Environmental noise and incident mental health problems: A prospective cohort study among school children in Germany

Cities and mental health: The role of the built environment, and environmental and lifestyle factors in Barcelona

Built environment characteristics and related environmental exposures and behaviors have been, separately, implicated in the development of poor mental health. However, it is unclear how these factors act together in relation to mental health. We studied these factors simultaneously to evaluate the impact of the built environment, and the mediating role of environmental exposures and physical activity, on mental health, while also studying moderation by sex, age, and length of residence. We used a cross-sectional population-based sample of 3145 individuals aged 15-97 years from Barcelona, Spain. Time spent walking and mental health status were assessed with validated questionnaires, administered through a face-to-face interview. We characterized the built environment (e.g., building, population and intersection density and green space), road traffic noise, and ambient air pollution at the residential level using land cover maps, remote sensing, noise maps and land use regression models. Adjusted regression models accounting for spatial clustering were analyzed to study associations between built environment attributes and mental health, and mediation and moderation effects. Density attributes were directly or indirectly, through air pollution and less consistently through walking, associated with poor mental health. Green space indicators were associated with lower prevalence of poor mental health, partly through lower air pollution exposure and more walking. In some cases, these associations differed by sex, age or length of residence. Non-linear associations of density indicators with environmental exposures, and of particulate matter with poor mental health indicated threshold effects. We conclude that living in dense areas with high air pollution concentrations was associated with poor mental health. On the other hand, green areas with lower air pollution concentrations were protective against poor mental health. Greater urban density might benefit health, but might only do so when air pollution concentrations are low.

A study on the impact of road traffic noise exposure on work efficiency of housewives

Housewives are individuals who take on the caregiving role in the family in virtually every society and while discharging their duties experience serious psychological difficulties due to external environmental pollutants like air, noise, etc., which influences their efficiency of performing household activities. This study hypothesizes a causal association between perception of traffic noise and the reduction in performance of housewives in their daily household activities. A simple mediation model was utilized for the study with traffic noise perception as the exposure variable. The sensitivity to traffic noise, annoyance caused due to traffic noise, and the effect of traffic noise on housewives were evaluated using questionnaire survey. Of the respondents, 57.33% reported high level of traffic noise perception, while 65.81% reported high annoyance due to traffic noise perception. Of the respondents, 88.69% reported higher levels of agreement with regard to negative effect of traffic noise on their household activities. The results supported the hypothesis with respondents belonging to high and moderate noise perception groups reporting a higher reduction in performance as compared to those belonging to the low noise perception group at higher values of sensitivity. There was no significant direct effect among those who perceived traffic noise as high and moderate. However, the indirect path revealed that there was a significantly higher reduction in performance among those belonging to the high and moderate noise perception group as compared to those belonging to the low noise perception group while those who perceived traffic noise as high and moderate did not differ significantly only at higher levels of sensitivity. Using OGRS computational tool, a sensitivity value of 5.586 was identified as the Johnson-Neyman boundary of significance for the direct effect. The results from the study highlight the need for including environmental noise related regulations with regard to residential structures by the concerned authorities and also the need for undertaking more rigorous studies by health authorities and organizations so that the effects are minimized if not eliminated completely.

The Contribution of Environmental Science to Mental Health Research: A Scoping Review

