, A., Waszkowska, M., Szymczak, W., et al. (2005) The impact of low-frequency noise on human mental performance. International journal of occupational medicine and environmental health. 18 (2), 185–198.

251. Pawlaczyk-Luszczynska, M., Dudarewicz, A., Waszkowska, M., Szymczak, W., et al. (2005) Does low frequency noise at modarate levels influence human mental performance? Journal of low frequency noise vibration and active control. 24 (1), 25–42.

252. Pedersen, E. & Persson Waye, K. (2004) Perception and annoyance due to wind turbine noise—a dose–response relationship. The Journal of the Acoustical Society of America. [Online] 116 (6), 3460. Available from: doi:10.1121/1.1815091.

253. Pedersen, E. & Persson Waye, K. (2007) Wind turbine noise, annoyance and self-reported health and well-being in different living environments. Occupational and environmental medicine. [Online] 64 (7), 480–486. Available from: doi:10.1136/oem.2006.031039.

254. Pedersen, E. & Waye, K.P. (2008) Wind turbines—low level noise sources interfering with restoration? Environmental Research Letters. [Online] 3 (1), 015002. Available from: doi:10.1088/1748-9326/3/1/015002.

255. Pedersen, E. (2007) Human response to wind turbine noise. Goteborgs University.


256. Pedersen, E. (2011) Health aspects associated with wind turbine noise - Results from three field studies. Noise control engineering journal. 59 (1), 47–53.

257. Pedersen, E., van den Berg, F., Bakker, R. & Bouma, J. (2009) Response to noise from modern wind farms in The Netherlands. The Journal of the Acoustical Society of America. [Online] 126 (2), 634–643. Available from: doi:10.1121/1.3160293.

258. Pedersen, E., van den Berg, F., Bakker, R. & Bouma, J. (2010) Can road traffic mask sound from wind turbines? Response to wind turbine sound at different levels of road traffic sound. Energy Policy. [Online] 38 (5), 2520–2527. Available from: doi:10.1016/j.enpol.2010.01.001.

259. Phan, H.Y.T., Yano, T., Phan, H.A.T., Nishimura, T., et al. (2010) Community responses to road traffic noise in Hanoi and Ho Chi Minh City. Applied Acoustics. [Online] 71 (2), 107–114. Available from: doi:10.1016/j.apacoust.2009.08.004.

260. Pirrera, S., De Valck, E. & Cluydts, R. (2010) Nocturnal road traffic noise: A review on its assessment and consequences on sleep and health. Environment international. [Online] 36 (5), 492–498. Available from: doi:10.1016/j.envint.2010.03.007.

261. Pirrera, S., De Valck, E. & Cluydts, R. (2011) Nocturnal road traffic noise assessment and sleep research: The usefulness of different timeframes and in- and outdoor noise measurements. Applied Acoustics. [Online] 72 (9), 677–683. Available from: doi:10.1016/j.apacoust.2011.03.007.

262. Prasher, D. (2009) Is there evidence that environmental noise is immunotoxic? Noise & Health. [Online] 11 (44), 151–155. Available from: doi:10.4103/1463-1741.53361.

263. Quehl, J. & Basner, M. (2006) Annoyance from nocturnal aircraft noise exposure: Laboratory and field-specific dose – response curves. Journal of Environmental Psychology. [Online] 26127–140. Available from: doi:10.1016/j.jenvp.2006.05.006.

264. Raschke, F. (2004) Arousals and aircraft noise - environmental disorders of sleep and health in terms of sleep medicine. Noise & Health. 6 (22), 15–26.

265. Rhee, M.-Y., Kim, H.-Y., Roh, S.-C., Kim, H.-J., et al. (2008) The effects of chronic exposure to aircraft noise on the prevalence of hypertension. Hypertension research. [Online] 31 (4), 641–647. Available from: doi:10.1291/hypres.31.641.

266. Ristovska, G., Gjorgjev, D. & Pop Jordanova, N. (2004) Psychosocial effects of community noise: cross sectional study of school children in urban center of Skopje, Macedonia. Croatian medical journal. 45 (4), 473–476.

267. Ristovska, G., Gjorgjev, D., Polozhani, A., Kocubovski, M., et al. (2009) Environmental noise and annoyance in adult population of Skopje: a cross-sectional study. Arhiv za higijenu rada i toksikologiju. [Online] 60 (3), 349–355. Available from: doi:10.2478/10004-1254-60-2009-1945.

268. Ristovska, G., Gjorgjev, D., Stikova, E., Petrova, V., et al. (2009) Noise Induced Sleep Disturbance in Adult Population: Cross Sectional Study in Skopje Urban Centre. Journal of Medicine (Cincinnati). [Online] 2 (3), 255–260. Available from: doi:10.3889/MJMS.1857-5773.2009.0060.

269. Roberts, M. & Roberts, J. (2009) Evaluation of the Scientific Literature on the Health Effects Associated with Wind Turbines and Low Frequency Sound. p.1–58.

270. Rosenlund, M. (2001) Increased prevalence of hypertension in a population exposed to aircraft noise. Occupational and Environmental Medicine. [Online] 58 (12), 769–773. Available from: doi:10.1136/oem.58.12.769.

271. Rylander, R. & Bjorkman, M. (2002) ROAD TRAFFIC NOISE ANNOYANCE AND WINDOW ORIENTATION IN DWELLINGS. Journal of Sound and Vibration. [Online] 249 (4), 828–831. Available from: doi:10.1006/jsvi.2001.3745.

272. Rylander, R. (2006) Noise, stress, and annoyance. Noise and Vibration Worldwide.

273. Sandrock, S., Griefahn, B., Kaczmarek, T., Hafke, H., et al. (2008) Experimental studies on annoyance caused by noises from trams and buses. Journal of Sound and Vibration. [Online] 313 (3-5), 908–919. Available from: doi:10.1016/j.jsv.2007.12.003.

274. Saremi, M., Grenèche, J., Bonnefond, A., Rohmer, O., et al. (2008) Effects of nocturnal railway noise on sleep fragmentation in young and middle-aged subjects as a function of type of train and sound level. International journal of psychophysiology. [Online] 70 (3), 184–191. Available from: doi:10.1016/j.ijpsycho.2008.08.002.


275. Sasazawa, Y., Kawada, T., Kiryu, Y. & Suzuki, S. (2004) The relationship between traffic noise and insomnia among adult Japanese women. Journal of Sound and Vibration. [Online] 277 (3), 547–557. Available from: doi:10.1016/j.jsv.2004.03.016.

276. Sato, T. (2002) Comparison of Community Response To Road Traffic Noise in Japan and Sweden—Part I: Outline of Surveys and Dose–Response Relationships. Journal of Sound and Vibration. [Online] 250 (1), 161–167. Available from: doi:10.1006/jsvi.2001.3892.

277. Sato, T., Yano, T., Bjorkman, M. & Rylander, R. (1999) ROAD TRAFFIC NOISE ANNOYANCE IN RELATION TO AVERAGE NOISE LEVEL, NUMBER OF EVENTS AND MAXIMUM NOISE. Journal of Sound and Vibration. 223775–784.

278. Schapkin, S. a, Falkenstein, M., Marks, A. & Griefahn, B. (2006) Executive brain functions after exposure to nocturnal traffic noise: effects of task difficulty and sleep quality. European journal of applied physiology. [Online] 96 (6), 693–702. Available from: doi:10.1007/s00421-005-0049-9.

279. Schneider, E., Paoli, P. & Brun, E. (2005) Noise in figures. Risk observatory. Thematic report. p.1–116.

280. Schomer, P. (2001) A White Paper: Assessment of noise annoyance.

281. Schomer, P.D. (2002) On Normalizing DNL to Provide Better Correlation with Response. Sound And Vibration. (December), 14–23.

282. Schomer, P.D. (2005) Criteria for assessment of noise annoyance. Noise Control Engineering Journal. [Online] 53 (4), 125. Available from: doi:10.3397/1.2839251.

283. Schram-Bijkerk, D., van Kempen, E., Knol, a B., Kruize, H., et al. (2009) Quantitative health impact assessment of transport policies: two simulations related to speed limit reduction and traffic re-allocation in the Netherlands. Occupational and environmental medicine. [Online] 66 (10), 691–698. Available from: doi:10.1136/oem.2008.041046.

284. Schreckenberg, D. & Meis, M. (2007) Noise annoyance around an international airport planned to be extended. In: Proceedings of the 36th International Congress and Exhibition on Noise Control Engineering. 30 July 2007. Turkey.

285. Schreckenberg, D., Griefahn, B. & Meis, M. (2010) The associations between noise sensitivity, reported physical and mental health, perceived environmental quality, and noise annoyance. Noise & health. [Online] 12 (46), 7–16. Available from: doi:10.4103/1463-1741.59995.

286. Schreckenberg, D., Meis, M., Kahl, C., Peschel, C., et al. (2010) Aircraft noise and quality of life around Frankfurt Airport. International journal of environmental research and public health. [Online] 7 (9), 3382–3405. Available from: doi:10.3390/ijerph7093382.

287. Schust, M. (2004) Effects of low frequency noise up to 100 Hz. Noise & Health. 6 (23), 73–85.

288. Seabi, J., Goldschagg, P. & Cockcroft, K. (2010) Does Aircraft Noise Impair Learners’ Reading Comprehension, Attention and Working Memory? A Pilot Study. JOURNAL OF PSYCHOLOGY IN AFRICA. 20 (1), 101–104.

289. Seidman, M.D. & Standring, R.T. (2010) Noise and quality of life. International journal of environmental research and public health. [Online] 7 (10), 3730–3738. Available from: doi:10.3390/ijerph7103730.

290. Selander, J. (2010) Traffic Noise and Cardiovascular Disease. Karolinska Institutet.

291. Selander, J., Bluhm, G., Theorell, T., Pershagen, G., et al. (2009) Saliva cortisol and exposure to aircraft noise in six European countries. Environmental health perspectives. [Online] 117 (11), 1713–1717. Available from: doi:10.1289/ehp.0900933.

292. Selander, J., Nilsson, M.E., Bluhm, G., Rosenlund, M., et al. (2009) Long-term exposure to road traffic noise and myocardial infarction. Epidemiology. [Online] 20 (2), 272–279. Available from: doi:10.1097/EDE.0b013e31819463bd.

293. Shepherd, D., Welch, D., Dirks, K.N. & Mathews, R. (2010) Exploring the Relationship between Noise Sensitivity, Annoyance and Health-Related Quality of Life in a Sample of Adults Exposed to Environmental Noise. International Journal of Environmental Research and Public Health. [Online] 7 (10), 3579–3594. Available from: doi:10.3390/ijerph7103580.

294. Shield, B.M. & Dockrell, J.E. (2008) The effects of environmental and classroom noise on the academic attainments of primary school children. The Journal of the Acoustical Society of America. [Online] 123 (1), 133–144. Available from: doi:10.1121/1.2812596.


