WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep

Evidence Relating to Environmental Noise Exposure and Annoyance, Sleep Disturbance, Cardio-Vascular and Metabolic Health Outcomes in the Context of IGCB (N): A Scoping Review of New Evidence

WHO published the Environmental Noise Guidelines for the European Region in 2018, based on seven systematic reviews including studies published between 2000 and 2014. Since then, new studies were published. At the request of the UK Department for Environment, Food and Rural Affairs (DEFRA), a review on annoyance, sleep disturbance, cardiovascular and metabolic effects in relation to environmental noise was prepared. The aim was to advise the Interdepartmental Group on Costs and Benefits Noise Subject Group (IGCB(N)) whether this new evidence warrants an update of their recommendations. Four databases for observational studies were screened and data were extracted on design, type and measurements of exposures and outcomes and confounders and their associations. The quality of the studies was indirectly assessed for cardiovascular and metabolic effects by only including studies with a case control or cohort design. For studies on annoyance and sleep disturbance, the risk of bias was expressed in exposure misclassification, selective participation and confounding. The update yielded 87 papers, pertaining to 108 new studies of which 40 new studies were on annoyance, 42 on sleep disturbance and 26 concerning cardiovascular and metabolic effects. The number, size and quality of the new studies suggest new meta-analyses could be undertaken over the sources and effects included in the WHO reviews.

Midregional pro atrial natriuretic peptide: a novel important biomarker for noise annoyance-induced cardiovascular morbidity and mortality?

Background

Environmental noise exposure has been associated with increased cardiovascular morbidity and mortality. Recently, noise annoyance was shown to induce atrial fibrillation, which was accompanied by significantly increased levels of midregional pro atrial natriuretic peptide (MR-proANP). Therefore, the aim of the present study was to analyze the association between noise annoyance, MR-proANP, incident cardiovascular events, and all-cause mortality.

Methods

Levels of MR-proANP were measured in the first 5000 participants of the population-based Gutenberg Health Study. Annoyance was assessed separately for aircraft, road traffic, railway, neighborhood, and industrial/construction noise during the day and sleep.

Results

In cross-sectional analyses, aircraft noise annoyance during day and sleep, industrial/construction noise annoyance during day, and railway noise annoyance during sleep were independently associated with increased levels of MR-proANP after multivariable adjustment. After a 5-year follow-up period, there were 43 cases of incident atrial fibrillation and 103 of incident cardiovascular disease (comprising atrial fibrillation, coronary artery disease, myocardial infarction, heart failure, or stroke). Moreover, there were 301 deaths after a mean follow-up of 7.42 ± 1.66 years. An odds ratio (OR) of 2.82 ([95% confidence interval (CI) 1.86; 4.35], p < 0.0001) for incident atrial fibrillation and an OR of 1.49 ([95% CI 1.13; 1.96], p = 0.0046) for incident cardiovascular disease per 1-standard deviation (SD) increase in MR-proANP levels were found. A 36% (hazard ratio: 1.36 [95% CI 1.19; 1.55], p < 0.0001) higher risk of death was found per 1-SD increase in MR-proANP levels.

Conclusions

Noise annoyance may contribute to cardiovascular morbidity and mortality and is characterized by increased levels of MR-proANP.

Graphic abstract

Effects of Changes in Acoustic and Non-Acoustic Factors on Public Health and Reactions: Follow-Up Surveys in the Vicinity of the Hanoi Noi Bai International Airport

Herein, the effects of changes in acoustic and non-acoustic factors on public health and reactions were assessed using two follow-up investigations; this was achieved after three surveys were conducted on the impact of the step change in noise caused by the increased number of flights at the Noi Bai International Airport in Hanoi (Vietnam) after the new terminal building was opened to the public. Exposure-response relationships established in the follow-up studies were less in number than those established in 2015 after the step change had occurred, and were almost similar to the relationship established in the survey conducted before the step change; however, these relationships were significantly greater than those established in the European Union position paper. Comparisons between respondents with high blood pressure and insomnia ratios at different noise level ranges showed that there is no significant association between ratios of high blood pressure and day-evening-night noise levels; however, an exposure-response relationship was discovered between insomnia and night-time noise levels. Non-acoustic factors such as noise sensitivity, sound insulation capacity of houses, and length of residence were found to curb the respondents’ annoyance, insomnia, and high blood pressure. Thus, an improvement in residence quality and a restriction on nighttime flight operation is necessitated.

Exposure to ambient air pollution and early childhood behavior: A longitudinal cohort study

BACKGROUND

Prenatal and early life air pollution exposure may impair healthy neurodevelopment, increasing risk of childhood behavioral disorders, but epidemiological evidence is inconsistent. Little is known about factors that determine susceptibility.

METHODS

Participants were mother-child dyads from the CANDLE study, an ECHO PATHWAYS Consortium birth cohort set in the mid-South United States, who completed a preschool visit. We estimated prenatal and childhood exposures to nitrogen dioxide (NO₂) and particulate matter less than 10 μm (PM₁₀) at participants' residences using a national annual average universal kriging model (land-use regression with spatial smoothing). Distance to nearest major roadway was used as a proxy for traffic-related pollution. Primary outcomes were children's internalizing and externalizing behavior problems. Regression models were adjusted for individual- and neighborhood-level socioeconomic measures, maternal IQ, and multiple other potential confounders. We tested for effect modification by select maternal and child characteristics.

RESULTS

The analytic sample (N = 975 of 1503 enrolled) was 64% African American and 53% had a household annual income below $35,000; child mean age was 4.3 years (SD: 0.4). Mean prenatal NO₂ and PM₁₀ exposures were 12.0 ppb (SD: 2.4) and 20.8 μg/m3 (SD: 2.0); postnatal exposures were lower. In fully adjusted models, 2 ppb higher prenatal NO₂ was positively associated with externalizing behavior (6%; 95% CI: 1, 11%). Associations with postnatal exposure were stronger (8% per 2 ppb NO₂; 95%CI: 0, 16%). Prenatal NO₂ exposure was also associated with an increased odds of clinically significant internalizing and externalizing behaviors. We found suggestive evidence that socioeconomic adversity and African American race increases susceptibility. PM₁₀ and road proximity were not associated with outcomes.

CONCLUSIONS

Findings showed that air pollution exposure is positively associated with child behavior problems and that African American and low SES children may be more susceptible. Importantly, associations were observed at exposures below current air quality standards.

Effect of the frequency spectrum of road traffic noise on sleep: A polysomnographic study

Spectrum of sound affects noise annoyance. Spectral differences of road traffic noise (RTN) transmitted indoors are usual because of spectrally different sound insulation of facades. The purpose was to compare the effect of RTN spectrum on sleep. Twenty-one volunteers slept three nights in a sleep laboratory in three sound conditions: low-frequency (LF) RTN, high-frequency (HF) RTN, and quiet (control). The A-weighted equivalent levels were 37, 37, and 17 dB L_Aeq,8h, respectively. The nocturnal time profiles of LF and HF were equal. Sleep was measured with polysomnography and questionnaires. HF and LF did not differ from each other in respect to their effects on both objective and subjective sleep quality. The duration of deep sleep was shorter, satisfaction with sleep lower, and subjective sleep latency higher in HF and LF than in quiet. Contrary to subjective ratings given right after the slept night, HF was rated as the most disturbing condition for sleep after the whole experiment (retrospective rating). The finding suggests the sound insulation spectrum of the facade construction might play a role regarding the effects of RTN. More research is needed about the effects of spectrum on sleep because the field is very little investigated.

[Nighttime transportation noise annoyance in Germany: personal and regional differences in the German National Cohort Study]

BACKGROUND

Noise annoyance is associated with adverse health-related conditions and reduced wellbeing. Thereby, subjective noise annoyance depends on the objective noise exposure and is modified by personal and regional factors.

OBJECTIVE

How many participants of the German National Cohort Study (GNC; NAKO Gesundheitsstudie) were annoyed by transportation noise during nighttime and what factors were associated with noise annoyance?

MATERIALS AND METHODS

This cross-sectional analysis included 86,080 participants from 18 study centers, examined from 2014 to 2017. We used multinomial logistic regression to investigate associations of personal and regional factors to noise annoyance (slightly/moderately or strongly/extremely annoyed vs. not annoyed) mutually adjusting for all factors in the model.

RESULTS

Two thirds of participants were not annoyed by transportation noise during nighttime and one in ten reported strong/extreme annoyance with highest percentages for the study centers Berlin-Mitte and Leipzig. The strongest associations were seen for factors related to the individual housing situation like the bedroom being positioned towards a major road (OR of being slightly/moderately annoyed: 4.26 [95% CI: 4.01;4.52]; OR of being strongly/extremely annoyed: 13.36 [95% CI: 12.47;14.32]) compared to a garden/inner courtyard. Participants aged 40-60 years and those in low- and medium-income groups reported greater noise annoyance compared to younger or older ones and those in the high-income group.