Mental health is influenced by multiple complex and interacting genetic, psychological, social, and environmental factors. As such, developing state-of-the-art mental health knowledge requires collaboration across academic disciplines, including environmental science. To assess the current contribution of environmental science to this field, a scoping review of the literature on environmental influences on mental health (including conditions of cognitive development and decline) was conducted. The review protocol was developed in consultation with experts working across mental health and environmental science. The scoping review included 202 English-language papers, published between 2010 and 2020 (prior to the COVID-19 pandemic), on environmental themes that had not already been the subject of recent systematic reviews; 26 reviews on climate change, flooding, air pollution, and urban green space were additionally considered. Studies largely focused on populations in the USA, China, or Europe and involved limited environmental science input. Environmental science research methods are primarily focused on quantitative approaches utilising secondary datasets or field data. Mental health measurement was dominated by the use of self-report psychometric scales. Measures of environmental states or exposures were often lacking in specificity (e.g., limited to the presence or absence of an environmental state). Based on the scoping review findings and our synthesis of the recent reviews, a research agenda for environmental science's future contribution to mental health scholarship is set out. This includes recommendations to expand the geographical scope and broaden the representation of different environmental science areas, improve measurement of environmental exposure, prioritise experimental and longitudinal research designs, and giving greater consideration to variation between and within communities and the mediating pathways by which environment influences mental health. There is also considerable opportunity to increase interdisciplinarity within the field via the integration of conceptual models, the inclusion of mixed methods and qualitative approaches, as well as further consideration of the socio-political context and the environmental states that can help support good mental health. The findings were used to propose a conceptual model to parse contributions and connections between environmental science and mental health to inform future studies.

New determinants of mental health: the role of noise pollution. A narrative review

Urbanisation processes and anthropogenic actions led to a significant increase in pollution levels, with relevant consequences on global health. In particular, noise pollution demonstrated an association with cardiovascular, metabolic, and respiratory diseases. Furthermore, increasing evidence underlined the possible role of air and noise pollution in the development of psychiatric disorders. In this narrative review, evidence concerning the relationship between noise pollution and the emergence of psychiatric symptoms or psychiatric disorders is summarised. After the literature search process was completed, 40 papers were included in the present review. The exposure to road-, rail-, and air- traffic represented a risk factor for the emergence of affective disorders. This could also be mediated by the occurrence of circadian rhythms disturbances or by noise annoyance and noise sensitivity, both influencing psychological well-being and health-related quality of life. Fewer studies concentrated on special populations, particularly pregnant women and children, for whom noise pollution was confirmed as a risk factor for psychopathology. The better clarification of the complex interaction between noise pollution and mental health may help to identify subjects at risk and targeting specific prevention and intervention strategies in the urban environment.

Impact of Noise on the Mental Health of Megapolis Adolescents

BACKGROUND: Mental health is one of the most significant components of overall health conditions. Mental health well-being results from genetic, psychological, and neuropsychological processes interacting with environmental and social influences. AIM: The study aims to examine the impact of noise on the psyche of megapolis adolescents and determine their levels of anxiety, depression, and stress susceptibility depending on the level of noise. MATHERIAL AND METHOD: The study included 322 adolescents (180 girls and 142 boys) aged 15 to 17 years, divided into two groups. RESULTS: Higher noise levels lead to greater vulnerability of adolescents to depression, anxiety, and stress. High noise levels provoke a 1.56 times (p < 0.05) greater incidence of depression on the HAM-D scale than among adolescents living with lower noise levels. Constant exposure to moderate noise levels showed 1.60 times (p < 0.05) higher anxiety levels on the HAM-A scale. CONCLUSION: High noise levels adversely affect the psyche of megapolis adolescents. The higher the noise level, the more adolescents were exposed to depression, anxiety, and stress. Increased noise levels negatively affect the psyche of megapolis adolescents.

Exposure to road traffic noise and behavioral problems in Chinese schoolchildren: A cross-sectional study

BACKGROUND

Transportation noise is second only to air pollution as an environmental contributor to adverse health outcomes in Western countries. However, no studies investigated the association between road traffic noise and behavioral problems among schoolchildren in China.

OBJECTIVE

To investigate the association between exposure to road traffic noise at home and behavioral problems in Chinese schoolchildren.