295. Smith, A., Nutt, D., Wilson, S. & Rich, N. (2002) Noise and insomnia: a study of community noise exposure, sleep disturbance , noise sensitivity.

296. Sobotova, L., Jurkovicova, J., Stefanikova, Z., Sevcikova, L., et al. (2010) Community response to environmental noise and the impact on cardiovascular risk score. Science of the Total Environment, The. [Online] 408 (6), 1264–1270. Available from: doi:10.1016/j.scitotenv.2009.12.033.

297. Sobotová, L., Jurkovicova, J., Stefanikova, Z., Sevcikova, L., et al. (2006) Community noise annoyance assessment in an urban agglomeration. Bratislavské lekárske listy. 107 (5), 214–216.

298. Sobotová, L., Jurkovicová, J., Voleková, J. & Aghová, L. (2001) Community noise annoyance risk in two surveys. International journal of occupational medicine and environmental health. 14 (2), 197–200.

299. Son, J.H., Park, S.J., Chang, S.I. & Lee, K. (2008) Differences in annoyance responses to combined noise from different region-classifications. In: 15th International Congress on Sound and Vibration. 2008 Korea, pp. 2225–2232.

300. Sørensen, M., Hvidberg, M., Andersen, Z.J., Nordsborg, R.B., et al. (2011b) Road traffic noise and stroke: a prospective cohort study. European heart journal. [Online] Available from: doi:10.1093/eurheartj/ehq466.

301. Sorensen, M., Hvidberg, M., Hoffmann, B., Andersen, Z.J., et al. (2011a) Exposure to road traffic and railway noise and associations with blood pressure and self-reported hypertension: a cohort study. Environmental health: a global access science source. [Online] 10 (1), 92. Available from: doi:10.1186/1476-069X-10-92.

302. Spreng, M. (2004) Noise induced nocturnal cortisol secretion and tolerable overhead flights. Noise & health. 6 (22), 35–47.

303. Stansfeld, S. & Crombie, R. (2011) Cardiovascular effects of environmental noise: research in the United Kingdom. Noise & health. [Online] 13 (52), 229–233. Available from: doi:10.4103/1463-1741.80159.

304. Stansfeld, S.A. & Matheson, M.P. (2003) Noise pollution: non-auditory effects on health. British Medical Bulletin. [Online] 68243–257. Available from: doi:10.1093/bmb/ldg033.

305. Stansfeld, S. a, Clark, C., Cameron, R.M., Alfred, T., et al. (2009) Aircraft and road traffic noise exposure and children’s mental health. Journal of Environmental Psychology. [Online] 29 (2), 203–207. Available from: doi:10.1016/j.jenvp.2009.01.002.

306. Stansfeld, S., Hygge, S., Clark, C. & Alfred, T. (2010) Night time aircraft noise exposure and children’s cognitive performance. Noise & health. [Online] 12 (49), 255–262. Available from: doi:10.4103/1463-1741.70504.

307. Stansfeld, S.A., Berglund, B., Clark, C., Lopez-Barrio, I., et al. (2005) Aircraft and road traffic noise and children’s cognition and health: a cross-national study. Lancet. 3651942–1949.

308. Stansfeld, S.A., Haines, M.M., Berry, B. & Burr, M. (2009) Reduction of road traffic noise and mental health: an intervention study. Noise & health. [Online] 11 (44), 169–175. Available from: doi:10.4103/1463-1741.53364.

309. Stosić, L., Belojević, G. & Milutinović, S. (2009) Effects of traffic noise on sleep in an urban population. Arhiv za higijenu rada i toksikologiju. [Online] 60 (3), 335–342. Available from: doi:10.2478/10004-1254-60-2009-1962.

310. Sushama, S. (2011) A study to assess the Noise Pollution and its effect on quality of life on the people of Indore City. Research journal of chemistry and environment. 15 (2), 1006–1009.

311. Swift, H. (2010) A Review of the Literature Related to Potential Health Effects of Aircraft Noise. PARTNER Project 19 Final report.

312. Tassi, P., Rohmer, O., Schimchowitsch, S., Eschenlauer, A., et al. (2010) Living alongside railway tracks: Long-term effects of nocturnal noise on sleep and cardiovascular reactivity as a function of age. Environment international. [Online] 36 (7), 683–689. Available from: doi:10.1016/j.envint.2010.05.001.

313. Tokuyama, T., Matsui, T., Hiramatsu, K., Miyakita, T., et al. (2009) Effects of Aircraft Noise on Preschool Children’s Misbehaviours: Results of Research around the Kadena and Futenma Airfields in Okinawa. Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene). [Online] 64 (1), 14–25. Available from: doi:10.1265/jjh.64.14.


314. Tominsek, J. & Bilban, M. (2011) The influence of noise on cardiovascular diseases. Zdravstveni Vestnik. 80 (5), 395–404.

315. Trentinaglia, I., Hörmann, A., Wichmann, H.E., D, P., et al. (2004) Exposure to Traffic and the Onset of Myocardial Infarction. The New England Journal of Medicine. 351 (17), 1721–1730.

316. Van Gerven, P.W.M., Vos, H., Van Boxtel, M.P.J., Janssen, S.A., et al. (2009) Annoyance from environmental noise across the lifespan. The Journal of the Acoustical Society of America. [Online] 126 (1), 187–194. Available from: doi:10.1121/1.3147510.

317. van Kamp, I., Job, R.F.S., Hatfield, J., Haines, M., et al. (2004) The role of noise sensitivity in the noise–response relation: A comparison of three international airport studies. The Journal of the Acoustical Society of America. [Online] 116 (6), 3471. Available from: doi:10.1121/1.1810291.

318. van Kempen, E., van Kamp, I., Fischer, P., Davies, H., et al. (2006) Noise exposure and children’s blood pressure and heart rate:the RANCH project. Occupational and Environmental Medicine. 63632–639.

319. van Kempen, E., van Kamp, I., Lebret, E., Lammers, J., et al. (2010) Neurobehavioral effects of transportation noise in primary schoolchildren: a cross-sectional study. Environmental health: a global access science source. [Online] 925. Available from: doi:10.1186/1476-069X-9-25.

320. van Kempen, E., van Kamp, I., Nilsson, M., Lammers, J., et al. (2010) The role of annoyance in the relation between transportation noise and children’s health and cognition. The Journal of the Acoustical Society of America. [Online] 128 (5), 2817–2828. Available from: doi:10.1121/1.3483737.

321. van Kempen, E.E.M.M., Kruize, H., Boshuizen, H.C., Ameling, C.B., et al. (2002) The association between noise exposure and blood pressure and ischemic heart disease: a meta-analysis. Environmental health perspectives. 110 (3), 307–317.

322. van Kempen, E.E.M.M., van Kamp, I., Stellato, R.K., Lopez-Barrio, I., et al. (2009) Children’s annoyance reactions to aircraft and road traffic noise. The Journal of the Acoustical Society of America. [Online] 125 (2), 895–904. Available from: doi:10.1121/1.3058635.

323. Van Wiechen, C.M.A.G., Franssen, E.A.M., de Jong, P.E. & Lebret, E. (2002) Aircraft noise exposure from schiphol airport: a relation with complainants. Noise & Health. 5 (17), 23–34.

324. Vincent, B., Vallet, M., Olivier, D. & Paque, G. (2000) Evaluation of variations of the annoyance due to aircraft noise. In: Inter-Noise 2000. 2000 Nice. pp. 1–4.

325. Wagner, J., Cik, M., Marth, E., Santner, B.I., et al. (2010) Feasibility of testing three salivary stress biomarkers in relation to naturalistic traffic noise exposure. International journal of hygiene and environmental health. [Online] 213 (2), 153–155. Available from: doi:10.1016/j.ijheh.2009.08.004.

326. Whitfield, a (2003) Assessment of noise annoyance in three distinct communities living in close proximity to a UK regional airport. International journal of environmental health research. [Online] 13 (4), 361–372. Available from: doi:10.1080/0960312031000122451.

327. WHO (2005) Quantifying burden of disease from environmental noise: Second technical meeting report.

328. WHO (2009) Night noise guidelines for Europe. p.1–162.

329. WHO (2011) Burden of disease from environmental noise. p.1–106.

330. Willich, S.N., Wegscheider, K., Stallmann, M. & Keil, T. (2006) Noise burden and the risk of myocardial infarction. European heart journal. [Online] 27 (3), 276–282. Available from: doi:10.1093/eurheartj/ehi658.

331. Yano, T. (2005) Community response to Shinkansen noise and vibration: a survey in areas along the Sanyo Shinkansen Line. In: Forum Acusticum 2005. Budapest. pp. 1837–1841.

332. Zaharna, M. & Guilleminault, C. (2010) Sleep, noise and health: Review. Noise & Health. [Online] 12

(47), 64–69. Available from: doi:10.4103/1463-1741.6


Appendix 4 - Extracts from Literature for Table 4.1

Link 1

From H Davies and I van Kamp. 2011. Noise and cardiovascular disease: a review of the literature 2008-2011.ICBEN 2011 Results regarding effect levels (thresholds) were fairly consistent. For hypertension lowest observable effect

levels (LOAEL, for road traffic noise) were reported at between 50 dBA (LAeq,24hr Jarup et al. 2008) and 60

dBA (LAeq,24hr Barregard et al. 2009; Bodin et al. 2009); response to noise at night was seen at lower levels:

45 dBA (LAeq, night) Belojevic et al. 2008) and 40-44 dBA (Jarup et al. 2008). Heart disease responses were seen

as low as 50 dBA ((LAeq,24hr Selander et al. 2009a, b) to 65 or 70 dBA (LDEN Gan et al. 2011a; Beelen et al.

2009). Eriksson et al. 2010 and Huss et al (2010) both identified LOAEL for aircraft related noise for HT (LDEN)

and AMI (LDN) respectively, at 60 dBA.

Back To Table


Link 2

Effect Dimension Acoustic indicator *

Threshold ** Time domain

Annoyance disturbance

Psychosocial, quality of life

Lden 42 Chronic


Quality of life, somatic health

Lnight 42 Chronic

Learning, memory Performance Leq 50 Acute, chronic

Stress hormones Stress indicator

Lmax Leq

NA Acute, chronic

Sleep (polysomnographic)

Arousal, motility, sleep quality

Lmax, indoors 32 Acute, chronic

Reported awakening

Sleep SELindoors 53 Acute

Reported health Well-being clinical health

Lden 50 Chronic

Hypertension Physiology somatic health

Lden 50 Chronic

Ischaemic heart diseases

Clinical health Lden 60 Chronic

Note: * Lden and Lnight are defined as outside levels. Lmax may be either internal or external as indicated. ** Level above which effects start to occur or start to rise above background.