CONCLUSION

In this study from Germany, transportation noise annoyance during nighttime varied by personal and regional factors.

[Effects of Noise Protection Measures on Annoyance, Sleep Disorders, and Cardiovascular Diseases: A Model Calculation]

AIM

In Germany, traffic noise-related threshold values are currently set at 70 decibels (dB) during the day and 60 dB at night. According to recent study results, these threshold values might not sufficiently protect against disease risks. The model calculation presented here aimed to estimate the effects of 3 specific noise-protection measures on annoyance, sleep disorders, and cardiovascular diseases.

METHODS

For road traffic noise and railway noise, 3 noise reduction approaches were modeled: (1) weighted 24 hours noise levels (LDEN) of at most 65 dB, and nightly sound pressure levels (LNight) of 55 dB; (2) LDEN of at most 60 dB and LNight of 50 dB; and (3) a general reduction of road and railway noise pressure levels by 3 dB. As an example, the effects of approaches (1) to (3) were determined for the study population of the NORAH study on disease risks (Rhine-Main area). The health consequences were estimated based on the results of the WHO Noise Guidelines (2018) and the NORAH study on disease risks.

RESULTS

The model calculations showed that noise protection approach (1) could reduce the number of people suffering from sleep disturbances as a result of nightly traffic noise and of those highly annoyed as well as the number of people suffering from traffic-related cardiovascular disease by 5 to 10%. Noise protection approach (2) could reduce traffic-related cardiovascular diseases by at least about 10%; according to the WHO Noise Guidelines, it would even be possible to reduce road traffic noise-related ischemic heart disease by more than 30%. All of these measures would be of particular benefit to the highly exposed population - an already vulnerable group due to their limited socio-economic resources. With the general reduction of traffic noise pressure levels by 3 dB, the incidence of annoyance, sleep disturbances and cardiovascular diseases could be reduced particularly among those exposed to low to medium noise pressure levels.

CONCLUSIONS

Considering the different objectives and target groups of the investigated noise protection measures, the introduction and implementation of specific threshold values should be supplemented by general noise reduction measures in the range below the threshold values.

High-resolution assessment of road traffic noise exposure in Denmark

Recent studies show associations between transportation noise and various diseases. However, selection bias remains an inherent limitation in many cohort studies. In this study, we aimed to model road traffic noise exposure across the entire Danish population and investigate its distribution in relation to area-level socioeconomic indicators and green space. Based on the Nordic prediction method, we estimated road traffic noise for all Danish residential addresses, in total 2,761,739 addresses, for the years 1995, 2000, 2005, 2010, and 2015 at the most and least exposed façades. Area-level sociodemographic variables encompassing education, income, and unemployment were collected and residential green within a 150 m radius buffer at the address level was estimated using high-resolution national land use classification data. Median levels of noise at both the most and least exposed facades across Denmark increased slightly from 1995 to 2015. Correlations between most and least exposed façades varied based on population density and building type, with the highest correlations between the most and least exposed façades found for semidetached homes and lowest for multistory buildings. Increasing median noise levels were observed across increasing levels of higher education, lower income, and higher unemployment. A decreasing trend in median noise levels with increasing levels of green space was observed. In conclusion, we showed that it is feasible to estimate nationwide, address-specific exposure over a long time-period. Furthermore, the low correlations found between most and least exposed façade for multistory buildings, which characterize metropolitan centers, suggests that the most exposed façade estimation used in most previous studies and predicts exposure at the silent façade relatively poorly.

Child and Parent Perceived Determinants of Children's Inadequate Sleep Health. A Concept Mapping Study

Many children do not meet the recommendations for healthy sleep, which is concerning given the potential negative effects on children’s health. To promote healthy sleep, it is crucial to understand its determinants. This concept mapping study therefore explores perspectives of children and parents on potential determinants of children’s inadequate sleep. The focus lies on 9–12 year old children (n = 45), and their parents (n = 33), from low socioeconomic neighbourhoods, as these children run a higher risk of living in a sleep-disturbing environment (e.g., worries, noise). All participants generated potential reasons (i.e., ideas) for children’s inadequate sleep. Next, participants sorted all ideas by relatedness and rated their importance. Subsequently, multidimensional scaling and hierarchical cluster analyses were performed to create clusters of ideas for children and parents separately. Children and parents both identified psychological (i.e., fear, affective state, stressful situation), social environmental (i.e., sleep schedule, family sleep habits), behavioural (i.e., screen behaviour, physical activity, diet), physical environmental (i.e., sleep environment such as temperature, noise, light), and physiological (i.e., physical well-being) determinants. These insights may be valuable for the development of future healthy sleep interventions.

Effects of sound environment on the sleep of college students in China

Chinese college students reside primarily in four-person bedrooms and even six-person bedrooms, where the sound from roommates may affect their sleep. Therefore, the purpose of the present study is to investigate the effects of different sound sources and sound levels on sleep for college students in China. Based on sleep quality measurements, acoustic environment measurements, and a questionnaire survey with 90 participants in a typical residence hall in Harbin city, China, the results are as following: First, 68.89% of college students experienced sleep deprivation, and indoor noise was the most influential environmental factor among 15 disruptors that disturbed 50% of college students. Second, the number of occupants per room was a significant factor affecting the background sound level of sleep, which was highest when the number of occupants was two, and lowest when the number was five. Third, deep sleep time and rapid eye movements (REM) sleep time decreased 1.7 min and 1.4 min per 1 dBA (decibel with A-weight), with R² = 0.352 and 0.332, respectively (p < .001). In terms of the effect of sound sources on sleep, sleep was mostly disturbed by roommate conversation (77.42%), and noise caused by roommate sleep-related activities was the most common source of activities (67.74%). The present study can provide guidelines to help enhance the sleep quality of Chinese college students through improvements in the sound environment.

Autonomous Vehicles and Public Health

Autonomous vehicles (AVs) have the potential to shape urban life and significantly modify travel behaviors. "Autonomous technology" means technology that can drive a vehicle without active physical control or monitoring by a human operator. The first AV fleets are already in service in US cities. AVs offer a variety of automation, vehicle ownership, and vehicle use options. AVs could increase some health risks (such as air pollution, noise, and sedentarism); however, if proper regulated, AVs will likely reduce morbidity and mortality from motor vehicle crashes and may help reshape cities to promote healthy urban environments. Healthy models of AV use include fully electric vehicles in a system of ridesharing and ridesplitting. Public health will benefit if proper policies and regulatory frameworks are implemented before the complete introduction of AVs into the market.

Environmental open-source data sets and sleep-wake rhythms of populations: an overview

OBJECTIVE/BACKGROUND

In recent decades, the epidemiology of sleep disorders has mainly consisted of interviewing subjects through validated questionnaires; more recently, this has been done by assessing total sleep time (TST) per 24 h via sleep logs or connected devices. Thus, a vast amount of data has helped demonstrate the decline of TST in most countries. Nonetheless, we believe from a societal and environmental point of view that sleep researchers have largely overlooked a wide-open field of data that may help us to better understand and describe global sleep wake rhythms (SWR), eg, data regarding the sleep environment.

METHODS

Based on recent literature, we identified several environmental and societal fields that may have an effect on SWR. With the help of an expert panel, we selected the five most pertinent fields with multiple open-source data sets that may have an impact on human SWR. Then, we performed web-based research and proposed open-field data sets for each field, all of which are open to researchers and possibly scientifically associated with SWR.

RESULTS

The open fields relevant to the environment that we selected were noise, light pollution, and radio frequencies. The two societal fields were transportation and internet use. The evolution of most of these fields in recent decades may explain (even partially) the decline in TST. Importantly, the open data sets in each field are widely available to sleep researchers.

CONCLUSIONS

SWR must be assessed not only by patient accounts, but also in terms of the evolution of environmental cues.

Adverse Cardiovascular Effects of Traffic Noise with a Focus on Nighttime Noise and the New WHO Noise Guidelines

Exposure to traffic noise is associated with stress and sleep disturbances. The World Health Organization (WHO) recently concluded that road traffic noise increases the risk for ischemic heart disease and potentially other cardiometabolic diseases, including stroke, obesity, and diabetes. The WHO report focused on whole-day noise exposure, but new epidemiological and translational field noise studies indicate that nighttime noise, in particular,is an important risk factor for cardiovascular disease (CVD) through increased levels of stress hormones and vascular oxidative stress, leading to endothelial dysfunction and subsequent development of various CVDs. Novel experimental studies found noise to be associated with oxidative stress-induced vascular and brain damage, mediated by activation of the NADPH oxidase, uncoupling of endothelial and neuronal nitric oxide synthase, and vascular/brain infiltration with inflammatory cells. Noise-induced pathophysiology was more pronounced in response to nighttime as compared with daytime noise. This review focuses on the consequences of nighttime noise.