METHODS

From January to June 2017, we screened 3236 children aged 7-13 years in Guangzhou (Guangdong, China) from the first investigation of an ongoing school-based cohort study with complete information on behavioral problems and residential geolocation. Residential road traffic noise exposure levels were assessed using a validated modeling method in different periods of the day, including daytime (L_day), nighttime (L_night), and weighted 24-hr (L_dn). The annual mean concentration of nitrogen dioxide was also modeled in our study. Behavioral problems were assessed by the parent-rated Strengths and Difficulties Questionnaire (SDQ). Generalized linear mixed models were utilized to estimate the associations between road traffic noise and behavioral problems.

RESULTS

In the main adjusted model, a 10-dB increase in L_dn was associated with 0.33 (95% CI: 0.08, 0.59), 0.08 (95% CI: -0.01, 0.17), and 0.09 (95% CI: 0.01, 0.16) increases in three subscales score for total difficulties score, emotional problems, and conduct problems, respectively. The same increase in L_dn was also associated with the abnormal total difficulties score (OR = 1.25, 95%CI: 1.01, 1.55), emotional problems (OR = 1.19, 95%CI: 0.98, 1.44), and conduct problems (OR = 1.28, 95%CI:1.02, 1.63). Externalising behavior appears more susceptible to traffic noise than internalising behavior. NO₂ had a small impact on the associations between L_dn and behavioral problems. Our estimates were generally robust in several sensitivity analyses.

CONCLUSION

Residential road traffic noise exposure might be related to increased behavioral problems in Chinese schoolchildren, such as emotional symptoms and conduct problems.

Remote work: Aircraft noise implications, prediction, and management in the built environment

The COVID-19 pandemic has greatly changed workplace management. Most workplaces have adopted the work-from-home policy to minimize the risk of community spread. Consequently, housing estates remain largely occupied during office hours. Since some housing estates are situated in the vicinity of an airport, noise pollution resulted from the takeoff and landing of aircraft is now more noticed by residents, causing annoyance. This problem would be most acute for those located directly under the flight path. Before the pandemic, such aircraft operations had lower effect on the residents because most of them were not at home but at workplaces. Evidently, it is timely that more emphasis should now be placed during urban planning to predict and minimize aircraft noise in the built environment. This article first defines the aircraft noise metrics commonly used to assess environmental impact. Preceded by an overview of how aircraft noise affects the built environment, this article reviews how various aircraft noise prediction models have been used in urban planning. Lastly, this article reviews how aircraft noise can be managed for better acoustic comfort of the residents. Anticipating the adoption of hybrid work arrangement moving forward, this article aims to provide urban planning professionals with an avenue to understand how aircraft noise can negatively affect the built environment, which, in turn, justify why prediction and management of aircraft noise should be emphasized from the outset of urban planning.

Environmental noise, brain structure, and language development in children

While excessive noise exposure in childhood has been associated with reduced language ability, few studies have examined potential underlying neurobiological mechanisms that may account for noise-related differences in language skills. In this study, we tested the hypotheses that higher everyday noise exposure would be associated with 1) poorer language skills and 2) differences in language-related cortical structure. A socioeconomically diverse sample of children aged 5-9 (N = 94) completed standardized language assessments. High-resolution T1-weighted magnetic resonance imaging (MRI) scans were acquired, and surface area and cortical thickness of the left inferior frontal gyrus (IFG) and left superior temporal gyrus (STG) were extracted. Language Environmental Analysis (LENA) was used to measure levels of exposure to excessive environmental noise over the course of a typical day (n = 43 with complete LENA, MRI, and behavioral data). Results indicated that children exposed to excessive levels of noise exhibited reduced cortical thickness in the left IFG. These findings add to a growing literature that explores the extent to which home environmental factors, such as environmental noise, are associated with neurobiological development related to language development in children.