From: EEA 2010 . Good Practice guide on noise exposure and potential effects. EEA Technical Report 11/2010 Table 2.1 EEA

Back to Table


Link 3

The EEA 2010 report also contains a comparison of Lden limit values across 14 EU countries

Further enquiries were made to Martin van den Berg in the Netherlands who edited the report for the EEA. He

provided a useful more detailed MSExcel file with the limit values sorted by country and by noise source. He noted

however that there is no information on how these values were derived, or how they are used in practice.

Back to Table


Link 4

From; Environmental Noise and Health: A Review. ERCD CAA REPORT 0907. February 2010.

Back to Table


Link 5

From; Environmental Noise and Health: A Review. ERCD REPORT 0907. February 2010.

Back to Table


Link 6

From WHO NNG

Back to Table



From HPA Report 2009

Back to Table


Appendix 5 - Papers published after 2006: noise and cardiovascular disease (inc. hypertension)

1. Dratva, J., Phuleria, H.C., Foraster, M., Gaspoz, J.-M., et al. (2012) Transportation noise and blood pressure in a population-based sample of adults. Environmental health perspectives. [Online] 120 (1), 50–55. Available from: doi:10.1289/ehp.1103448.

2. La Torre, G., Coniglione, D., Scagliosi, A., Ciocci, G., et al. (2011) [Exposure to noise in the general population and hypertension: results from a pilot case-control study in Rome]. Annali di igiene : medicina preventiva e di comunità. 23 (3), 209–217.

3. Sorensen, M., Hvidberg, M., Hoffmann, B., Andersen, Z.J., et al. (2011a) Exposure to road traffic and railway noise and associations with blood pressure and self-reported hypertension: a cohort study. Environmental health: a global access science source. [Online] 10 (1), 92. Available from: doi:10.1186/1476-069X-10-92.

4. Sørensen, M., Hvidberg, M., Andersen, Z.J., Nordsborg, R.B., et al. (2011b) Road traffic noise and stroke: a prospective cohort study. European heart journal. [Online] Available from: doi:10.1093/eurheartj/ehq466.

5. Tominsek, J. & Bilban, M. (2011) The influence of noise on cardiovascular diseases. Zdravstveni Vestnik. 80 (5), 395–404.

6. Paunović, K., Stansfeld, S., Clark, C. & Belojević, G. (2011) Epidemiological studies on noise and blood pressure in children: Observations and suggestions. Environment international. [Online] 37 (5), 1030–1041. Available from: doi:10.1016/j.envint.2011.03.017.

7. Babisch, W. (2011) Cardiovascular effects of noise. Noise & health. [Online] 13 (52), 201–204. Available from: doi:10.4103/1463-1741.80148.

8. Belojevic, G., Paunovic, K., Jakovljevic, B., Stojanov, V., et al. (2011) Cardiovascular effects of environmental noise: research in Serbia. Noise & health. [Online] 13 (52), 217–220. Available from: doi:10.4103/1463-1741.80156.

9. Bluhm, G. & Eriksson, C. (2011) Cardiovascular effects of environmental noise: research in Sweden. Noise & health. [Online] 13 (52), 212–216. Available from: doi:10.4103/1463-1741.80152.

10. Kempen, E. van (2011) Cardiovascular effects of environmental noise: research in The Netherlands. Noise & health. [Online] 13 (52), 221–228. Available from: doi:10.4103/1463-1741.80158.

11. Lercher, P., Botteldooren, D., Widmann, U., Uhrner, U., et al. (2011) Cardiovascular effects of environmental noise: Research in Austria. Noise and Health. [Online] 13 (52), 234. Available from: doi:10.4103/1463-1741.80160.

12. Maschke, C. (2011) Cardiovascular effects of environmental noise: Research in Germany. Noise & health. [Online] 13 (52), 205–211. Available from: doi:10.4103/1463-1741.80150.

13. Stansfeld, S. & Crombie, R. (2011) Cardiovascular effects of environmental noise: research in the United Kingdom. Noise & health. [Online] 13 (52), 229–233. Available from: doi:10.4103/1463-1741.80159.

14. Chang, T.-Y., Liu, C.-S., Bao, B.-Y., Li, S.-F., et al. (2010) Characterization of road traffic noise exposure and prevalence of hypertension in central Taiwan. The Science of the total environment. [Online] Available from: doi:10.1016/j.scitotenv.2010.11.039.

15. Haralabidis, A.S., Dimakopoulou, K., Velonaki, V., Barbaglia, G., et al. (2010) Can exposure to noise affect the 24 h blood pressure profile? Results from the HYENA study. Journal of epidemiology and community health. [Online] 1–7. Available from: doi:10.1136/jech.2009.102954.

16. Eriksson, C., Bluhm, G., Hilding, A., Ostenson, C.-G., et al. (2010) Aircraft noise and incidence of hypertension-Gender specific effects. Environmental research. [Online] 110764–772. Available from: doi:10.1016/j.envres.2010.09.001.

17. Lepore, S.J., Shejwal, B., Kim, B.H. & Evans, G.W. (2010) Associations between chronic community noise exposure and blood pressure at rest and during acute noise and non-noise stressors among urban school children in India. International journal of environmental research and public health. [Online] 7 (9), 3457–3466. Available from: doi:10.3390/ijerph7093457.


18. Babisch, W. (2010) Noise sensitivity in cardiovascular noise studies. In: Proceedings of the 39th International Congress on Noise Control Engineering. 2010 Lisbon,

19. Sobotova, L., Jurkovicova, J., Stefanikova, Z., Sevcikova, L., et al. (2010) Community response to environmental noise and the impact on cardiovascular risk score. Science of the Total Environment, The. [Online] 408 (6), 1264–1270. Available from: doi:10.1016/j.scitotenv.2009.12.033.

20. Huss, A., Spoerri, A., Egger, M. & Röösli, M. (2010) Aircraft Noise, Air Pollution, and Mortality from Myocardial Infarction. Epidemiology. [Online] 21 (6), 829–836. Available from: doi:10.1097/EDE.0b013e3181f4e634.

21. Selander, J. (2010) Traffic Noise and Cardiovascular Disease. Karolinska Institutet.

22. Asuquo, U.E., Onuu, M.U., Akpan, A.O. & Asuquo, A.U. (2009) Noise and Blood Pressure: a Cross Sectional and Longitudinal Study of the Effects of Exposure to Loud Noise on Residents in Calabar , Cross River State, Nigeria. International Journal of Acoustics and Vibration. 14 (2), 56–69.

23. Babisch, W., Neuhauser, H., Thamm, M. & Seiwert, M. (2009) Blood pressure of 8 – 14 year old children in relation to traffic noise at home — Results of the German Environmental Survey for Children (GerES IV). Science of the Total Environment. [Online] 407 (22), 5839–5843. Available from: doi:10.1016/j.scitotenv.2009.08.016.

24. Bodin, T., Albin, M., Ardö, J., Stroh, E., et al. (2009) Road traffic noise and hypertension: results from a cross-sectional public health survey in southern Sweden. Environmental health: a global access science source. [Online] 838. Available from: doi:10.1186/1476-069X-8-38.

25. Babisch, W. & Kamp, I.V. (2009) Exposure-response relationship of the association between aircraft noise and the risk of hypertension. Noise & Health. [Online] 11 (44), 161–168. Available from: doi:10.4103/1463-1741.53363.

26. Barregard, L., Bonde, E. & Ohrström, E. (2009) Risk of hypertension from exposure to road traffic noise in a population-based sample. Occupational and environmental medicine. [Online] 66 (6), 410–415. Available from: doi:10.1136/oem.2008.042804.

27. Beelen, R., Hoek, G., Houthuijs, D., Brandt, P.A.V.D., et al. (2009) The joint association of air pollution and noise from road traffic with cardiovascular mortality in a cohort study. Occupational and Environmental Medicine. [Online] 66243–250. Available from: doi:10.1136/oem.2008.042358.

28. Hoffmann, B., Moebus, S., Dragano, N., Möhlenkamp, S., et al. (2009) Residential traffic exposure and coronary heart disease: results from the Heinz Nixdorf Recall Study. Biomarkers. [Online] 14 (Suppl 1), 74–78. Available from: doi:10.1080/13547500902965096.

29. Oftedal, B., Aasvang, G.M., Biswas, R.T., Nafstad, P., et al. (2009) Exposure to long-term traffic noise, noise annoyance and blood pressure. Norsk Epidemiologi. 19 (Suppl 1), 51.

30. Chang, T.-yuan, Lai, Y.-an, Hsieh, H.-hui, Lai, J.-shoung, et al. (2009) Effects of environmental noise exposure on ambulatory blood pressure in young adults. Environmental Research. [Online] 109 (7), 900–905. Available from: doi:10.1016/j.envres.2009.05.008.

31. Selander, J., Nilsson, M.E., Bluhm, G., Rosenlund, M., et al. (2009) Long-term exposure to road traffic noise and myocardial infarction. Epidemiology. [Online] 20 (2), 272–279. Available from: doi:10.1097/EDE.0b013e31819463bd.

32. Graham, J.M.A., Janssen, S.A., Vos, H. & Miedema, H.M.E. (2009) Habitual traffic noise at home reduces cardiac parasympathetic tone during sleep. International journal of psychophysiology. [Online] 72 (2), 179–186. Available from: doi:10.1016/j.ijpsycho.2008.12.004.

33. Greiser, E., Janhsen, K. & Greiser, C. (2008) Night-time aircraft noise leads to increased prescription volumes of antihypertensive and cardiovascular drugs – the Cologne-Bonn Airport Study.

34. Babisch, W. (2008a) Road traffic noise and cardiovascular risk. Noise & Health. 10 (38), 27–33.

35. Babisch, W. (2008b) Associations between road traffic noise level, road traffic noise annoyance and high blood pressure in the HYENA study. In: Proceedings of Acoustics’08 Paris. 2008 Paris, pp. 3365–3370. Available from: doi:10.1121/1.2934267.

36. Davies, H. & Kamp, I.V. (2008) Environmental noise and cardiovascular disease: Five year review and future directions. In: ICBEN 2008. 2008 Foxwoods,


37. Jarup, L., Babisch, W., Houthuijs, D., Pershagen, G., et al. (2008) Hypertension and exposure to noise near airports: the HYENA study. Environmental health perspectives. [Online] 116 (3), 329–333. Available from: doi:10.1289/ehp.10775.

38. Belojević, G. a, Jakovljević, B.D., Stojanov, V.J., Slepcević, V.Z., et al. (2008a) Nighttime road-traffic noise and arterial hypertension in an urban population. Hypertension research: official journal of the Japanese Society of Hypertension. [Online] 31 (4), 775–781. Available from: doi:10.1291/hypres.31.775.

39. Haralabidis, A.S., Dimakopoulou, K., Vigna-taglianti, F., Giampaolo, M., et al. (2008) Acute effects of night-time noise exposure on blood pressure in populations living near airports. European Heart Journal. [Online] 29658–664. Available from: doi:10.1093/eurheartj/ehn013.