Evidence for Environmental Noise Effects on Health for the United Kingdom Policy Context: A Systematic Review of the Effects of Environmental Noise on Mental Health, Wellbeing, Quality of Life, Cancer, Dementia, Birth, Reproductive Outcomes, and Cognition

This systematic review commissioned by the UK Department for the Environment, Food and Rural Affairs (Defra), considers how the evidence base for noise effects on health has changed following the recent reviews undertaken for the WHO Environmental Noise Guidelines. This systematic review assesses the quality of the evidence for environmental noise effects on mental health, wellbeing, and quality of life; birth and reproductive outcomes; and cognition for papers published since the WHO reviews (mid-2015 to March 2019), as well as for cancer and dementia (January 2014 to March 2019). Using the GRADE methodology (Grading of Recommendations Assessment, Development and Evaluation) most evidence was rated as low quality as opposed to very low quality in the previous reviews. There is now low-quality evidence for a harmful effect of road traffic noise on medication use and interview measures of depression and anxiety and low quality evidence for a harmful effect of road traffic noise, aircraft noise, and railway noise on some cancer outcomes. Many other conclusions from the WHO evidence reviews remain unchanged. The conclusions remain limited by the low number of studies for many outcomes. The quantification of health effects for other noise sources including wind turbine, neighbour, industrial, and combined noise remains a research priority.

Assessing the Treatment of Potential Effect Modifiers Informing World Health Organisation Guidelines for Environmental Noise

Methodologies employed in the production of systematic reviews used to inform policy must be robust. In formulating the recent World Health Organisation (WHO) Environmental Noise Guidelines for the European Region, seven systematic reviews of evidence were commissioned to assess the relationship between environmental noise exposure and a range of health outcomes, six of which were nonauditory. Within the methodological guidance document devised for these reviews, inclusion and exclusion criteria for individual studies and existing reviews were applied in accordance with the Population-Exposure-Comparator-Outcome-Study (PECOS) framework for the evaluation of evidence. Specific criteria were defined for "populations" and source-specific "exposure", but no criteria were defined for the treatment of potential "effect modifiers". Furthermore, no criteria were set for the treatment of combined exposures. Employing a custom-designed assessment matrix, we assess the treatment of potential effect modifiers in the formulation of the aforementioned systematic reviews, all published in a Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), titled "WHO Noise and Health Evidence Reviews". We identify substantial methodological variation in their treatment and propose the differentiation of "moderators" and "mediators" from "confounders" as the basis for criteria development-including combined exposures-for future systematic reviews.

Social Noise Exposure in a Sample of Slovak University Students

Purpose: Social noise exposure is currently an emerging problem in adolescents and young adults. Various leisure time activities may be responsible for hearing impairment (temporary or permanent hearing threshold shift or hearing loss). The study aimed to quantify environmental noise from various sources—voluntary (social) noise (personal music players (PMPs), high-intensity noise exposure events), and road traffic noise and to detect hearing disorders in relation to individual listening to PMPs in the sample of young adults living and studying in Bratislava, the capital city of Slovakia. Methods: The study included 1003 university students (306 men and 697 women, average age 23.1 ± 2) living in Bratislava for 4 or more years; 347 lived in the student housing facility exposed to road traffic noise (L_Aeq = 67.6 dB) and 656 in the control one (L_Aeq = 53.4 dB). Respondents completed a validated ICBEN 5-grade scale “noise annoyance questionnaire”. In the exposed group a significant source of annoyance was road traffic noise (p < 0.001), noise from entertainment facilities (p < 0.001), industrial noise (p < 0.001), and noise from neighboring flats (p = 0.003). The exposure to PMPs was objectified by the conversion of the subjective evaluation of the volume setting and duration. With the cooperation of the Ear, Nose and Throat (ENT)specialist, we arranged audiometric examinations on the pilot sample of 41 volunteers. Results: From the total sample of respondents, 79.2% reported the use of a PMP in the course of the last week, and the average time was 285 min. There was a significant difference in PMP use between the road traffic noise-exposed (85.6%) and the control group (75.8%) (p = 0.01). Among PMP users 30.7% exceeded the lower action value (LAV) for industry (L_Aeq,8h = 80 dB). On a pilot sample of volunteers (n = 41), audiometry testing was performed indicating a hearing threshold shift at higher frequencies in 22% of subjects. Conclusions: The results of the study on a sample of young healthy individuals showed the importance of exposure to social noise as well as to road traffic noise and the need for prevention and intervention.

O isolamento social durante a pandemia do SARS-CoV-2 aumenta ou diminui a poluição sonora no ambiente urbano?

RESUMO A disseminação pandêmica do SARS-CoV-2 por mais de 100 países em todo o mundo fez com que diversos governos decretassem medidas de restrição de mobilidade social conhecidas como ‘isolamento social’. Esse cenário pode ter, como efeito colateral, uma percepção de redução da poluição sonora, que pode ser corroborada pela mensuração do impacto sonoro em ambientes públicos nas cidades submetidas às medidas de isolamento social. Entretanto, há registros de crescimento de queixas às autoridades por poluição sonora advindos de zonas residenciais, o que pode indicar, contrariamente, seu aumento. Considerar essas facetas duais do assunto é importante para qualquer estudo que deseje aprofundar as análises. A poluição sonora e seus efeitos danosos sobre a saúde são de grande relevância no cenário pandêmico atual, pois podem se somar a vários outros estressores que, conjuntamente, ameaçam a saúde mental de populações neste cenário. Este trabalho, baseado em publicações científicas e de imprensa feitas durante o período, analisa e coloca em discussão as diferentes facetas dessa conjuntura que podem influenciar a elaboração de políticas públicas em saúde.

Cross-sectional association between outdoor artificial light at night and sleep duration in middle-to-older aged adults: The NIH-AARP Diet and Health Study

INTRODUCTION

Artificial light at night (ALAN) can disrupt circadian rhythms and cause sleep disturbances. Several previous epidemiological studies have reported an association between higher levels of outdoor ALAN and shorter sleep duration. However, it remains unclear how this association may differ by individual- and neighborhood-level socioeconomic status, and whether ALAN may also be associated with longer sleep duration.

METHODS

We assessed the cross-sectional relationship between outdoor ALAN and self-reported sleep duration in 333,365 middle- to older-aged men and women in the NIH-AARP Diet and Health Study. Study participants reported baseline addresses, which were geocoded and linked with outdoor ALAN exposure measured by satellite imagery data obtained from the U.S. Defense Meteorological Satellite Program's Operational Linescan System. We used multinomial logistic regression to estimate the multinomial odds ratio (MOR) and 95% confidence intervals (CI) for the likelihood of reporting very short (<5 h), short (<7 h) and long (≥9 h) sleep relative to reporting 7-8 h of sleep across quintiles of LAN. We also conducted subgroup analyses by individual-level education and census tract-level poverty levels.

RESULTS

We found that higher levels of ALAN were associated with both very short and short sleep. When compared to the lowest quintile, the highest quintile of ALAN was associated with 16% and 25% increases in the likelihood of reporting short sleep in women (MORQ1 vs Q5, (95% CI), 1.16 (1.10, 1.22)) and men (1.25 (1.19, 1.31)), respectively. Moreover, we found that higher ALAN was associated with a decrease in the likelihood of reporting long sleep in men (0.79 (0.71, 0.89)). We also found that the associations between ALAN and short sleep were larger in neighborhoods with higher levels of poverty.

CONCLUSIONS

The burden of short sleep may be higher among residents in areas with higher levels of outdoor LAN, and this association is likely stronger in poorer neighborhoods. Future studies should investigate the potential benefits of reducing light intensity in high ALAN areas in improve sleep health.

Short review: Air pollution, noise and lack of greenness as risk factors for Alzheimer's disease- epidemiologic and experimental evidence

The number of patients with Alzheimer's disease (AD) is likely to triple in a few decades as the world's population ages. Given the high personal and societal burden of this disease, it is imperative to identify its risk factors. The etiology of AD is still not fully understood, but environmental factors have emerged as plausible important risk factors on the population-level. In this short review, the author summarizes literature on air pollution, noise and (lack of) greenness as risk factors for AD. In conclusion, a link between air pollution and AD is supported by experimental studies as well as epidemiological studies, although a multi-exposure approach is lacking in most epidemiological studies. Although evidence is much more limited regarding noise and (lack of) greenness as risk factors for AD, future epidemiological studies should have a multi-exposure approach in order to separate potential effects of air pollution, noise and lack of greenness. Given the heavy toll of AD on individuals and society, as well as the ubiquitous nature of environmental factors, a link between environmental stressors and AD deserves special attention.