The association of road traffic noise with problem behaviour in adolescents: A cohort study

The findings of environmental noise exposure and behavioural disorders in children and adolescents are inconclusive, and longitudinal studies are scarce. We studied the response of behaviour and behavioural change within one year in a cohort of 886 adolescents in Switzerland aged 10-17 years in response to road traffic noise exposure. Participants filled in a comprehensive questionnaire at baseline and follow-up. It included the Strengths and Difficulties Questionnaire (SDQ), which measures self-rated positive and negative behaviours in five scales. We modelled road traffic noise for participants' most exposed facade at home and school addresses in various metrics (L_den, L_night, L_day, Intermittency Ratio and Number of events). We addressed missing data with multiple imputation and performed mixed linear cross-sectional analyses and longitudinal change score analyses. In cross-sectional analyses, peer relationship problems increased by 0.15 units (95%CI: 0.02, 0.27; scale range: 0-10) per 10 dB road traffic noise increase. In longitudinal analyses, increases in SDQ scales between baseline and follow-up were not related to noise exposure. This study suggests subtle associations between road traffic noise exposure and behaviour problems in adolescents, but longer follow-up times may be needed to observe longitudinal changes.

Association between community noise and children's cognitive and behavioral development: A prospective cohort study

BACKGROUND

Noise exposure has been associated with adverse cognitive and behavioral outcomes in children, but evidence on longitudinal associations between community noise and child development in low- and middle-income countries is rare. We investigated associations between community noise and behavioral and cognitive development in preschool children in São Paulo.

METHODS

We linked child development data from the São Paulo Western Region Birth Cohort with average (Lden) and night-time (Lnight) community noise exposure at children's home, estimated by means of a land use regression model using various predictors (roads, schools, greenness, residential and informal settlements). Outcomes were the Strengths and Difficulties Questionnaire (SDQ) and Regional Project on Child Development Indicators (PRIDI) at 3 years of age and the Child Behavior Checklist (CBCL) and International Development and Early Learning Assessment (IDELA) at 6 years of age. We investigated the relationship between noise exposure and development using cross-sectional and longitudinal regression models.

RESULTS

Data from 3385 children at 3 years of age and 1546 children at 6 years of age were analysed. Mean Lden and Lnight levels were 70.3 dB and 61.2 dB, respectively. In cross-sectional analyses a 10 dB increase of Lden above 70 dB was associated with a 32% increase in the odds of borderline or abnormal SDQ total difficulties score (OR = 1.32, 95% CI: 1.04; 1.68) and 0.72 standard deviation (SD) increase in the CBCL total problems z-score (95% CI: 0.55; 0.88). No cross-sectional association was found for cognitive development. In longitudinal analyses, each 10 dB increase was associated with a 0.52 SD increase in behavioral problems (95% CI: 0.28; 0.77) and a 0.27 SD decrease in cognition (95%-CI: 0.55; 0.00). Results for Lnight above 60 dB were similar.

DISCUSSION

Our findings suggest that community noise exposure above Lden of 70 dB and Lnight of 60 dB may impair behavioral and cognitive development of preschool children.

Enhanced Sound Absorption Properties of Ceramics with Graphene Oxide Composites

Noise pollution is acknowledged as the main environmental problem and is as harmful to human physical and mental health as water and air pollution. However, the acoustic properties of traditional sound absorption materials in low frequency ranges still need to be improved. Herein, the low-frequency sound absorption coefficient of porous ceramics was further improved by coating a graphene oxide (GO) and styrene-butadiene rubber (SBR) composite film inside the porous ceramics. The improved sound absorption coefficient of the porous composite reached 30.4% in the range of 200-800 Hz, which is attributed to the enhancement of the thermal viscous effect and the extension of the dissipation mechanism. Predictably, designing the morphology of three-dimensional interconnected porous structures on the microscale is comparatively useful for developing a porous sound absorbing material effective in middle- and low-frequency noise.

Effect of Noise on Sleep and Autonomic Activity in Children according to Source

BACKGROUND

Noise has been a major issue in children due to its effect on emotional symptoms and sleep problems. The present study investigated the effect of noise on sleep and autonomic activity in children according to three variables, namely, road traffic noise, aircraft noise, and noise sensitivity (NS).