40. Rhee, M.-Y., Kim, H.-Y., Roh, S.-C., Kim, H.-J., et al. (2008) The effects of chronic exposure to aircraft noise on the prevalence of hypertension. Hypertension research. [Online] 31 (4), 641–647. Available from: doi:10.1291/hypres.31.641.

41. Belojevic, G., Jakovljevic, B., Vesna, S., Paunovic, K., et al. (2008b) Urban road-traffic noise and blood pressure and heart rate in preschool children. Environment international. [Online] 34 (2), 226–231. Available from: doi:10.1016/j.envint.2007.08.003.

42. Jarup, L., Babisch, W., Houthuijs, D., Pershagen, G., et al. (2008) Acute and Long-Term Effect On Blood Pressure Of Exposure To Noise Near Airports - The HYENA Study. In: Internoise 2008. 2008.

43. Greiser, E., Greiser, C. & Janhsen, K. (2007) Night-time aircraft noise increases prevalence of prescriptions of antihypertensive and cardiovascular drugs irrespective of social class—the Cologne-Bonn Airport study. Journal of Public Health. [Online] 15 (5), 327–337. Available from: doi:10.1007/s10389-007-0137-x.

44. Babisch, W., Houthuijs, D., Velonakis, M., Cadum, E., et al. (2007) Association between noise annoyance and high blood pressure. Preliminary results from the HYENA study. In: Inter-Noise 2007. [Online]. July 2007 Istambul,. pp. 161–161. Available from: doi:10.1260/135101007781447993.

45. Bluhm, L.G., Berglind, N., Nordling, E. & Rosenlund, M. (2007) Road traffic noise and hypertension. Occupational and environmental medicine. [Online] 64 (2), 122–126. Available from: doi:10.1136/oem.2005.025866.

46. Eriksson, C., Rosenlund, M., Pershagen, G., Hilding, A., et al. (2007) Aircraft noise and incidence of hypertension. Epidemiology. [Online] 18 (6), 716–721. Available from: doi:10.1097/EDE.0b013e3181567e77.

47. de Kluizenaar, Y., Gansevoort, R.T., Miedema, H.M.E. & de Jong, P.E. (2007) Hypertension and road traffic noise exposure. Journal of occupational and environmental medicine. [Online] 49 (5), 484–492. Available from: doi:10.1097/JOM.0b013e318058a9ff.

48. van Kempen, E., van Kamp, I., Fischer, P., Davies, H., et al. (2006) Noise exposure and children’s blood pressure and heart rate:the RANCH project. Occupational and Environmental Medicine. 63632–639.

49. Willich, S.N., Wegscheider, K., Stallmann, M. & Keil, T. (2006) Noise burden and the risk of myocardial infarction. European heart journal. [Online] 27 (3), 276–282. Available from: doi:10.1093/eurheartj/ehi658.

Additional papers that were identified but not considered for data extcation:

Tassi, P., Rohmer, O., Schimchowitsch, S., Eschenlauer, A., et al. (2010) Living alongside railway tracks: Long-term effects of nocturnal noise on sleep and cardiovascular reactivity as a function of age. Environment international. [Online] 36 (7), 683–689. Available from: doi:10.1016/j.envint.2010.05.001.

Aydin, Y. & Kaltenbach, M. (2007) Noise perception, heart rate and blood pressure in relation to aircraft noise in the vicinity of the Frankfurt airport. Clinical research in cardiology: official journal of the German Cardiac Society. [Online] 96 (6), 347–358. Available from: doi:10.1007/s00392-007-0507-y.

Black, D., Black, J., Issarayangyun, T. & Samuels, S. (2007) Aircraft noise exposure and resident’s stress and hypertension: A public health perspective for airport environmental management. Journal of Air Transport Management. [Online] 13 (5), 264–276. Available from: doi:10.1016/j.jairtraman.2007.04.003.


Appendix 6 - Papers related to noise and cardiovascular disease published after 2006 (in bold if considered)

Refere

nce Study design

(number of participant

s)

Noise exposure assessment (M-

measured, C-

calculated)

Noise source

Noise exposure

(DI - dichotomus, CA-

categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)

Type of outcome (O-objectively

measured, S-subjective)

Effect size (DI - noise given as dichotomous

variable, CA - noise given as

categorical variable, CO - noise

given as continuous

variable)

Statistics Exposure-response curve (Y-yes, N-no)

Thres-hold

identified (Y-yes, N-

no)

Confounding factors (Y-yes,

N-no)

Conclusion

Dratva et al. 2012

cohort (6450)

C - Lday, Lnight (dbA)

railway and

traffic

CO Lday,traffic=51 ,

Lnight,traffic=39, Lday,rail=

19, Lnight,rail=17

O - blood pressure, S - hypertension

for a 10 dB(A) increase in Lnight, rail

SBP β = 0.84 (95% CI: 0.22, 1.46); DBP β = 0.44 (95% CI:

0.06, 0.81) and 10 dB(A) change in Lday SBP β = 0.60

(95% CI: 0.07, 1.13)

logistic regression

for hypertension and noise,

mixed linear regression model for

association between BP and noise

N N Y Increase in railway noise

was significantly associated with

BP, with stronger

associations for night-time than

for daytime railway noise.

Significant associations

with traffic noise were seen only

among participants with

diabetes La

Torre et al. 2011

case-control (241)

C - LAeq Traffic DI <65, ≥65 <65 O - blood pressure

OR = 2.09 (95% CI: 1.01 - 4.47,

p=0.049)

multivariate logistic

regression

N N Y Noise exposure (>65 dB(A)) was

directly associated with hypertension


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Søren sen et

al. 2011b

cohort (44083)

C - Lden,

road, LAeq,24h,

rail

road traffic and

railway

DI (rail) and CA (road)

CA: < 55, 55-65,

>65; DI: <60, >60

<55 for road

traffic, <60 for rail

O- blood pressure; S - hypertension

CO - 0.26 Hgmm higher systolic BP

per 10 dB(A) increment in road

traffic noise; IRR=1.02 (95%CI: 0.95-1-10) per 10 dB increment in

road traffic in relation to

hypertension; DI - 8% greater

risk of hypertension above 60 dB railway noise (95% CI: -2%;

19%, P = 0.11) as compared with

those exposed to <60 dB

linear regression - road traffic and railway noise and

BP at enrolment,

Cox regression - incident self-

reported hypertension

N N Y Long-term exposure to road traffic

noise (>55 dBA) was weakly

associated with a higher systolic BP but not self-

reported hypertension. Railway noise

>60 dBA increased the risk though

insignificantly of hypertension compared to

those exposed to < 60 dBA.

Sørensen et

al. 2011a

prospective cohort (57053)

C - Laeq , Lden

road traffic

CA and CO

CA: <55, 55-58, 58-61, 61-64, 64-68, 68-

73, >73 CO: 40-82

<55 Lden O - stroke CO - IRR 1.14 (95% CI: 1.03–1.25) for stoke per 10 dB Lden

increment (above 64.5 years of age, the IRR was 1.23

(95% CI: 1.09–1.39) and below

64.5 years of age, the IRR was 1.01

(95% CI: 0.89–1.15). (IRR

railway: 1.04; 95% CI: 0.92–1.17 and IRR airport:

0.73; 95% CI: 0.39–1.37)

CA - see graph

Cox regression

model

Y Y (60 dB)

Y Road traffic noise

increases the risk of stroke

(when noise is >60 dB for

subjects >64.5 years and

when noise is >73 dB for the

age group <64.5 years) compared to

those exposed to < 55 dBA

Lden. Exposure to railway and airport noise

was not associated

with a higher risk for stroke .


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Chang et al. 2010

cross-sectional

(820)

M - LAeq,8h

road traffic

CA and CO

DI: low exposure

group (77.2±1.6) and high exposure

group (82.2±1.7) CA: <77,

77-80, 80-83, >83

DI: low exposure

group, CA: <77

S - hypertension

DI: in high exposure group

adjOR=2.15 (95% CI=1.08–4.26) for

hypertension compared to low exposed group, CA: OR=1.62, (95%CI= 1.11-

2.36, p=0.0013) per 3dBA increment

logistic regression

Y Y (80 dB

when ref

category is <77 dB)

Y Residents who were exposed to road traffic noise 80-83

dBA and <83 dBA had a 4.14 and 7.62 fold

risk of hypertension

than those who exposed <77

dBA

Haralabidis et al. 2010

cross sectional

(149)

C - LAeq

24 h, Lnight, Lmax,

SEL; M -LAeq, night

aircraft and road

traffic

CO Air: 39-55 LAeq,24h, Road 43-51 LAeq, 24h

? O - BP dipping

5 dB increase in measured road

traffic noise during the study night is associated with

0.8% (-1.55, -0.05) less dipping in diastolic BP.

Modelled long -term noise

exposure was not associated with

BP dipping during the study night.

multiple linear

regression

N N Y Road traffic noise exposure

may be associated with a decrease in dipping. Noise from aircraft

was not found to affect dipping in a consistent

way across centres and indoor noise

was not associated with

dipping. Erikkson et

al. 2010

cohort (4721, 8-10 years follow-up) Stockholm Diabetes

C - Lden aircraft DI and CA

DI: <50, ≥50; CA: <50; 50–

54; 55–59; ≥60

<50 dBA O - hypertension

DI=adjRR of 1.02 (95% CI 0.90–

1.15) for subjects exposed to ≥50

dBA in comparison to the reference group.

RR= 1.42 (95% CI 1.11–1.82) for

subjects reporting annoyance CA: Only

significant for males RR= 1.94

(0.66–5.65) when ≥60 dB.

generalized linear model

N N Y No increased risk for

hypertension was found

among subjects exposed to

aircraft noise >50 dBA Lden

except for men not using

tobacco and for annoyed subjects


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

CO: after exclusion of smokers, a

significant risk increase per 5

dB(A) was found in men, RR=1.21 (1.05–1.39) but not in women

Lepore et al. 2010

quasi-experimental (189)

M - ? traffic DI peak at noisy

area: 82, quiet area:

65

O - blood pressure

N N Y children in the noisy school

tended to have lower blood

pressure than children in the quiet school, noisy-school children had lower SBP

reactivity than quiet-school

children Sobotova et

al. 2010

case-control (659

subjects)

M - Leq, 24h, C -

Lden

road traffic

DI noisy area:

Leq,24 h=67±2

(Lden=66±2), quiet area:

Leq,24 h=58.7±6 (Lden=56±4

)

quiet area O - blood pressure,

cardiovascular risk score (Faringham)

SBP OR=1.16 (95% CI=0.75–1.78) and DBP OR=1.13 (95%

CI=0.60–2.11) in the exposed group

(sleep (awakening)

OR=1.66, 95% CI=1.23–2.45,

annoyance ORMH=5.15, 95% CI=4.11–6.97); Cardiovascular

risk scores OR=1.69 (95% CI=1.08–2.65) projected to the

age of 60

multiple logistic

regression

N N Y cardiovascular risk scores

projected to the age of 60 were

significantly higher for

exposed group


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Huss et al. 2010

cohort (4.6

million)

C - LdnA

aircraft CA <45, 45–49, 50–54,

55–59, and ≥60

<45 O - myocardial infarction,

stroke

adjusted hazard ratio comparing >60 dB(A) with <45 dB(A) was

1.3 (95% IC=0.96–1.7)

overall, and 1.5 (1.0–2.2) in

persons who had lived at the same place for at least

15 years

Cox proportiona

l hazard model

N N Y Statistically significant

associations with

myocardial infarction with aircraft noise ≥60 vs. <45 dB in subgroup

living in same place for 15+

years. No associations

with circulatory disease or

stoke.