Exposure to traffic noise and gestational weight gain and postpartum weight retention: a cohort study

OBJECTIVES

Transportation noise has been associated with markers of obesity. We aimed to investigate whether road traffic and railway noise were associated with weight gain during and after pregnancy.

METHODS

Among the women participating in the Danish National Birth Cohort, 74 065 reported on weight before and during the pregnancy (gestational week 30) and 52 661 reported on weight before and 18 months after pregnancy. Residential address history from conception to 18 months after pregnancy was obtained in national registers, and road traffic and railway noise were modelled for all addresses. Associations between noise and gestational weight gain (GWG) and postpartum weight retention (PPWR) were analysed using the linear and log-binomial regression.

RESULTS

A 10 dB(A) higher road traffic noise was associated with an increase in GWG of 3.8 g/week (95% CI 2.3 to 5.3) and PPWR of 0.09 kg (95% CI 0.02 to 0.16). For PPWR, this association seemed confined to women who were overweight (0.17 kg, 95% CI 0.02 to 0.32) or obese (0.49 kg, 95% CI 0.26 to 0.73) before pregnancy. Further adjustment by nitrogen dioxide reduced GWG risk estimates and slightly increased PPWR risk estimates. Railway noise ≥65 dB(A) was associated with an increase in GWG of 4.5 g/week (95% CI -2.7 to 11.6) and PPWR of 0.26 kg (95% CI -0.09 to 0.60) compared with levels <55 dB(A).

CONCLUSIONS

Our findings suggest that road traffic noise is associated with weight gain during and after the pregnancy, which adds to the literature linking transportation noise to adiposity.

Effectiveness of incentives and follow-up on increasing survey response rates and participation in field studies

Background

Questionnaires are valuable data collection instruments in public health research, and can serve to pre-screen respondents for suitability in future studies. Survey non-response leads to reduced effective sample sizes and can decrease representativeness of the study population, so high response rates are needed to minimize the risk of bias. Here we present results on the success of different postal questionnaire strategies at effecting response, and the effectiveness of these strategies at recruiting participants for a field study on the effects of aircraft noise on sleep.

Methods

In total, we mailed 17 rounds of 240 questionnaires (total n = 4080) to randomly selected households around Atlanta International Airport. Different mailing rounds were varied in the length of the questionnaire (11, 26 or 55 questions), survey incentive (gift card or $2 cash), number of follow-up waves (0, 2 or 3), incentive for participating in a 5-night in-home sleep study ($100, $150 or $200), and address personalization.

Results

We received completed questionnaires from 407 respondents (response rate 11.4%). Personalizing the address, enclosing a $2 cash incentive with the initial questionnaire mailing and repeated follow-up mailings were effective at increasing response rate. Despite the increased expense of these approaches in terms of each household mailed, the higher response rates meant that they were more cost-effective overall for obtaining an equivalent number of responses. Interest in participating in the field study decreased with age, but was unaffected by the mailing strategies or cash incentives for field study participation. The likelihood that a respondent would participate in the field study was unaffected by survey incentive, survey length, number of follow-up waves, field study incentive, age or sex.

Conclusions

Pre-issued cash incentives and sending follow-up waves could maximize the representativeness and numbers of people from which to recruit, and may be an effective strategy for improving recruitment into field studies.

Assessment Of Ambient-Noise Exposure Among Female Nurses In Surgical Cardiac Intensive Care Unit

PURPOSE

To measure noise levels in the Saud Albabtain Cardiac Center cardiac surgical intensive-care unit (CSICU) at different locations to find out the prevalence of noise-induced hearing loss among female nurses.

METHODS

Ambient CSICU noise was measured using a sound-level meter and personal noise dosimeter during morning and night shifts (12 hours each) for 30 days. An audiometry test and questionnaire were used to test nursing responses to noise levels.

RESULTS

Mean 12-hour average noise levels at the station during night shift were 60.3±7.1 dB(A) and inside rooms 62.48±8.02 dB(A). However, during morning shift 64.1±8.4 dB(A) in the rooms was recorded, while 68.8±8.2 dB(A) was recorded at the station, with a significant difference between the shifts (p<0.0001). ICU monitors recorded the highest noise-source levels of 82.7±5.3 dB(A). The lowest significant source was the suction machines, with an average of 67.1±12.5 dB(A). A significant correlation between decibel loss and nurse experience was observed.

CONCLUSION

Noise levels in the CSICU at Saud Albabtain Cardiac Center were higher than World Health Organization standards. CSICU nurses are exposed to noise levels that can affect their hearing capacity. Further research isneeded for effective medical device-alarm management.

Air Pollution (Particulate Matter) Exposure and Associations with Depression, Anxiety, Bipolar, Psychosis and Suicide Risk: A Systematic Review and Meta-Analysis

BACKGROUND

Particulate air pollution's physical health effects are well known, but associations between particulate matter (PM) exposure and mental illness have not yet been established. However, there is increasing interest in emerging evidence supporting a possible etiological link.

OBJECTIVES

This systematic review aims to provide a comprehensive overview and synthesis of the epidemiological literature to date by investigating quantitative associations between PM and multiple adverse mental health outcomes (depression, anxiety, bipolar disorder, psychosis, or suicide).

METHODS

We undertook a systematic review and meta-analysis. We searched Medline, PsycINFO, and EMBASE from January 1974 to September 2017 for English-language human observational studies reporting quantitative associations between exposure to PM < 1.0 μ m in aerodynamic diameter (ultrafine particles) and PM < 2.5 and < 10 μ m in aerodynamic diameter (PM 2.5 and PM 10 , respectively) and the above psychiatric outcomes. We extracted data, appraised study quality using a published quality assessment tool, summarized methodological approaches, and conducted meta-analyses where appropriate.

RESULTS

Of 1,826 citations identified, 22 met our overall inclusion criteria, and we included 9 in our primary meta-analyses. In our meta-analysis of associations between long-term (> 6   months ) PM 2.5 exposure and depression (n = 5 studies), the pooled odds ratio was 1.102 per 10 - μ g / m 3 PM 2.5 increase (95% CI: 1.023, 1.189; I 2 = 0.00 % ). Two of the included studies investigating associations between long-term PM 2.5 exposure and anxiety also reported statistically significant positive associations, and we found a statistically significant association between short-term PM 10 exposure and suicide in meta-analysis at a 0-2 d cumulative exposure lag.

DISCUSSION

Our findings support the hypothesis of an association between long-term PM 2.5 exposure and depression, as well as supporting hypotheses of possible associations between long-term PM 2.5 exposure and anxiety and between short-term PM 10 exposure and suicide. The limited literature and methodological challenges in this field, including heterogeneous outcome definitions, exposure assessment, and residual confounding, suggest further high-quality studies are warranted to investigate potentially causal associations between air pollution and poor mental health. https://doi.org/10.1289/EHP4595.

Survey Results of a Pilot Sleep Study Near Atlanta International Airport

Aircraft noise can disturb the sleep of residents living near airports. To investigate potential effects of aircraft noise on sleep, recruitment surveys for a pilot field study were mailed to households around Atlanta International Airport. Survey items included questions about sleep quality, sleep disturbance by noise, noise annoyance, coping behaviors, and health. Of 3159 deliverable surveys, 319 were returned (10.1%). Calculated outdoor nighttime aircraft noise (Lnight) was significantly associated with lower sleep quality (poor or fair; odds ratio (OR) = 1.04/decibel (dB); p < 0.05), trouble falling asleep within 30 min ≥1/week (OR = 1.06/dB; p < 0.01), and trouble sleeping due to awakenings ≥1/week (OR = 1.04/dB; p < 0.05). Lnight was also associated with increased prevalence of being highly sleep disturbed (OR = 1.15/dB; p < 0.0001) and highly annoyed (OR = 1.17/dB; p < 0.0001) by aircraft noise. Furthermore Lnight was associated with several coping behaviors. Residents were more likely to report often or always closing their windows (OR = 1.05/dB; p < 0.01), consuming alcohol (OR = 1.10/dB; p < 0.05), using television (OR = 1.05/dB; p < 0.05) and using music (OR = 1.07/dB; p < 0.05) as sleep aids. There was no significant relationship between Lnight and self-reported general health or likelihood of self-reported diagnosis of sleep disorders, heart disease, hypertension or diabetes. Evidence of self-reported adverse effects of aircraft noise on sleep found in this pilot study warrant further investigation in larger, more representative subject cohorts.

The Cardiovascular Effects of Noise

BACKGROUND

Traffic noise can induce chronic stress reactions and thereby elevate the risk of cardiovascular disease. The responsible pathophysiological mechanisms are as yet unclear.

METHODS

This review is based on publications retrieved by a selective search in PubMed for epidemiological and experimental studies (2007-2018) on the relation between noise and the risk of cardiovascular disease. The search terms were "noise AND cardiovascular effects" and "noise cardiovascular effects."