METHODS

The study is epidemiological in nature. A total of 474 subjects of four elementary schools were evaluated in conjunction with the 2014 noise map data gathered from two metropolitan regions, Seoul and Ulsan, in South Korea. Each subject completed the children's sleep habits questionnaire, and heart rate variability (HRV) was recorded. Analysis of covariance was performed using monthly income as a covariate.

RESULTS

Aircraft noise was associated with night waking (P = 0.047), whereas no significant association was observed between sleep and road traffic noise. After stratifying by NS, no significant results were obtained for road traffic noise. However, high levels of aircraft noise in the high-NS group were associated with high degrees of bedtime resistance (P = 0.049). In terms of HRV, no significant difference was observed in the results between groups.

CONCLUSION

Road traffic noise did not significantly alter sleep or autonomic activity in children, whereas aircraft noise exerted a negative effect on sleep. The findings suggest that the impact of noise on sleep in children varies depending on noise sources.

Trauma-informed neighborhoods: Making the built environment trauma-informed

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Many individuals and communities have a history of trauma.

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Neighborhood built environments can trigger re-traumatization or foster healing.

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Trauma-informed approaches merit attention in urban design and public planning.

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Research is needed to explore the idea of trauma-informed neighborhoods.

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Trauma-informed neighborhoods may promote individual and community well-being.

Trauma is a response to a deeply distressing or disturbing event, such as sexual assault, violent crime, or childhood abuse. Trauma has impacted the majority of Americans, with racial/ethnic minority and socioeconomically disadvantaged populations being disproportionately affected. Extensive evidence demonstrates trauma’s harmful effects on physical and psychosocial functioning and healthcare costs. Over the past decade, there has been greater recognition of the need to respond to trauma across various care delivery and program settings. Such recognition led to development of trauma-informed care, an approach that acknowledges trauma’s widespread impact and delivers care in a manner to promote healing and avoid re-traumatization. To date, trauma-informed approaches have been applied to clinical interventions, social programs, and community organizations. However trauma-informed approaches have not been widely applied to the built environment. Here, we propose the concept of a trauma-informed neighborhood. The idea of a trauma-informed neighborhood has not been elucidated in public health or medicine, yet merits attention because physical aspects of the neighborhood environment, such as lighting, traffic density, noise, and greenspace, may either trigger trauma or promote healing for individuals and communities. Research using geospatial, population health, and community-engaged approaches is needed and could build from the existing literature on how the built environment impacts mental health. Evidence would have direct implications for public policy and urban planning, particularly for neighborhoods where residents bear a disproportionate trauma burden. Until the built environment is routinely included in trauma-informed efforts, a key setting that influences trauma recovery, health, and well-being will remain overlooked.

Associations between road traffic noise exposure at home and school and ADHD in school-aged children: the TRAILS study

Environmental noise may play a role in the manifestation and severity of attention deficit/hyperactivity disorder (ADHD) symptoms, but evidence is limited. We investigated the cross-sectional associations between residential and school road traffic noise exposure and ADHD symptoms and diagnosis. The sample included n = 1710, 10-12-year-old children from the TRAILS study in The Netherlands. ADHD symptoms were measured using a DSM-IV based subscale from the Child Behavior Checklist. Children with diagnosed ADHD originated from the clinic-referred cohort. Road traffic noise (L_den) was estimated at the residence and school level, by model calculation. Risk ratios for ADHD symptoms and ADHD diagnoses, and regression coefficients for symptom severity were estimated separately and simultaneously for residential and school road traffic noise. Adjusted multinomial models with residential road traffic noise showed that residential noise was not associated with ADHD symptoms, but was associated with lower risks for ADHD diagnosis (RR = 0.93; 95% CI 0.89, 0.97). Similar associations were observed for models including school road traffic noise and models including both exposures. No clear exposure response relationship was observed for associations between residential or school noise and ADHD symptom severity. We found no evidence for a harmful association between road traffic noise and ADHD. Associations between noise and lower risks for ADHD were observed only in referred cases with a confirmed ADHD diagnosis and may be due to residual confounding or selection bias. Future studies should focus on residential and school noise exposure, and study associations with ADHD symptoms and diagnosis over time.