Asuquo et al. 2009

cross-sectional

(2000) and longitudina

l (15)

M - Laeq DI <80, >80 <80 O and S - blood

pressure

Babisch et al. 2009

cross sectional (1048)

M - LASm,

LASmax, and

Lapeak, C -

subjective rating of traffic

flow

road traffic

CO Leq,15min=27 to

86dB(A)

O - blood pressure

blood pressure increases of

1.0mm Hg (95% CI: 0.3 to 1.6, p=0.004) and

0.6mmHg (95% CI: 0.1 to 1.2,

p=0.025), respectively, per

10dB(A)

descriptive analyses

N N Y children who are exposed to high levels of road

traffic noise may have higher

blood pressure

Bodin et al. 2009

cross-sectional (24238)

C - Laeq,24h

road traffic

CA <45, 45-49, 50-54, 55-59, 60-

64, >64

<45 S - hypertension

CA: hypertension OR≈1.1 (for 45 -64

dBA and OR= 1.45 (95% CI 1.04

- 2.02) for >64 dBA CO:

OR=1.06(95% CI 1.00-1.13) per 10 dBA increment

logistic regression

N N Y Road traffic noise at high

average levels (>60 dB)

associated with self-reported

hypertension in middle-aged (40 - 59 years old) compared to

those exposed to <45 dBA


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Babisch and Kamp 2009

review and meta-analysis

aircraft S and O - hypertension

OR=1.13 (95% IC 1.00 - 1.28) per 10 dBA range = 45-

70 dB(A)

Barregard,

Bonde &

Ohrström

2009


C - Laeq,24h

road traffic, railway

CA 45-50, 51-55, 56-60, 61-70, >70

45–50 dB S - hypertension

, use of antihypertensive drugs

Hypertension OR= 1.1 (95%CI 0.8-

1.6) and antihypertensive drugs OR=1.3

(95% CI 0.9-1.9) in highest noise

(56-70 dBA) category

compared to lowest category

BUT! for>10 years of latency, the OR for hypertension was 1.9 (95% CI 1.1 to 3.5) in the

highest noise category (56-70

dBA) and 3.8 (95% CI 1.6 to

9.0) in men. The incidence rate ratio was increased in this group of men,

and the relative risk of

hypertension in a Poisson

regression model was 2.9 (95% CI

1.4 to 6.2)

Poisson and Cox

regression

N N Y road traffic noise (LAeq,24h

>55 dBA) increases the

risk of hypertension in men compared to <50 DBA. A trend towards an exposure–

response relationship was

statistically significant

(p=0.03) for antihypertensive

drugs


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Beelen et al.

2009

cohort (120852)

C - LAeq road traffic

CA and CO

CO: 29–75

CA: 50-55, 55-60, 60-65, >65

≤ 50 O - cardiovasc

ular mortality

RR for IHD=1.15 (95% CI 0.86 -

1.53) and heart failure mortality RR=1.99 (95% CI 1.05-3.79) for >65 dB(A). BUT! after

adjustment for black smoke

concentrations and traffic

intensity, traffic noise risks estimates

became unity (RR=1.01) for IHD

mortality, and RR=1.90 for heart failure mortality

Cox propor- tional

hazards model

N N y traffic noise above 65 dB(A)

were associated

with specific cardiovascular

causes of death

compared to those exposed

to ≤ 50 dBA

Chang et al. 2009

panel study (60)

M - Leq and

TWA of noise

exposures

traffic CO LAeq, day=56.6±

16.5, LAeq,

night=49.0±14.2

O - blood pressure

per 5-dBA increment in 24-h

average environmental noise exposure

significantly increased

averages of 1.43mmHg in SBP and 1.40mmHg in

DBP among all subjects.

Increments of 24-h ambulatory SBP

and DBP induced by a 5-dBA

increase were higher in females (1.65 [1.36–1.94] mmHg and 1.51

[1.27–1.75] mmHg) than in

males (1.15 [0.76–1.54]mmHg and

1.27 [0.96–1.58]mmHg).

linear mixed-effects

regression

N N Y environmental noise

(LAeq,24h=of 56.6±16.5dBA) is associated

with the elevations of ambulatory

blood pressure in young adults

aged 18–32 years. Young females are

more susceptible to

noise.


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Selander et

al. 2009

case-control (3666)

C - LAeq,24

h

road traffic

DI and CA

DI: <50, ≥50;

CA: <50, 50-54, 55-

59, ≥60

<50 O - myocardial infarction

DI: OR for MI= 1.12 (95% CI

0.95–1.33) for ≥50 dBA

CA: OR for MI=1.15-1.21 for

exposure categories ≥50 dBA (95% CI:

0.81-1.77). When excluding

persons with hearing loss or

exposure to noise from other

sources, the corresponding OR=1.38 (1.11–

1.71), with a positive

exposure–response trend CO: OR=1.061, 0.95– 1.16 per 5dB increment

unconditional logistic regression

N N Y long-term exposure to road traffic

noise (Laeq,24h)

increases the risk for MI ≥50 dBA compared

to those exposed to <50

dBA

Garham et al.

2009

quasi-experimen

tal (36)

M - Laeq,22.00-9.00h

road and rail

CO 31.8±7.9 O - cardiac sympathetic

and parasympat

hetic nervous

system tone

Mean indoor traffic noise exposure was negatively related to mean respiratory sinus arrhythmia (RSA) during the sleep

period

multilevel linear

regression

N N indoor traffic noise reduces

cardiac parasympathetic tone during the second half of

the sleep period BUT no effect

on sympathetic tone


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Jarup et al. 2008

cross-sectional (4861) - HYENA

C - Lday,16hr,aicraft

or LAeq,24h,road

and Lnight, aircraft

aircraft, road traffic

CO Lday,16hr, aircraft: ≤

35-75; Lnight,aicraft: ≤ 30-

70; LAeq,24hr

,road: ≤ 45-77;

<45 for Laeq,24hroad, <35

for Lnight,road, <35 for Lday,16h,

aircraft and <30

for Lnight,airc

raft

O and S - hypertension

OR=1.14 (95% CI 1.01-1.29, p = 0.031) per 10

dB(A) increase in Lnight,aircraft,

OR= 1.10 (95% CI 1.00-1.20, p = 0.044) per 10

dB(A) increase in Leq,24h,roadtraffic (OR=0.93 (95% CI

= 0.83-1.04, p = 0.190 per 10

dB(A) increase in Lday,16h,aicraft)

multiple logistic

regression

Y N Y Significant exposure-response

relationships between night-

time aircraft and average daily

road traffic noise and risk of

hypertension. Subjects who had lived for

many years in their present home had a higher traffic noise-related

risk of hypertension.

Belojevic et

al. 2008a


M- LAeq, night

road traffic

DI ≤45, >45 ≤45 O - hypertension

OR=1.58 (95% CI 1.03-2.42,

p=0.038) for men >45 dBA (OR=0.9, 95% CI 0.59-1.38,

p=0.644 for women in >45

dBA)

multiple logistic

regression

N N Y LAeq, night >45 dBA was

significantly increased the risk for arterial hypertension in men compared

to those exposed ≤45

dBA Haralabidis et al. 2008

cross-sectional (4861) - HYENA

M – LAeq,1min; LAeq,15min

aircraft, road traffic

CO no exact number

nor range only a figure

? O - blood pressure, heart rate

during sleep with the

presence/absence of a noise event

when Lmax>35

dBA

6.2 mmHg (95% CI 0.63–12)

increment in SBP and 7.4 mmHg (95% CI 3.1-12)

fincrement in DBP per 5dB in

Laeq,15min. A non-significant increase in HR

was also observed (by 5.4 b.p.m.)

Linear mixed models

N N Y both systolic and diastolic BP levels as well as

HR increased with higher noise levels during the preceding minutes,

independently of the noise

source and of the sequence of

the measurement

during sleep time


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Rhee et al. 2008

case-control (137

cases, 252 controls)

M - LAeq,8h;

Lamax

military aircraft noise

CO LAeq,8h, control=53-54 dB(A),

Lmax, control=88-89 dB(A); LAeq,8h,

case, helicopter

=71-72 dBA,

LAeq,8h, fighter

jet=68-82 dBA; Lmax case,

helicopter=114-116

dBA; Lmax, case, fighter

jet=105-115 dBA

control group

O - hypertension (measured

blood pressure)

helicopter group showed a

significantly higher prevalence of hypertension

(p=0.020), whereas the

fighter- jet group did not (p=0.094)

hypertension OR=1.62 (95% CI,

1.02–2.59) for helicopter group and OR= 1.23 (95% CI, 0.87–

1.74) for fright jet noise

multiple logistic

regression

N N Y Chronic exposure to

military aircraft noise may be

associated with hypertension. Different kinds

of noise will have different influences on

the prevalence of hypertension.

Belojevic et

al 2008b

cross-sectional

(328)

M - Leq road traffic

CO and CA

Leq,noisy residence=55.5±6.7

dBA, Leq,quiet residence=41.8±3.0

dBA; Leq,noisy kindergard

en=66.9±5.3 dBA,

Leq,quiet kindergard

en=55.7±2.8 dB(A)

residential area: ≤45

dBA during night,

kidnergard

en: ≤60 dBA

O - blood pressure and heart

rate

significantly higher SBP (5 Hgmm,

p=0.001) for noisy residence and kindergarten,

significantly higher heart beat (2

beats/min ,p<0.05) for noisy residence

SBP (β=1.056, 95% CI: 0.269-

1.843, p=0.009), DBP (β=−0.531, 95% CI: −1.277-0.215, p=0.162),

HR (β=0782, 95% CI: -0.215-1.731,

p=0.126)

multiple linear

regression

N N Y Correlation between noise exposure and

childrens' systolic

pressure was positive and statistically

significant. No significant

influence of noise exposure

was found neither on children's diastolic

pressure nor on heart rate.