RESULTS

Epidemiological studies have shown that noise caused by air, road, and rail traffic has a dose-dependent association with elevated cardiovascular morbidity and mortality. A current meta-analysis commissioned by the World Health Organization concludes that road-traffic noise elevates the incidence of coronary heart disease by 8% per 10 dB(A) increase starting at 50 dB(A) (95% confidence interval [1,01; 1,15]). Traffic noise at night causes fragmentation of sleep, elevation of stress hormone levels, and oxidative stress. These factors can promote the development of vascular dysfunction (endothelial dysfunction) and high blood pressure, which, in turn, elevate the cardiovascular risk.

CONCLUSION

Traffic noise, and air-traffic noise in particular, is an important cardiovascular risk factor that has not been sufficiently studied to date. Preventive measures are needed to protect the population from the harmful effects of noise on health.

Influence of translational vehicle dynamics on heavy vehicle noise emission

Vehicle dynamics can play a significant role in the noise emission from heavy vehicles. In this work, a heavy vehicle noise emission model is presented to study the influence of translational vehicle dynamics on the sound power level emitted by heavy-duty trucks. Vehicle speed and acceleration are calculated using an analytical approximation that describes the tractive and retarding forces acting on a heavy vehicle on grade. Heavy vehicle noise emission associated with rolling noise is defined with reference to the Nordic traffic noise model that takes into account the number of axles for different articulated trucks. An expression for engine noise emission in terms of vehicle speed, weight, engine power, aerodynamic properties and road grade is derived. The individual and combined effects of engine noise and rolling noise for different vehicle mass combinations are examined. The influence of road grade on vehicle kinematics and noise emission is also investigated.

Acute exposure to nocturnal train noise induces endothelial dysfunction and pro-thromboinflammatory changes of the plasma proteome in healthy subjects

Nocturnal train noise exposure has been associated with hypertension and myocardial infarction. It remains unclear whether acute nighttime train exposure may induce subclinical atherosclerosis, such as endothelial dysfunction and other functional and/or biochemical changes. Thus, we aimed to expose healthy subjects to nocturnal train noise and to assess endothelial function, changes in plasma protein levels and clinical parameters. In a randomized crossover study, we exposed 70 healthy volunteers to either background or two different simulated train noise scenarios in their homes during three nights. After each night, participants visited the study center for measurement of vascular function and assessment of other biomedical and biochemical parameters. The three nighttime noise scenarios were exposure to either background noise (control), 30 or 60 train noise events (Noise30 or Noise60), with average sound pressure levels of 33, 52 and 54 dB(A), respectively. Flow-mediated dilation (FMD) of the brachial artery was 11.23 ± 4.68% for control, compared to 8.71 ± 3.83% for Noise30 and 8.47 ± 3.73% for Noise60 (p < 0.001 vs. control). Sleep quality was impaired after both Noise30 and Noise60 nights (p < 0.001 vs. control). Targeted proteomic analysis showed substantial changes of plasma proteins after the Noise60 night, mainly centered on redox, pro-thrombotic and proinflammatory pathways. Exposure to simulated nocturnal train noise impaired endothelial function. The proteomic changes point toward a proinflammatory and pro-thrombotic phenotype in response to nocturnal train noise and provide a molecular basis to explain the increased cardiovascular risk observed in epidemiological noise studies.

Self-Reported Sleep Disturbance from Road, Rail and Aircraft Noise: Exposure-Response Relationships and Effect Modifiers in the SiRENE Study

This survey investigates the cross-sectional association between nighttime road, rail and aircraft noise exposure and the probability to be highly sleep disturbed (%HSD), as measured by self-report in postal and online questionnaires. As part of the Swiss SiRENE study, a total of 5592 survey participants in the entire country were selected based on a stratified random sample of their dwelling. Self-reported sleep disturbance was measured using an ICBEN-style 5-point verbal scale. The survey was carried out in four waves at different times of the year. Source-specific noise exposure was calculated for several façade points for each dwelling. After adjustment for potential confounders, all three noise sources showed a statistically significant association between the nighttime noise level LNight at the most exposed façade point and the probability to report high sleep disturbance, as determined by logistic regression. The association was strongest for aircraft noise and weakest for road traffic noise. We a priori studied the role of a range of effect modifiers, including the “eventfulness” of noise exposure, expressed as the Intermittency Ratio (IR) metric, bedroom window position, bedroom orientation towards the closest street, access to a quiet side of the dwelling, degree of urbanization, sleep timing factors (bedtime and sleep duration), sleep medication intake, survey season and night air temperature. While bedroom orientation exhibited a strong moderating effect, with an Leq-equivalent of nearly 20 dB if the bedroom faces away from the nearest street, the LNight-%HSD associations were not affected by bedroom window position, sleep timing factors, survey season, or temperature.

Road Traffic Noise Exposure and Depression/Anxiety: An Updated Systematic Review and Meta-Analysis

Unlike other World Health Organization evidence reviews, the systematic review on mental disorders could not provide a quantitative estimate of the effect of environmental noise. With that in mind, we aimed to update it with additional studies published through to 18 August 2019 in order to allow for a formal meta-analysis of the association of residential road traffic noise with anxiety and depression. The quality effects and random effects estimators were used for meta-analysis and the robustness of findings was tested in several sensitivity analyses. Ten studies were included in the qualitative synthesis, from which we extracted 15 estimates for depression (n = 1,201,168) and five for anxiety (n = 372,079). Almost all studies were cross-sectional and the risk of bias in them was generally high. We found 4% (95% CI: -3%, 11%) higher odds of depression and 12% (95% CI: -4%, 30%) of anxiety associated with a 10 dB(A) increase in day-evening-night noise level (Lden). Both models suffered from moderate heterogeneity (55% and 54%), but there was evidence of publication bias only in the depression model. These findings were robust with no evidence of study-level moderators. A sensitivity analysis on an alternative set of categorically-reported estimates supported a linear relationship between Lden and depression. Taking into account an overall quality assessment for the included studies, we conclude that there is evidence of "very low" quality that increasing exposure to road traffic noise may be associated with depression and anxiety.

Associations of Various Nighttime Noise Exposure Indicators with Objective Sleep Efficiency and Self-Reported Sleep Quality: A Field Study

It is unclear which noise exposure time window and noise characteristics during nighttime are most detrimental for sleep quality in real-life settings. We conducted a field study with 105 volunteers wearing a wrist actimeter to record their sleep during seven days, together with concurrent outdoor noise measurements at their bedroom window. Actimetry-recorded sleep latency increased by 5.6 min (95% confidence interval (CI): 1.6 to 9.6 min) per 10 dB(A) increase in noise exposure during the first hour after bedtime. Actimetry-assessed sleep efficiency was significantly reduced by 2%-3% per 10 dB(A) increase in measured outdoor noise (Leq, 1h) for the last three hours of sleep. For self-reported sleepiness, noise exposure during the last hour prior to wake-up was most crucial, with an increase in the sleepiness score of 0.31 units (95% CI: 0.08 to 0.54) per 10 dB(A) Leq,1h. Associations for estimated indoor noise were not more pronounced than for outdoor noise. Taking noise events into consideration in addition to equivalent sound pressure levels (Leq) only marginally improved the statistical models. Our study provides evidence that matching the nighttime noise exposure time window to the individual's diurnal sleep-wake pattern results in a better estimate of detrimental nighttime noise effects on sleep. We found that noise exposure at the beginning and the end of the sleep is most crucial for sleep quality.

Unconventional natural gas development and adverse birth outcomes in Pennsylvania: The potential mediating role of antenatal anxiety and depression

BACKGROUND

Studies have reported associations between unconventional natural gas development (UNGD) and adverse birth outcomes. None have evaluated potential mediating mechanisms.

OBJECTIVES

To evaluate associations between (1) UNGD and antenatal anxiety and depression and (2) antenatal anxiety and depression and preterm birth (<37 weeks gestation) and reduced term birth weight, (3) stochastic direct and indirect effects of UNGD on preterm birth and term birth weight operating through antenatal anxiety and depression, and (4) effect modification by family-level socioeconomic status.

METHODS

This retrospective cohort study included mothers without prevalent anxiety or depression at time of conception, who delivered at Geisinger in Pennsylvania between January 2009-January 2013. We assembled phase-specific UNGD activity data from public sources. Mothers were categorized as exposed (quartile 4) or unexposed (quartiles 1-3) based on average daily inverse distance-squared UNGD activity metric between conception and the week prior to anxiety or depression (cases) or the pregnancy-average daily metric (non-cases). We estimated associations with a doubly robust estimator (targeted minimum loss-based estimation) and adjusted for potential individual- and community-level confounding variables.