Exposure assessment to road traffic noise levels and health effects in an arid urban area

Road traffic noise exposures have been recognized as serious environmental health concerns, especially in most developing countries with arid climate conditions, rapid increase in vehicle population, and limited traffic management systems. The excessive noise exposure level is associated with increase in the incidence of cardiovascular diseases and anxiety, including annoyance. This study aimed at determining traffic noise levels in residential areas, including the assessment of its annoyance and health effects based on the people's perception and reportage. To do so, field measurement and traffic noise modeling were carried out in six road points to estimate the current noise levels along various roads close to human inhabitants in Muscat Governorate, Sultanate of Oman. The detailed measured noise levels in urban residential areas across the selected roads showed that noise levels have exceeded the local and international threshold limits at all locations during the entire day. The high sound levels (48.0-56.3 dBA) were observed using the US Federal Highway Administration's Traffic Noise Model (TNM, version 2.5) results, which were in agreement with the observed (56.3-60.4 dBA) data. To assess health implication to residents through interviews (n = 208), annoyance at home was found to be little (32%), moderate (28%), and high (9%) in comparison with workplace settings of 42%, 43%, and 15%, respectively. Nineteen percent of the interviewees had difficulties in sleeping, while 19.8% experienced stress due to road traffic noise exposures. Moreover, a strong association (p < 0.05) was established between the use and objection of noise barriers. The study revealed high noise levels and the prevalence of annoyance and health effects among the exposed population. Therefore, immediate action is required to tackle the current noise levels.

Association of the Built Environment With Childhood Psychosocial Stress

IMPORTANCE

Emerging research suggests that factors associated with the built environment, including artificial light, air pollution, and noise, may adversely affect children's mental health, while living near green space may reduce stress. Little is known about the combined roles of these factors on children's stress.

OBJECTIVE

To investigate associations between components of the built environment with personal and home characteristics in a large cohort of children who were assessed for perceived stress.

DESIGN, SETTING, AND PARTICIPANTS

In this cohort study, a total of 2290 Southern California Children's Health Study participants residing in 8 densely populated urban communities responded to detailed questionnaires. Exposures of artificial light at night (ALAN) derived from satellite observations, near-roadway air pollution (NRP) determined from a dispersion model, noise estimated from the US Traffic Noise Model, and green space from satellite observations of the enhanced vegetation index were linked to each participant's geocoded residence.

MAIN OUTCOMES AND MEASURES

Children's stress was assessed at ages 13 to 14 years and 15 to 16 years using the 4-item Perceived Stress Scale (PSS-4), scaled from 0 to 16, with higher scores indicating greater perceived stress. Measurements were conducted in 2010 and 2012, and data were analyzed from February 6 to August 24, 2019. Multivariate mixed-effects models were used to examine multiple exposures; modification and mediation analyses were also conducted.

RESULTS

Among the 2290 children in this study, 1149 were girls (50%); mean (SD) age was 13.5 (0.6) years. Girls had significantly higher perceived stress measured by PSS-4 (mean [SD] score, 5.7 [3.4]) than boys (4.9 [3.2]). With increasing age (from 13.5 [0.6] to 15.3 [0.6] years), the mean PSS-4 score rose from 5.6 (3.3) to 6.0 (3.4) in girls but decreased for boys from 5.0 (3.2) to 4.7 (3.1). Multivariate mixed-effects models examining multiple exposures indicated that exposure to secondhand smoke in the home was associated with a 0.85 (95% CI, 0.46-1.24) increase in the PSS-4 score. Of the factors related to the physical environment, an interquartile range (IQR) increase in ALAN was associated with a 0.57 (95% CI, 0.05-1.09) unit increase in the PSS-4 score together with a 0.16 score increase per IQR increase of near-roadway air pollution (95% CI, 0.02-0.30) and a -0.24 score decrease per IQR increase of the enhanced vegetation index (95% CI, -0.45 to -0.04). Income modified the ALAN effect size estimate; participants in households earning less than $48 000 per year had significantly greater stress per IQR increase in ALAN. Sleep duration partially mediated the associations between stress and both enhanced vegetation index (17%) and ALAN (18%).