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Greiser et al. 2007

cross- sectional (809379) Cologne-

Bonn study

C - Leq during

the time period 3.00–5.00 a.m.

aircraft CA 40–43, 44–45, 46–47, 48– 61

≤39 O - antihypertensive drugs,

other cardiac

drugs and anxiolytic

drugs prescription

moderate ORs for antihypertensive

drugs and cardiovascular drugs except subgroup with

mulit-drug prescription

OR=3.733 (95% CI: 2.505–5.563) in males and of OR=3.941 (95% CI: 3.107–4.998)

for females FOR TRENDS

see the publication

Multivariate logistic

analyses

N N Y Night-time aircraft noise increases the prevalence of

prescriptions for antihypertensive

and cardiovascular

drugs, especially when

prescribed combined and in conjunction with anxiolytic drugs compare

to those exposed ≤39

dBA Bluhm et al. 2007

cross-sectional

(667)

C - Leq,24h

road traffic

CA ≤45, 45-50, 50-55, 55-60, 60-

65, >65

≤45 S - hypertension

hypertension OR=1.38 (95% CI 1.06-1.80) per 5 dB(A) increase

(stronger association for those living in residence>10

years OR= 1.93; 95% CI 1.29-2.83

and whose bedroom window facing to street

OR= 1.82; 95% CI 1.22-2.70

multiple logistic

regression

N N Y There is an association

between road traffic noise and

self-reported hypertension.

The result point to linear

exposure-response

relationship at lower noise exposures


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

Erikkson et

al. 2007

cohort (2027)

Stockholm Diabetes

C - Laeq,24

h, Lamax

aircraft CO and CA

Laeq: 50–55, 55–60, 60–65, or

>65 LAmax: 70–72, 73–75,

>75

Laeq: <50 Lamax:

<70

O - hypertension

(based on BP

measurement) S -

hypertension

CA: RR=1.19 (95% CI 1.03–

1.37) for hypertension for those exposed

>50 dBA Laeq and RR=1.20 (95% CI 1.03–1.40) those exposed >70 dBA

LAmax Stronger

associations were suggested among

older subjects, those with a

normal glucose tolerance, non-smokers, and subjects not

annoyed by noise from other sources

CO: RR=1.10 (95% CI 1.01–

1.19) per 5 dB(A) increase in Laeq

and RR=1.10 (95% 1.02–1.19)

per 3 dB(A) increase in Lamax

binomial regression with the log link function

N N Y Long-term aircraft noise exposure may

increase the risk for hypertension above 50 dBA compared to

those exposed <50 dBA

de Kluizenaar et al. 2007


and cohort (8592)-

PREVEND

C - Lden road traffic

CA and CO

<45, 45-50, 50-55, 55-60, 60-

65, >65 for cohort: <50 and

≥50

? S - use of antihyperten

sive medication

O - hypertension

(based on BP

measurement or

pharmacy registration)

in cohort

in cross-sectional before adjustment: OR= 1.31 (95% CI 1.25-1.37) per 10 dB increase BUT

adjOR only significant above 55 dBA OR=1.21

(95% CI 1.05-1.38) per 10 dB

increment in cohort before

adjustment OR=1.35 (95% CI

logistic regression

N N Y Exposure to road traffic

noise may be associated with hypertension in subjects who

are between 45 and 55 years

old. Associations seemed to be

stronger at higher (>55 dBA

Lden) noise


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

1.27-1.45) per 10 dBA increase BUT

adj OR only significant for 40-

55 yers old (OR=1.27, 95% CI

1.08-1.49)

levels.

Willich et al.

2006

case-control (4115)

NaRoMI

C - LAeq, day,

LAeq, night

environmental

and workpla

ce

CA LAeq, day: 60-

65, 65-70, >70

LAeq, night: 50-55, 55-60,

>60

LAeq, day: ≤60;

LAeq, night: ≤50

O - myocardial infarction

OR= 1.46 (95% CI 1.02–2.09,

p=0.040) in men, OR=3.36 (95% CI

1.40–8.06, p=0.007) in

women

multivariate logistic

regression

N N Y Environmental sound levels

were associated

with increased risk in men and

women compared to

those exposed ≤60 dBA

van Kempen et

al. 2006


RANCH

C - Laeq,7-

23h

road traffic and

aircraft

? ? ? O - blood pressure and heart

rate

After pooling the data, chronic

aircraft noise at school was related

to a statistically non-significant

increase in systolic (x2=2.7,

df=1, p=0.10) and diastolic (x2=1.4, df=1, p=0.22) BP

and heart rate (x2=1.0, df=1,

p=0.33). Chronic aircraft noise at

home (expressed as LAeq, 7–23hr) was statistically

related to systolic(x2=4.2,

df=1, p=0.04) and diastolic (x2=3.9,

df=1,p=0.05) blood pressure:

increases of 0.10 (95% CI 0.00

to0.20) and 0.19 (95% CI 0.05 to

multilevel model

N N Y Aircraft noise at school

statistically significantly

increased the SBP


Reference

Study design


s)


measured, C-

calculated)

Noise source

Noise exposure


categorical, CO -

continious)

Noise level (dBA)

Reference cathegory

(dBA)






given as continuous

variable)


Thres-hold


no)


N-no)

Conclusion

0.32) mmHg/dB(A) were found for

systolic and diastolic blood

pressure, respectively.


Appendix 7 - Email Notification of Questionnaire Survey

The Email

Dear Colleagues,

The UK consultancy AECOM, working with partners from BEL, Peter Mapp Associates, and Imperial

College, have been commissioned by the Department for Environment Food and Rural Affairs

DEFRA to undertake a research project in support of the Noise Policy Statement for England NPSE.

See NPSE at http://archive.defra.gov.uk/environment/quality/noise/policy/documents/noise-

policy.pdf

The NPSE makes use of the following concepts;

LOAEL – Lowest Observed Adverse Effect Level - This is the level above which adverse effects

on health and quality of life can be detected.

SOAEL – Significant Observed Adverse Effect Level - This is the level above which significant

adverse effects on health and quality of life occur.

The aim of the new research project is, through a literature search and synthesis of relevant

research, standards, and guidance to provide, where possible, robust and well supported

information that defines SOAEL and LOAEL for the more commonly encountered noise

situations.

We hope you can assist this project by answering the Survey Questions which follow in the link

below, and also supplying relevant information by email.

We really appreciate the time given to this, and will do our best to ensure that all those participating

are kept informed of future developments which arise from this project. We will ensure you are sent

the Final Report, when published.

*** Because of the timescale of the project- we need your replies by December 14.

>>>> LINK TO QUESTIONS ---- http://www.surveymonkey.com/s/323MHNF

Please send any additional material in response to these questions, or any requests for clarification

about the survey to BOTH of the following emails

[email protected], [email protected] many thanks Bernard Berry and Helga

Laszlo, on behalf of the Project Team


The Questionnaire:

Background

The UK consultancy AECOM, working with partners from BEL, Peter Mapp Associates and Imperial

College, has been commissioned by the Department for Environment Food and Rural Affairs DEFRA

to undertake a research project in support of the Noise Policy Statement for England NPSE

See http://archive.defra.gov.uk/environment/quality/noise/policy/documents/noise-policy.pdf

The long term vision of the NPSE is supported by the following aims:

Through the effective management and control of environmental, neighbour and neighbourhood

noise, within the context of Government policy on sustainable development:



• where possible, contribute to the improvement of health and quality of life.

The intention is that the NPSE should apply to all types of noise apart from noise in the workplace

(occupational noise). For the purposes of the NPSE, “noise” includes:

• Environmental Noise – which includes noise from transportation sources;

• Neighbour Noise - which includes noise from inside and outside people’s homes; and

• Neighbourhood Noise - which includes noise arising from within the community such as industrial

and entertainment premises, trade and business premises, construction sites, renewable energy

infrastructure and noise in the street.

The NPSE makes use of the following concepts

LOAEL – Lowest Observed Adverse Effect Level - This is the level above which adverse effects on

health and quality of life can be detected.

SOAEL – Significant Observed Adverse Effect Level - This is the level above which significant

adverse effects on health and quality of life occur.

The aim of the new research project is, through a literature search and synthesis of relevant

research, standards, and guidance to provide, where possible, robust and well supported information

that defines SOAEL and LOAEL for the more commonly encountered noise situations.

We hope you can assist this project by answering the following short survey - the survey only

consists of between four and six questions (depending on your answers). We really appreciate the

time given to this and will do our best to ensure that everyone who takes part is kept informed of

future developments which arise from this project. We will also ensure you are sent the Final Report


when published.

Because of the timescale of the project, we need your replies by 14 December 2011.

Q1. Your Name:

Q2. Your email address:


Q3. Does any Noise Policy, Regulation, or National standard in your country give specific levels of

noise that should be avoided for health or quality of life based reasons? If yes, please give details

below.

Q4. Does any Noise Policy, Regulation, or National standard in your country make use of the

concepts of LOAEL and/or SOAEL in the setting of threshold, standard or limit values?

If yes –please provide references to any relevant documents, or links to websites etc explaining such

use of the concepts. Please send copies if possible by email to [email protected] and

[email protected].

Q5. If LOAELs and/or SOAELs are defined in such documents, what is the basis for any defined

levels?

Scientific research in your country

WHO Guidelines

Other, please specify

Q6. If you believe there to be a scientific basis, please can you describe further

B. RESEARCH

Q7. Are you aware of any recently published research on the health effects of noise, or on “noise

and the quality of life”, which you consider might be relevant to the challenge of defining LOAELs

and SOAELs?

If yes –please provide references to any relevant documents, or links to websites etc explaining such

use of the concepts. Please send copies if possible by email to [email protected].

Q8. Are you aware of any ongoing projects which might be relevant?

If yes – please provide details.

Thank you for taking part – please email any relevant documents or further information to Bernard

Berry – Director, Berry Environmental Ltd [email protected] and also to Dr Helga Laszlo,

Imperial College London [email protected].


Appendix 8 - Details of Replies to Questionnaire Survey


Q3. Does any Noise Policy, Regulation, or National standard in your country give specific levels of noise that should be

avoided for health or quality of life based reasons?

No: Response Country

1 Legal act and regulation of Ministry of Health of Slovak Republic with the everyday noise limits in outside and inside of living areas, houses and flats obliged or valid for particular noise sources (or providers of this sources), for example for traffic, railways, airports and others noise sources, which are based on WHO recommendations from annoyance and disturbance point of view.