RESULTS

Analyses included 8,371 births to 7,715 mothers, 12.2% of whom had antenatal anxiety or depression. We found 4.3 additional cases of antenatal anxiety or depression per 100 women (95% CI: 1.5, 7.0) under the scenario where all mothers lived in the highest quartile of UNGD activity versus quartiles 1-3. The risk difference appeared larger among mothers receiving Medical Assistance (indicator of low family income) compared to those who did not, 5.6 (95% CI: 0.5, 10.6) versus 2.9 (95% CI: -0.7, 6.5) additional cases of antenatal anxiety or depression per 100 women. We found no relationship between antenatal anxiety or depression and adverse birth outcomes and no mediation effect either overall or when stratifying by Medical Assistance.

CONCLUSION

We observed a relationship between UNGD activity and antenatal anxiety and depression, which did not mediate the overall association between UNGD activity and adverse birth outcomes.

Bilateral high-frequency hearing loss is associated with elevated blood pressure and increased hypertension risk in occupational noise exposed workers

Objective

To investigate the association of bilateral high-frequency hearing loss (BHFHL) with blood pressure and hypertension among occupational noise exposed workers.

Methods

Occupational noise exposed workers were enrolled in 2017 from the occupational diseases survey of Chengdu. BHFHL was classified as normal, mild, or high by the bilateral high-frequency tone average. Linear regression model was used to assess the effects of occupational noise exposure time and BHFHL on blood pressure. Logistic regression model was performed to estimate hypertension risk odds ratios (ORs) associated to occupational noise exposure time and BHFHL.

Results

Increasing years of occupational noise exposure and BHFHL were significantly associated with systolic and diastolic blood pressure increase (all P<0.001). The lineal trend was only significant in males, with adjusted ORs for hypertension gradually increasing with increasing years of occupational noise exposure (P<0.001). Furthermore, subjects having mild and high BHFHL had a higher hypertension risk of 34% and 281%, respectively (both P<0.001). Dose-response relationship between BHFHL and hypertension was found in both males and females.

Conclusions

Occupational noise exposure was positively associated with blood pressure levels and hypertension risk.

Environmental noise and sleep and mental health outcomes in a nationally representative sample of urban US adolescents

BACKGROUND

Environmental noise has been linked to negative health outcomes, like poor sleep, poor mental health, and cardiovascular disease, and likely accounts for more than 1 million disability-adjusted life years annually in Western Europe. Adolescence may be a particularly sensitive period for noise exposure due to an increased need for sleep, failure to meet sleep guidelines, and increased risk for first onset of some mental health disorders. However, the potential health effects of living in high-noise environments have not been studied in US adolescents, rarely in European adolescents, and mental health outcomes studied have not corresponded to diagnoses from the Diagnostic and Statistical Manual of Mental Disorders (DSM).

METHODS

Using a US-based nationally representative survey of urban adolescents (N = 4,508), we estimated associations of day-night average sound levels exceeding the US Environmental Protection Agency's 55 decibel limit with sleep outcomes and lifetime mental health DSM diagnoses. We implemented doubly robust targeted minimum loss-based estimation coupled with propensity score matching to account for numerous potential adolescent, household, and environmental confounders.

RESULTS

Living in a high- versus low-noise Census block group was associated with later bedtimes on weeknights (0.48 hours, 95% confidence interval [CI] = -0.15, 1.12) and weekend nights (0.65 hours, 95% CI = 0.37, 0.93), but not with total hours slept. Associations between living in a high- versus low-noise Census block group and mental disorders were mixed, with wide CIs, and not robust to sensitivity analyses.

CONCLUSIONS

We find evidence for an association between residence in a high-noise area and later bedtimes among urban adolescents but no consistent evidence of such an association with mental health disorders.

Road Traffic Noise Exposure and Birth Outcomes: An Updated Systematic Review and Meta-Analysis

Unlike the other WHO evidence reviews, the systematic review on birth outcomes could not provide a quantitative estimate of the effect of environmental noise. With that in mind, we aimed to update it with additional studies published through to 12 May, 2019 to allow for a formal meta-analysis of the association of residential road traffic noise with birth weight, low birth weight (LBW), small for gestational age (SGA), and preterm birth (PTB). The quality effects and random effects estimators were used for meta-analysis and the robustness of findings was tested in several sensitivity analyses. Nine studies were included in the qualitative synthesis, from which we extracted seven estimates for birth weight (n = 718,136 births) and LBW (n = 620,221), and five for SGA (n = 547,256) and PTB (n = 74,609). We found -8.26 g (95% CI: -20.61 g, 4.10 g) (I2 = 87%) lower birth weight associated with a 10 dB(A) increase in day-evening-night noise level (Lden), and this effect became significant in sensitivity analyses. No evidence of significant effects was found for LBW (OR = 1.06; 95% CI: 0.91, 1.23) (I2 = 49%), SGA (OR = 1.02; 95% CI: 0.86, 1.21) (I2 = 90%), or PTB (OR = 1.00; 95% CI: 0.79, 1.27) (I2 = 69%). The quality of evidence for continuous birth weight was graded as "moderate", while for the other outcomes it was deemed "very low". Finally, we discuss limitations of the risk of bias assessment criteria employed by Nieuwenhuijsen et al.

Burden of Disease Due to Traffic Noise in Germany

Traffic noise is nearly ubiquitous and thus can affect the health of many people. Using the German noise mapping data according to the Directive 2002/49/EC of 2017 and exposure-response functions for ischemic heart disease, noise annoyance and sleep disturbance assessed by the World Health Organization's Environmental Noise Guidelines for the European Region the burden of disease due to traffic noise is quantified. The burden of disease is expressed in disability-adjusted life years (DALYs) and its components. The highest burden was found for road traffic noise, with 75,896 DALYs when only considering moderate evidence. When including all available evidence, 176,888 DALYs can be attributable to road traffic noise. The burden due to aircraft and railway noise is lower because fewer people are exposed. Comparing the burden by health outcomes, the biggest share is due to ischemic heart disease (90%) in regard to aircraft noise, however, the lowest evidence was expressed for the association between traffic noise and ischemic heart disease. Therefore, the results should be interpreted with caution. Using alternative input parameters (e.g., exposure data) can lead to a much higher burden. Nevertheless, environmental noise is an important risk factor which leads to considerable loss of healthy life years.

Road traffic noise and markers of adiposity in the Danish Nurse Cohort: A cross-sectional study

BACKGROUND

Studies have suggested that traffic noise is associated with markers of obesity. We investigated the association of exposure to road traffic noise with body mass index (BMI) and waist circumference in the Danish Nurse Cohort.

METHODS

We used data on 15,501 female nurses (aged >44 years) from the nationwide Danish Nurse Cohort who, in 1999, reported information on self-measured height, weight, and waist circumference, together with information on socioeconomic status, lifestyle, work and health. Road traffic noise at the most exposed façade of the residence was estimated using Nord2000 as the annual mean of a weighted 24-h average (L_den). We used multiple linear regression models to examine associations of road traffic noise levels in 1999 (1-year mean) with BMI and waist circumference, adjusting for potential confounders, and evaluated effect modification by degree of urbanization, air pollution levels, night shift work, job strain, sedative use, sleep aid use, and family history of obesity.

RESULTS

We did not observe associations between road traffic noise (per 10 dB increase in the 1-year mean L_den) and BMI (kg/m²) (β: 0.00; 95% confidence interval (CI): -0.07, 0.07) or waist circumference (cm) (β: -0.09; 95% CI: -0.31, 0.31) in the fully adjusted model. We found significant effect modification of job strain and degree of urbanization on the associations between L_den and both BMI and waist circumference. Job strained nurses were associated with a 0.41 BMI-point increase, (95% CI: 0.06, 0.76) and a 1.00 cm increase in waist circumference (95% CI: 0.00, 2.00). Nurses living in urban areas had a statistically significant positive association of L_den with BMI (β: 0.26; 95% CI: 0.11, 0.42), whilst no association was found for nurses living in suburban and rural areas.

CONCLUSION

Our results suggest that road traffic noise exposure in nurses with particular susceptibilities, such as those with job strain, or living in urban areas, may lead to increased BMI, a marker of adiposity.

Environmental public health risks in European metropolitan areas within the EURO-HEALTHY project

Urban areas in Europe are facing a range of environmental public health challenges, such as air pollution, traffic noise and road injuries. The identification and quantification of the public health risks associated with exposure to environmental conditions is important for prioritising policies and interventions that aim to diminish the risks and improve the health of the population. With this purpose in mind, the EURO-HEALTHY project used a consistent approach to assess the impact of key environmental risk factors and urban environmental determinants on public health in European metropolitan areas. A number of environmental public health indicators, which are closely tied to the physical and built environment, were identified through stakeholder consultation; data were collected from six European metropolitan areas (Athens, Barcelona, Lisbon, London, Stockholm and Turin) covering the period 2000-2014, and a health impact assessment framework enabled the quantification of health effects (attributable deaths) associated with these indicators. The key environmental public health indicators were related to air pollution and certain urban environmental conditions (urban green spaces, road safety). The air pollution was generally the highest environmental public health risk; the associated number of deaths in Athens, Barcelona and London ranged between 800 and 2300 attributable deaths per year. The number of victims of road traffic accidents and the associated deaths were lowest in the most recent year compared with previous years. We also examined the positive impacts on health associated with urban green spaces by calculating reduced mortality impacts for populations residing in areas with greater green space coverage; results in Athens showed reductions of all-cause mortality of 26 per 100,000 inhabitants for populations with benefits of local greenspace. Based on our analysis, we discuss recommendations of potential interventions that could be implemented to reduce the environmental public health risks in the European metropolitan areas covered by this study.