CONCLUSIONS AND RELEVANCE

In this cohort study, children's exposure to smoke at home in addition to residential exposure to ALAN and near-roadway air pollution were associated with increased perceived stress among young adolescent children. These associations appeared to be partially mitigated by more residential green space. The findings may support the promotion of increased residential green spaces to reduce pollution associated with the built environment, with possible mental health benefits for children.

Associations of Green Spaces and Streets in the Living Environment with Outdoor Activity, Media Use, Overweight/Obesity and Emotional Wellbeing in Children and Adolescents

Aspects of the living environment can affect health and wellbeing of children and adolescents. Whereas most previous studies assessed the more distant residential urban environment, less is known on possible effects of the close environment. The present study investigated associations of the proportion of streets and green spaces in the immediate urban living environment (50, 100 and 400 m around the home) with media use, outdoor activity, overweight/obesity and emotional problems in two samples of younger (age 3–10, n = 395) and older children (age 10–19, n = 405). Independently of socioeconomic parameters, a higher proportion of streets was associated with overweight/obesity (in younger and older children), higher media use (in younger children), less outdoor activity and more emotional problems (in older children). Older children’s outdoor activity in winter increased with increasing proportions of green spaces. The observations suggest that the immediate urban living environment is a factor that can affect leisure behavior and health in children.

Nephrotoxic effects caused by co-exposure to noise and toluene in New Zealand white rabbits: A biochemical and histopathological study

The biological and renal effects made by simultaneous and non-simultaneous exposure to toluene and noise were investigated. Twenty-four New Zealand white rabbits were exposed to 100 dB of white noise and 1000 ppm of toluene vapor for two weeks. The examined biochemical factors were urea, uric acid, creatinine, glucose, triglyceride, cholesterol, and albumin serum levels, measured on different days after the end of the exposure. Moreover, glutathione peroxidase activity (GPX), malondialdehyde dismutase activity (MDA), and superoxide dismutase (SOD) parameters were measured in the kidney tissue. The hematoxylin and eosin staining method was used for histopathological experiments. Overall, the noise increased albumin, uric acid, creatinine, and glucose levels, but it decreased urea, cholesterol, and triglyceride levels. Toluene decreased albumin, uric acid, and urea levels, while it increased creatinine, triglyceride, cholesterol, and glucose levels. Simultaneous exposure to noise and toluene decreased albumin, uric acid, cholesterol, and urea levels, whereas it increased creatinine, glucose, and triglyceride levels. GPX, MDA, and SOD levels increased by simultaneous and non-simultaneous exposure to noise and toluene. Furthermore, massive tubular degeneration, tubular cell vacuolization, glomerular disorganization, congestion, glomerular cell shrinkage, and unclear brush border were detected in the kidney tissue.

The mediating effect of self-esteem on the relationship of living environment, anxiety, and depression of underprivileged children: A path analysis in Chinese context

This study aimed to explore the relationships of living environment, self-esteem, anxiety, and depression of children in poverty. A sample of 1314 children (grades 4–9) was collected by a school-based survey in Xiushui city, Mainland China. Structural equation modeling was adopted to analyze the data and verify the hypothesized model. Results showed that living environment was negatively correlated with poor children’s anxiety and depression levels, and self-esteem had a mediating effect on the relationship between living environment and the mental health of underprivileged children. Based on these findings, we proposed relevant theoretical and practical implications.