Slovak Republic

2 The Italian National Framework Law on environmental noise, L.Q. October, 26th 1995, n. 447, art.2, lett.g, introduces the “attention value” as “the noise value that signals the presence of a potential risk for human health or for the environment”. The implementation Decree of the Framework Law, D.P.C.M. November 14th 1997 “Determination of the limit values for noise sources”, defines the different noise limit values (emission limit value, input limit value, attention limit value and quality limit value), referred to the acoustic zoning of the territory of each municipality. Framework law 447/95 establishes the classification of territory in six zones, based on the characteristics regarding the presence of transports infrastructures, the population density, the residential areas, the presence of industrial sites. The first zone is characterized by the presence of typologies where the “quiet condition” is necessary to carry out the activities (Hospital, Schools, urban parks, etc). The six homogeneous areas are characterized by different noise limit values, in Leq (A), on two temporal periods, referred to day period (06-22) and night period (22-06). The attention limit values, in Leq (A), referred to long-term time (time necessary for the acoustic characterization) are: a) If they are referred to a measure time of an hour, the input limit values, increased by 10 dB for the day period and 5 dB for the night period b) If they are referred to the two temporal periods (day period 6-22; night period 22-6), the limit values are the input limit values (see table) Exceeding of the values requires the adoption of a noise abatement plan. Acoustic zones and related input noise limit values (Leq dB(A), DPCM 14/11/1997) are: Area I – Particularly protected areas: the areas belong to this zone are territories where the quiet represents a priority characteristics: hospitals, schools, areas dedicated to relax and recreation, public park, residential rural areas, more interesting urban planning areas, etc.: 50 LAeq day; 40 LAeq night. Area II – Areas mainly dedicated to a residential use: the areas belong to this zone are mainly characterized by local road traffic, low population density, low presence of commercial activities and absence of industrial and handcrafted activities: 55 LeqA day; 45 LeqA night. Area III – Mixed areas: the areas belong to this zone are characterized by local and crossing road traffic, by media density of population, presence of commercial activities, offices, low density of handcraft activities and absence of industries; rural areas characterized by the presence of equipment:60 LeqA day; 50 LeqA night. Area IV – Intensive human activities areas: the areas belong to this zone are characterized by busy road traffic, high density of population, high presence of commercial activities and offices, presence of handcraft activities; areas close to main road traffic and railway infrastructure; ports, areas with a presence of factories: 65 LeqA day; 55 LeqA night. Area V – Mainly industrial areas: the areas belong to this zone are characterized by the presence of factories and a low presence of residential buildings: 70 LeqA day; 60 LeqA night. Area VI – Exclusively industrial areas: the areas belong to this zone are interested exclusively by industrial activities and there are not residential buildings: 70 LeqA day; 70 LeqA night.

Italy

3 The basic obligation of entrepreneurs and legal persons not to exceed permissible values (limits) of environmental noise during their activities is stated in national Act No. 355/2007 Coll. on Protection, Support and Development of Public Health as amended. Permissible values of noise are stated in Notice of the Ministry of Health of the Slovak Republic No. 549/2007 Coll. laying down details of permissible values of noise, infrasound and vibration requirements and objectification of noise, infrasound and vibration in the environment. Permissible value of environmental noise for specific situation depends on the type of protected area (areas for treatment, spa, etc. / areas for living and recreation / areas for living and recreation near roads / industrial zones), type of noise source (roads, railways,

Slovak Republic.


aviation, other (stationary) sources) and also time interval (day / evening / night).Control on following those limits provides national Public Health Authority (state administration body working under Ministry of Health), usually based on complaints from citizens. Unfortunatelly, we don´t have the version of our law documents. If you would have further questions, please, don´t hesitate to contact us at [email protected].

4 Dutch noise legislation: Since the end of the seventies, the core of the Dutch noise legislation is formed by the so-called Noise Annoyance Law (Wgh) which focuses on the protection of citizens in their living environment from noise of roads, railways and lagre industrial zones. Wgh contains specific limit values for sensitive buildings such as dwellings and schools in order to prevent that noise levels during one year will not exceed certain maximum limit values. When creating Wgh it was thought that parliament should make the decisions about the impact on health. The considered health effects were mainly annoyance; severe health effects such as cardiovascular disease, were not an issue at that time. The basic norm was chosen in line with an acceptable occurrence of annoyance. The Dutch Health Council stated in 1971 that a level of 50 dB(A) (Letmaal) during the day was a reasonable basic level considering traffic noise. It referred to a percentage of 10% annoyed in the population. In addition, a legal construction of rules was made to manage the costs that would result from regulation. The law's structure enables authorities to exceed this preferred level up to a maximum level. The value of that maximum strongly depends on the situation. The highest maximum levels are allowed within cities; this pragmatic approach was based on the knowledge of existing noise exposure. During the years the norms have undergone some minor changes; the principles of the legal construction, however remain unchanged. However, the complexity of Wgh and the wish to create more options for local policy are the main reasons that the law is "under construction" in the last decade. This "construction" process is in the Netherlands known as SWUNG. To a certain way, the answer is yes: Dutch noise policy: Since the beginning of the 1990's, the Dutch government has implemented targets for noise abatement policy. The fourth National Environmental Policy Plan contained a target for "achieving acoustic quality in 2030 in keeping with the use of the relevant area. In order to achieve this, the limit value of 70 dBA in homes may no longer be exceeded in 2010." Although Dutch noise policy is not directed to prevent severe health effects such as cardiovascular disease, due to noise, health does play a role in noise policy: the Dutch Health Council has provided the Dutch government with specific information with which to underpin their noise regulations.

Netherlands

5 There is a National regulation which comply with Environmental Noise Directive requirements. (By-Law on Assessment and management of Environmental Noise). In that regulation specific limit values have been put into force for each noise sources such as roads, railways, airports, industries, small enterprises, constructions and entertainment facilities in order to protect general human health.

Turkey

6 RULEBOOK ON LIMIT VALUES OF THE LEVEL OF NOISE IN THE ENVIRONMENT Article 4 The limit values for the level of basic indicators of noise inside the premises where people reside, and especially those premises where the vulnerable population groups are residing, as well as for the prevention of adverse effects on the health, are: Types of premises noise level expressed in dВА Ld Le Ln Hospital room, intensive care units, operating theatres 30 30 30 Rooms in residential buildings, children relaxation rooms bedrooms in old people's home, hotel rooms 35 35 30 Surgery in health facilities, 40 40 35 conference halls, cinemas, theatres and concert halls Classrooms, reading rooms, amphitheatres, 40 40 40 lecture rooms, facilities for scientific research work Operating rooms in administrative 50 50 50 buildings, offices Theatre and cinema lobby, hair and 55 55 55

Macedonia


beauty salons, restaurants, Article 5 The limit value for the additional indicator, LAmax, which shall not be exceeded in order to prevent adverse health effects in exposed populations, is: Types of premises level of noise expressed in dВА LАmax day LАmax night Residential area (outside) / 60 Rooms in residential buildings, children relaxation rooms bedrooms in old people's home and hotel rooms (inside) / 45 Hospitals and other stationary objects for treatment / 45 Industrial, commercial, trade and traffic areas 110 110 Public gatherings, festivals, concerts, discos 110 110Tu

7 Ministry of Health - Decree No. 272/2011 Col., Public health safety against adverse effects of noise and vibrations

Czech Republic

8 I will send materials by email Estonia

9 UAE Federal Law 24 states daytime and night time limits for Residential commercial and industrial, these vary between 30 - 40 Night Resi to 60 - 70 Day Industrial There are also various Local Orders per Royal decree for each Emirate.

United Arab Emirates

10 Regulation on noise nr. 724/2008: "The level of which noise could start to have an effect on people’s health is 85 decibel(A) LAeq (equal value over 8 hours). When assessing the effect of noise one must keep in mind: - the value of noise measured in decibel (A). - pitch of the noise - If the noise is constant or if it varies - duration of the noise each day - what time of day the noise is present - over all duration, that can be assumed that the noise is present (days/weeks) - that children are more sensitive to noise than adults. The annex presents the limits which are set for allowed noise, regarding traffic, air traffic, industry, construction and events.

Iceland

11 The last Govt (including the Green Party) had prepared a Noise Nuisance Bill and this was due to be introduced into Legislation around February 2011. The Govt was defeated in the general election in Mar 2011, and the proposed noise bill has now been put on hold. The Bill covered the following: Deals mainly with noise nuisance issues and will be enforced mainly by local authorities. Noise from EPA licensed sites will continue to be a matter for the EPA to enforce. Provides significant new powers to local authorities to prevent nuisance noise (e.g. car alarms, house alarms, dogs, noisy neighbours, etc.) Provision for issue of on the spot fines; An annual report covering all aspects of noise (Local Authority activities, EPA activities, noise maps and action plans, guidance, research, other information) to be prepared by the EPA; Codes of Practice will be prepared and issued by the EPA on issues such as construction noise, commercial activities, neighbourhood activities, agricultural activities, etc. Sections 106, 107, 108 and 109 of the EPA Acts will be repealed and included in the new Act as necessary (with amendments)

Ireland

12 Noise level guidelines http://www.ymparisto.fi/default.asp?contentid=216752&lan=EN http://www.stm.fi/c/document_library/get_file?folderId=28707&name=DLFE-3518.pdf Summary on page 5. Target/recommended levels indoor noise page 39, LF-noise on page 40 table 3 (LAeq,1h should read Leq,1h. unweighted 1/3-octave levels), music noise, night time, sleeping rooms max. LAeq,1h <= 25 dB.

Finland

13 General noise regulations are established to keep the "annoyance" at an acceptable level (around 10 % highly annoyed) and to allow people to sleep with bedroom windows partly open without being sleep disturbed. The objectives of the regulations are "to prevent noise annoyance and to protect quiet areas against noise". Health and well-being is not

Norway


specifically mentioned 14 Environmental and traffic noise levels are set by the regulatory authority to avoid

community annoyance No email address

15 Yes, Our Provincial Occupational Health & Safety Act limits noise exposure dose to 85dBA @ 8 hrs. Yes, Environmental Noise from facilities are limited depending and the time of day. Most typically 50dBA daytime (07:00 - 19:00), 47dBA evening (19:00 - 23:00) and 45dBA nighttime (23:00 - 07:00). These limits only apply if the existing ambient levels from other non-facility sources do not exceed them. In that case the existing ambient level becomes the limit. Document NPC-205 or NPC-232 as applicable. Yes, Road traffic noise is typically limited at the municipal planning level via adoption of the Ontario Model By-Law. Limits exist for outdoor living areas, plane of window (living and bedroom) as well as indoor levels of noise. This applies to new residential where building components can be changed prior to design to achieve limits. Limits depend on traffic type air, rail and road as well as time of day. Document LU-131.

Canada

16 Each Council's sets its own rules, however national guidance is set out within NZS6802:2008 which recommends the following limits for the reasonable protection of health and amenity for residential areas; Daytime 55 dB LAeq Evening 50 dB LAeq Night-time 45 dB LAeq Night-time 75 dB LAFmax

New Zealand

17 State based regulations provide acceptable noise limits for external noise levels from industrial, road and rail sources.

No email address

Q4. Does any Noise Policy, Regulation, or National standard in your country make use of the concepts of LOAEL and/or

SOAEL in the setting of threshold, standard or limit values?