NoiseModelling: An Open Source GIS Based Tool to Produce Environmental Noise Maps

The urbanisation phenomenon and related cities expansion and transport networks entail preventing the increase of population exposed to environmental pollution. Regarding noise exposure, the Environmental Noise Directive demands on main metropolis to produce noise maps. While based on standard methods, these latter are usually generated by proprietary software and require numerous input data concerning, for example, the buildings, land use, transportation network and traffic. The present work describes an open source implementation of a noise mapping tool fully implemented in a Geographic Information System compliant with the Open Geospatial Consortium standards. This integration makes easier at once the formatting and harvesting of noise model input data, cartographic rendering and output data linkage with population data. An application is given for a French city, which consists in estimating the impact of road traffic-related scenarios in terms of population exposure to noise levels in relation to both a threshold value and level classes.

Acute Effects of Air Pollution and Noise from Road Traffic in a Panel of Young Healthy Adults

Panel studies are an efficient means to assess short-term effects of air pollution and other time-varying environmental exposures. Repeated examinations of volunteers allow for an in-depth analysis of physiological responses supporting the biological interpretation of environmental impacts. Twenty-four healthy students walked for 1 h at a minimum of four separate occasions under each of the following four settings: along a busy road, along a busy road wearing ear plugs, in a park, and in a park but exposed to traffic noise (65 dB) through headphones. Particle mass (PM_2.5, PM₁), particle number, and noise levels were measured throughout each walk. Lung function and exhaled nitrogen oxide (NO) were measured before, immediately after, 1 h after, and approximately 24 h after each walk. Blood pressure and heart rate variability were measured every 15 min during each walk. Recorded air pollution levels were found to correlate with reduced lung function. The effects were clearly significant for end-expiratory flows and remained visible up to 24 h after exposure. While immediate increases in airway resistance could be interpreted as protective (muscular) responses to particulate air pollution, the persisting effects indicate an induced inflammatory reaction. Noise levels reduced systolic blood pressure and heart rate variability. Maybe due to the small sample size, no effects were visible per specific setting (road vs. park).

Temporal and spatial stratification for the estimation of nocturnal long-term noise levels

Noise pollution in cities is mainly caused by the vehicular traffic but, depending on the place under assessment, it could be affected by the land use. For noise assessment and strategic noise mapping, the night period equivalent level (L_night), which evaluates sleep disturbance, is one of the requirements of the European Directive 2002/49/EC to be presented for the equivalent time of one year. This research aims to find the influence of the land use in the weekdays stratification to improve the accuracy of the long-term noise level estimation for the night period. It is found that depending on the land use of the place under assessment, the weekdays temporal and spatial stratification could be affected by leisure activities. From a statistical analysis based on a clustering procedure of L_night samples in 19 points, it is observed that both, temporal and spatial stratification depend on the intensity of the surrounding leisure activity, and not on traffic. Following these stratification criteria, a sampling method is presented that reduces by 47% the number of days needed to estimate the annual levels with respect to random sampling.

Assessing the exposure-response relationship of sleep disturbance and vibration in field and laboratory settings

Exposure to nocturnal freight train vibrations may impact sleep, but exposure-response relationships are lacking. The European project CargoVibes evaluated sleep disturbance both in the field and in the laboratory and provides unique data, as measures of response and exposure metrics are comparable. This paper therefore provides data on exposure-response relationships of vibration and sleep disturbance and compares the relationships evaluated in the laboratory and the field. Two field studies (one in Poland and one in the Netherlands) with 233 valid respondents in total, and three laboratory studies in Sweden with a total of 59 subjects over 350 person-nights were performed. The odds ratios (OR) of sleep disturbance were analyzed in relation to nighttime vibration exposure by ordinal logit regression, adjusting for moderating factors common for the studies. Outcome specific fractions were calculated for eleven sleep outcomes and supported comparability between the field and laboratory settings. Vibration exposure was significantly associated with sleep disturbance, OR = 3.51 (95% confidence interval 2.6-4.73) denoting a three and a half times increase in the odds of sleep disturbance with one unit increased 8 h nighttime log10 Root Mean Square vibration. The results suggest no significant difference between field and laboratory settings OR = 1.37 (0.59-3.19). However, odds of sleep disturbance were higher in the Netherlands as compared to Sweden, indicating unexplained differences between study populations or countries, possibly related to cultural and contextual differences and uncertainties in exposure assessments. Future studies should be carefully designed to record explanatory factors in the field and enhance ecological validity in the laboratory. Nevertheless, the presented combined data set provides a first set of exposure response relationships for vibration-induced sleep disturbance, which are useful when considering public health outcomes among exposed populations.

The influence of wind turbine visibility on the health of local residents: a systematic review

PURPOSE

The health effects of visible wind turbine features on residents were investigated. Further, it was examined, if visual annoyance has an influence on residents' health, and if wind turbine visibility impacts residents' health independently of or in combination with acoustical aspects.

METHODS

Medical databases, Google Scholar, public health institutions, and reference lists were searched systematically (PROSPERO registry number: CRD42016041737). Two independent reviewers screened titles/abstract and full texts, extracted data, and critically appraised the methodology of included studies. Study findings were analyzed qualitatively and quantitatively.

RESULTS

Seventeen studies from 19 publications of varying methodological quality were included (two cohort studies, fifteen cross-sectional studies). The pooled prevalence of high annoyance due to altered views and shadow flicker was 6% each. The results of other health effects were inconsistent, with some indications showing that direct wind turbine visibility increases sleep disturbance. Annoyance by direct visibility, shadow flicker, and blinking lights was significantly associated with an increased risk for sleep disorders. One study indicated reactions to visual wind turbine features may be influenced by acoustical exposures.

CONCLUSIONS

In interpreting the results, the differing methodological quality of the included studies needs to be considered. Direct and indirect wind turbine visibility may affect residents' health, and reactions may differ in combination with noise. Further, annoyance by wind turbine visibility may interact as mediator between visual exposures and the health of local residents. To confirm the results, more high-quality research is needed.

Noise-induced sleep disruption increases weight gain and decreases energy metabolism in female rats

Background/objectives:

Inadequate sleep increases obesity and environmental noise contributes to poor sleep. However, women may be more vulnerable to noise and hence more susceptible to sleep disruption-induced weight gain than men. In male rats, exposure to environmental (i.e. ambient) noise disrupts sleep and increases feeding and weight gain. However, the effects of environmental noise on sleep and weight gain in female rats are unknown. Thus, this study was designed to determine whether noise exposure would disturb sleep, increase feeding and weight gain and alter the length of the estrous cycle in female rats.

Subjects/methods:

Female rats (12-weeks old) were exposed to noise for 17d (8h/d during the light period) to determine the effects of noise on weight gain and food intake. In a separate set of females, estrous cycle phase and length, EEG, EMG, spontaneous physical activity and energy expenditure were recorded continuously for 27d during baseline (control, 9d), noise exposure (8h/d, 9d) and recovery (9d) from sleep disruption.

Results:

Noise exposure significantly increased weight gain and food intake compared to females that slept undisturbed. Noise also significantly increased wakefulness, reduced sleep and resulted in rebound sleep during the recovery period. Total energy expenditure was significantly lower during both noise exposure and recovery due to lower energy expenditure during spontaneous physical activity and sleep. Notably, noise did not alter the estrous cycle length.

Conclusions:

As previously observed in male rats, noise exposure disrupted sleep and increased weight gain in females but did not alter the length of the estrous cycle. This is the first demonstration of weight gain in female rats during sleep disruption. We conclude that the sleep disruption caused by exposure to environmental noise is a significant tool for determining how sleep loss contributes to obesity in females.

Adverse impact of nocturnal transportation noise on glucose regulation in healthy young adults: Effect of different noise scenarios

BACKGROUND

Epidemiological evidence indicates an association between transportation noise exposure and a higher risk of developing type 2 diabetes. Sleep disturbances are thought to be one of the mechanisms as it is well established that a few nights of short or poor sleep impair glucose tolerance and insulin sensitivity in healthy good sleepers.