1 Permissible levels of environmental noise in Slovakia are partly based on the current state of scientific knowledge with regard to the economic level of society, rather historically given. The concepts of LOAEL and SOAEL is not used this legislation. However, the concept of NOEL, LOAEL, etc. is used by experts providing assessment of health risks (generally, not in relation to noise only), mostly in the process of environmental impact assessment (EIA) or health impact assessment (HIA), e.g. when deciding on new activities of investors in the territory, etc.

Slovak Republic

2 See details to Question.3 above reply No:4 Netherlands

3 Details to Question 3 above, reply No: 7. Transportation noise outdoors - LAeq,T > 70/60 dB (day/night) = intolerable "old burden" of noise; 70/60 > LAeq,T> 65/55 dB (day/night) - SOAEL (?)= tolerable "old burden" of noise; 55/45 < LAeq,T< 65/55 dB (day/night) = acceptable health risks LAeq,T= 55/45 dB (day/night) - LOAEL; The all declared limits are obligatory and enforced by law in all circumstances

Czech Republic

4 I will send by email – see additional information below from Estonia Estonia

5 Not mentioned, but target/recommended levels agree closely with WHO guide line levels. This means zero health risk levels.

Finland

6 Planning requirements under the Resource Management Act requires the sustainable development and protection of natural and physical resources in a way, or at a rate, which enables people and communities to provide for their social, economic and cultural well-being and for their health and safety while - 1.sustaining the potential of natural and physical resources (excluding minerals) to meet the reasonably foreseeable needs of future generations, and 2.safeguarding the life-supporting capacity of air, water, soil and ecosystems, and 3.avoiding, remedying or mitigating any adverse effects of activities on the environment. The Act also imposes a general duty on everybody (s.16) to avoid unreasonable noise. In most cases compliance with the above limits are considered to meet the s.16 duty and are adequate to avoid any significant adverse noise effects on the environment (note; under the Act "environment" is defined as including people and communities).

New Zealand


Q5. If LOAELs and/or SOAELs are defined in such documents, what is the basis for any defined levels?


1 WHO Guidelines Slovak Republic

2 WHO Guidelines Czech Republic

3 WHO Guidelines No email address

4 We do not define those specific terms, but recommendations for national standards etc. is based mostly on international literature eg. WHO

New Zealand

5 The old draft of EU directive, not enforced Estonia

Scientific research in your country.

WHO Guidelines.

Other, please specify.

Q6. If you believe there to be a scientific basis, please can you describe further?

No responses

B. RESEARCH

Q7. Are you aware of any recently published research on the health effects of noise, or on “noise and the quality of life”,

which you consider might be relevant to the challenge of defining LOAELs and

No Response Country

1 WHO - Burden of disease from environmental noise. Quantification of healthy life years lost in Europe http://www.euro.who.int/en/what-we-publish/abstracts/burden-of-disease-from-environmental-noise.-quantification-of-healthy-life-years-lost-in-europe

Hungary

2 Burden of disease from Environmental noise, (WHO, JRC) - Environmental Burden of Disease – European countries (EBoDE) project Quantification, comparison and ranking of environmental stressors within and between participating countries (2010) - European Perspectives on Environmental Burden of Disease. Estimates for Nine Stressors in Six European Countries - WHO LARES Noise effects and morbidity (2004) - ICBEN 2011 Congress Proceeding Regarding the quality of life, ISPRA had carried out a research about the “acoustic quality” in urban park in Rome, using the soundscape methodology, as a contribute for the definition of the quiet areas introduced by the END. A paper has been presented to ICBEN Congress and it will be sent to e-mail addressed: S. Curcuruto, F. Asdrubali, G. Brambilla, R. Silvaggio, F. D'Alessandro, V. Gallo. Socio-acoustic survey and soundscape analysis in urban parks in Rome. 10th International Congress on Noise as a Public Health Problem (ICBEN) 2011, London, UK. 24-28 July 2011T

Italy

3 WHO Night Noise Guidelines http://www.euro.who.int/__data/assets/pdf_file/0017/43316/E92845.pdf

Slovak Republic

4 Not yet published and another ongoing research in the field of noise in the surrounding of children, for example. in playgrounds and schools, in Iceland, the researcher is a speech specialist, the Agency is working on these matters currently. Significant value for the work being done concerning noise in Iceland.

Iceland

5 WHO Burden of disease from environmental noise Website: http://www.euro.who.int/en/what-we-publish/abstracts/burden-of-disease-from-environmental-noise.-quantification-of-healthy-life-years-lost-in-europe

Ireland

6 See additional information below from Finland Finland


7 WHO Burden of disease from environmental noise

Norway

Q8. Are you aware of any ongoing projects which might be relevant?

No Response Country

1 We are interesting and providing the collection of data in this time in Bratislava through the comprehensive noise questioners which are based and started on complaints for noise from any sources and many reasons. We suppose this investigation in critical hot spots according to END as one of issues of Action Plans in every 5-years period.

Slovak Republic

2 We will start on next year the study to assess the limits Estonia 3 See reply to Question 7 above reply No: 4 Iceland

Additional information received from email respondents

Country Additional Information

Czech

Republic

the Decree No. 272/2011 Col., issued by the Czech Ministry of Health, that declares hygienic noise limits in the environmental and occupational area. Unfortunately, it is only in Czech.

Canada 1. SOUND LEVEL LIMITS FOR STATIONARY SOURCES IN CLASS 1 & 2 AREAS (URBAN) PUBLICATION NPC-205 OCTOBER 1995 Ministry of the Environment

2. Annex to Publication LU-131 Noise Assessment Criteria in Land Use Planning October 1997

3. Noise Assessment Criteria in Land Use Planning Publication LU-131 October 1997

4. SOUND LEVEL LIMITS FOR STATIONARY SOURCES IN CLASS 3 AREAS (RURAL) PUBLICATION NPC-232 OCTOBER 1995 Ministry of the Environment

5. Noise Assessment Criteria in Land Use Planning: Requirements, Procedures and Implementation October 1997 This document provides technical details pertinent to MOE Guideline LU-131, Noise Assessment Criteria in Land Use Planning.

6.

Noise Guidelines for Wind Farms

Interpretation for Applying MOE NPC Publications to Wind Power Generation Facilities Ministry of the Environment October 2008

Finland

To be on the safe side, I correct my typing. Please read 0% health risk as zero health risk. Difference LOAEL – LOAL: http://ec.europa.eu/health/opinions/en/tooth-whiteners/glossary/jkl/loael.htm To save your time, here is the definition used in the Community noise guidelines (page XV):


Here you have additional background information: You know WHO’s Guidelines for Community noise: http://www.who.int/docstore/peh/noise/guidelines2.html I attended a meeting where WHO’s spokesman and one of the authors, Dr. Dietrich Schwela, introduced this document and target levels. Dietrich was asked why WHO suggest these low target levels that are not realistic (e.g. in big cities, along high density traffic routes, around bigger airports, etc). Answer was: These are 0% health risk values. Every one (country, municipality…) who apply these values have right to decide him/herself what risks he/she is ready to accept. This 0% risk criterion might differ from LOEAL and SOAEL criteria. The back ground of this WHO document is interesting, but I do not comment it now. In Finland we have target/recommended noise levels, but in building codes some mandatory HVAC noise levels and R’w+L*n,w values. Although recommendations, these values are applied widely in environmental permits and in land use planning. In both cases recommendations are turned as mandatory values. Semi open questions are found in cases where long term variations of levels are significant. One school consider that it is absolutely illegal to exceed levels (e.g. LAeq,day, LAeq,night, LAFmax) issued in environmental permits and land use plans, another school consider that it is question about levels “in typical weather and environmental conditions”. Typical weather is considered as stable atmosphere conditions, most often met in (2 – 5 m/s) down wind.

I was a member of WG1 (indicators) suggesting to the commission noise indicators to be used in the environmental noise directive. These long term variation problems were partially solved by selecting LDEN,year and Lnight,year + 10 years corrections as indicators (for chronic noise effects). As far as my memory serves me well, only the Netherlands, Germany (industrial noise) and France (traffic) had one year levels in force. In the Nordic countries one-year average daily traffic density was used as the basis of noise mapping (although road traffic noise model was so called neutral atmosphere model, railway noise model was down wind model). You know that in many cases noise source specific LDEN,year and Lnight,year are impossible to measure (due to too high continuous or temporarily existing corrupting background noises, even too high wind induced noises during one year) accurately enough

Estonia

Table about the limits used in Estonia – see Table below


NOISE LEVELS, LpAeq, T, dB Land use category

Period

Application level Limit level Critical level Max level

Planned area Existing area Existing area Existing area Existing area Traffic noise

Industrial, sports and entertainment business, trade noise

Traffic noise


Traffic noise


Construction noise

Traffic noise

Industrial noise

Traffic noise individual events

Aviation noise LpA, max on sensitive area

Aviation maximum sound pressure level on critical sensitive areas

Natural recreation area, I

Day

50 45* 55 50 55 55 65 60 85 85 90

Night

40

35*

45 40 50 40 45³ 60 50 75 75 80

Living area, II including schools, kindergartens etc

Day

55 50* 60

55

60 65¹

60 70 65 85 85 90

Night

45 40* 50 40 55 60¹

45 45³ 65 55 75 75 80

Mixed area, III including living houses, industry, service

Day

60 55* 60 65¹

60 65 70¹

65 60²

75 70 85 85 90

Night

50 45* 50 55¹

45 55 60¹

50 45²

50³ 65 55 75 75 80

Industrial area, IV

Day

65 65* 70 65 75 70 80 75 85 85

Night

55 55* 60 55 65 60 65³ 70 65 75 75

*Local governments co-ordinated sports and entertainment sites induced noise limit values are identical to industrial noise application level for existing areas, but the noise limit value of local authority co-ordinated events, can be 10 dB (A) higher than industrial noise application level for existing areas. ¹ allowed to the noise-sensitive buildings at road (railway) side; ² the recommended standard level for implementation of measures against noise ³ maximum construction noise levels at night may not exceed 10 dB (A) in excess the allowed equivalent level of noise. Application level – used in new planning (construction projects) to improve existing noise situation. Limit level – used in assessing the current situation and the design of new buildings to the existing built-up area. Exceeding the limit value, must implement measures to reduce noise. Critical level – used in the existing situation, the level is characteristic of a poor noise situation


Appendix 9 - Stansted Noise Contours, LAeq,16-hour day, 2015 and 2030

Figure A9.1 Contour plot in 2015 for both the Base case and the Development case.


Figure A9.2. Contour plot in 2030 for both the Base case and the Development case.


Appendix 10 - Exposure-response relationships considered in the 2009 Stanstead G2 HIA

Documents

Possible Options for the Identification of SOAEL and …randd.defra.gov.uk/Document.aspx?Document=13333_NANR316...reasonable steps should be taken to mitigate and minimise adverse