OBJECTIVES

The present study aimed to determine the extent to which exposure to nocturnal transportation noise affects glucose metabolism, and whether it is related to noise-induced sleep alterations.

METHODS

Twenty-one young healthy volunteers (nine women) participated in a six-day laboratory study starting with a noise-free baseline night, then four nights sleeping with randomly-presented transportation noise scenarios (three road and one railway noise scenario) with identical average sound level of 45dB but differing in eventfulness and ending with a noise-free recovery night. Sleep was measured by polysomnography. Glucose tolerance and insulin sensitivity were measured after the baseline, the last noise night and the recovery nights with an oral glucose tolerance test using Matsuda and Stumvoll insulin sensitivity indexes. Eleven participants were assigned a less eventful noise scenario during the last noise night (LE-group), while the other ten had a more eventful noise scenario (ME-group). Baseline metabolic and sleep variables between the two intervention groups were compared using a non-parametric Mann-Whitney U test while mixed models were used for repeated measure analysis.

RESULTS

All participants had increased glucose_AUC (mean±SE, 14±2%, p<0.0001) and insulin_AUC (55±10%, p<0.0001) after the last noise night compared to the baseline night. 2h-glucose level tended to increase only in the ME-group between baseline (5.1±0.22mmol·L^-1) and the last noise night (6.1±0.39mmol·L^-1, condition: p=0.001, interaction: p=0.08). Insulin sensitivity assessed with Matsuda and Stumvoll indexes respectively decreased by 7±8% (p=0.001) and 9±2% (p<0.0001) after four nights with transportation noise. Only participants in the LE-group showed beneficial effects of the noise-free recovery night on glucose regulation (relative change to baseline: glucose_AUC: 1±2%, p=1.0 for LE-group and 18±4%, p<0.0001 for ME-group; Stumvoll index: 3.2±2.6%, p=1.0 for LE-group and 11±2.5%, p=0.002 for ME-group). Sleep was mildly impaired with increased sleep latency of 8±2min (<0.0001) and more cortical arousals per hour of sleep (1.8±0.6arousals/h, p=0.01) during the last noise night compared to baseline. No significant associations between sleep measures and glucose tolerance and insulin sensitivity were found.

CONCLUSION

In line with epidemiological findings, sleeping four nights with transportation noise impaired glucose tolerance and insulin sensitivity. Based on the presented sound exposure, the eventfulness of the noise scenarios seems to play an important role for noise-induced alterations in glucose regulation. However, we could not confirm our hypothesis that transportation noise impairs glucose regulation via deterioration in sleep quality and quantity. Therefore, other factors, such as stress-related pathways, may need to be considered as potential triggers for noise-evoked glucose intolerance in future research.

Long-term exposure to transportation noise and its association with adiposity markers and development of obesity

The contribution of different transportation noise sources to metabolic disorders such as obesity remains understudied. We evaluated the associations of long-term exposure to road, railway and aircraft noise with measures of obesity and its subphenotypes using cross-sectional and longitudinal designs. We assessed 3796 participants from the population-based Swiss Cohort Study on Air Pollution and Lung and Heart Diseases (SAPALDIA), who attended the visits in 2001 (SAP2) and 2010/2011 (SAP3) and who were aged 29-72 at SAP2. At SAP2 we measured body mass index (BMI, kg/m²). At SAP3 we measured BMI, waist circumference (centimetres) and Kyle body Fat Index (%) and derived overweight, central and general obesity. Longitudinally for BMI, we derived change in BMI, incidence of overweight and obesity and a 3-category outcome combining the latter two. We assigned source-specific 5-year mean noise levels before visits and during follow-up at the most exposed dwelling façade (Lden, dB), using Swiss noise models for 2001 and 2011 and participants' residential history. Models were adjusted for relevant confounders, including traffic-related air pollution. Exposure to road traffic noise was significantly associated with all adiposity subphenotypes, cross-sectionally (at SAP3) [e.g. beta (95% CI) per 10 dB, BMI: 0.39 (0.18; 0.59); waist circumference: 0.93 (0.37; 1.50)], and with increased risk of obesity, longitudinally (e.g. RR = 1.25, 95% CI: 1.04; 1.51, per 10 dB in 5-year mean). Railway noise was significantly related to increased risk of overweight. In cross-sectional analyses, we further identified a stronger association between road traffic noise and BMI among participants with cardiovascular disease and an association between railway noise and BMI among participants reporting bad sleep. Associations were independent of the other noise sources, air pollution and robust to all adjustment sets. No associations were observed for aircraft noise. Long-term exposure to transportation noise, particularly road traffic noise, may increase the risk of obesity and could constitute a pathway towards cardiometabolic and other diseases.

Wind Turbine Noise and Sleep: Pilot Studies on the Influence of Noise Characteristics

The number of onshore wind turbines in Europe has greatly increased over recent years, a trend which can be expected to continue. However, the effects of wind turbine noise on long-term health outcomes for residents living near wind farms is largely unknown, although sleep disturbance may be a cause for particular concern. Presented here are two pilot studies with the aim of examining the acoustical properties of wind turbine noise that might be of special relevance regarding effects on sleep. In both pilots, six participants spent five consecutive nights in a sound environment laboratory. During three of the nights, participants were exposed to wind turbine noise with variations in sound pressure level, amplitude modulation strength and frequency, spectral content, turbine rotational frequency and beating behaviour. The impact of noise on sleep was measured using polysomnography and questionnaires. During nights with wind turbine noise there was more frequent awakening, less deep sleep, less continuous N2 sleep and increased subjective disturbance compared to control nights. The findings indicated that amplitude modulation strength, spectral frequency and the presence of strong beats might be of particular importance for adverse sleep effects. The findings will be used in the development of experimental exposures for use in future, larger studies.

Pathways linking residential noise and air pollution to mental ill-health in young adults

BACKGROUND

Recent years have seen growing, but still tentative, evidence of the potential associations of environmental noise and air pollution with mental disorders. In the present study, we aimed to examine the associations between residential noise and air pollution exposures and general mental health in young adults with a focus on underlying processes METHODS: We sampled 720 students (18-35 years) from one university in the city of Plovdiv, Bulgaria. Residential noise (L_Aeq; day equivalent noise level) and air pollution (NO₂) were assessed at participant's residential address by land use regression models. General mental health was measured with a short form of the General Health Questionnaire (GHQ). The following putative mediators were considered: annoyance from environmental pollution, sleep disturbance, restorative quality of the neighborhood, neighborhood social cohesion, and commuting/leisure time physical activity. Structural equation modeling was used to analyze the theoretically-indicated interplay between exposures, mediators, and GHQ.

RESULTS

We observed an association between higher L_Aeq and GHQ, in which environmental annoyance and neighborhood restorative quality emerged as key mediators. First, L_Aeq was associated with higher annoyance, and through it with lower restorative quality, and then in turn with lower physical activity, and thus with higher GHQ. Simultaneously, higher annoyance was associated with higher sleep disturbance, and thereby with higher GHQ. NO₂ had no overall association with GHQ, but it was indirectly associated with it through higher annoyance, lower restorative quality, and lower physical activity working in serial.

CONCLUSION

We found evidence that increased residential noise was related to mental ill-health through several indirect pathways. Air pollution was associated with mental health only indirectly.

A Multilevel Analysis of Perceived Noise Pollution, Geographic Contexts and Mental Health in Beijing

With rapid urbanization and increase in car ownership, ambient noise pollution resulting from diversified sources (e.g., road traffic, railway, commercial services) has become a severe environmental problem in the populated areas in China. However, research on the spatial variation of noise pollution and its potential effects on urban residents’ mental health has to date been quite scarce in developing countries like China. Using a health survey conducted in Beijing in 2017, we for the first time investigated the spatial distributions of multiple noise pollution perceived by residents in Beijing, including road traffic noise, railway (or subway) noise, commercial noise, and housing renovation (or construction) noise. Our results indicate that there is geographic variability in noise pollution at the neighborhood scale, and road traffic and housing renovation/construction are the principal sources of noise pollution in Beijing. We then employed Bayesian multilevel logistic models to examine the associations between diversified noise pollution and urban residents’ mental health symptoms, including anxiety, stress, fatigue, headache, and sleep disturbance, while controlling for a wide range of confounding factors such as socio-demographics, objective built environment characteristics, social environment and geographic context. The results show that perceived higher noise-pollution exposure is significantly associated with worse mental health, while physical environment variables seem to contribute little to variations in self-reported mental disorders, except for proximity to the main road. Social factors or socio-demographic attributes, such as age and income, are significant covariates of urban residents’ mental health, while the social environment (i.e., community attachment) and housing satisfaction are significantly correlated with anxiety and stress. This study provides empirical evidence on the noise-health relationships in the Chinese context and sheds light on the policy implications for environmental pollution mitigation and healthy city development in China.