Effect of parking lanes on assessing the impact of road traffic noise on building façades

The use of strategic noise maps as a means for estimating population exposure to environmental noise and defining action plans to mitigate its effects on human health has become a reality since the publication of the European Noise Directive. In this context, it is known that some differences can be found between the values obtained for sound indicators through simulation and measurements due to different causes. One of these factors is the presence of elements in urban environments not currently considered in calculation methods but certainly present in validation measurements. This paper presents an assessment of the acoustic shielding effect due to parked vehicles on urban streets using computational methods. First of all, a process of validation of the software model by means of different simulation methods and in situ measurements was carried out. Then, a study was developed varying different variables related to urban planning and noise modelling, as well as considering different typologies of real streets according to a categorisation method. Broadband results show that this shielding effect can be significant in common configurations in urban environments, even to receiver heights of 4 m considered as a reference in strategic noise maps. The magnitude of this effect varied depending on the distances between the building façade, parked vehicles and sound sources, as well as the receiver height. Differences up to 4 dBA in sound levels were found in several configurations between situations without and with cars parked at 4 m, although in some specific cases it reached up to 8 dBA. Therefore, results of this study indicated that parking lane shielding effect should be considered in calculations and validation measurements for strategic noise maps in order to obtain an adequate estimation of population exposure to road traffic noise.

Influence of Classroom Acoustics on Noise Disturbance and Well-Being for First Graders

Several studies have shown so far that poor acoustics inside classrooms negatively affects the teaching and learning processes, especially at the lowest grades of education. However, the extent to which noise exposure or excessive reverberation affect well-being of children at school in their early childhood is still unanswered, as well as their awareness of noise disturbance. This work is a pilot study to investigate to which extent classroom acoustics affects the perceived well-being and noise disturbance in first graders. About 330 pupils aged from 6 to 7 years participated in the study. They belonged to 20 classes of 10 primary schools located in Torino (Italy), where room acoustic measurements were performed and where noise level was monitored during classes. The school buildings and the classrooms were balanced between socioeconomic status and acoustic conditions. Trained experimenters administered questionnaires in each class, where pupils answered all together during the last month of the school year (May). Questions included the happiness scale, subscales assessing self-esteem, emotional health, relationship at home and with friends, enjoyment of school, intensity and noise disturbance due to different sound sources, and quality of voice. The findings of the study suggest that long reverberation times, which are associated with poor classroom acoustics as they generate higher noise levels and degraded speech intelligibility, bring pupils to a reduced perception of having fun and being happy with themselves. Furthermore, bad classroom acoustics is also related to an increased perception of noise intensity and disturbance, particularly in the case of traffic noise and noise from adjacent school environments. Finally, happy pupils reported a higher perception of noise disturbance under bad classroom acoustic conditions, whereas unhappy pupils only reported complaints in bad classroom acoustics with respect to the perception of pleasances with himself or herself and of fitting in at school. Being a mother tongue speaker is a characteristic of children that brings more chances of attending classes in good acoustics, of being less disturbed, and of having more well-being, and richer districts presented better acoustic conditions, in turn resulting in richer districts also revealing a greater perception of well-being.

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.

Population-Based Approaches to Mental Health: History, Strategies, and Evidence

There is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: (a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, (b) public health practice interventions that can be implemented by public health department officials, and (c) health care system interventions that can be implemented by hospital and health care system leaders.

Associations of exposure to green space with problem behaviours in preschool-aged children

Background

Limited evidence is available regarding the association of green-space exposure with childhood behavioural development. This study aimed to investigate the associations of exposure to green space with multiple syndromes of behavioural development in preschool children.

Methods

This cross-sectional study was conducted in Wuhan, China from April 2016 to June 2018. We recruited a sample of 6039 children aged 5–6 years from 17 kindergartens located in five urban districts of the city. We measured the greenness using average Normalized Difference Vegetation Index (NDVI) within a circular buffer area of 100 metres surrounding the central point of residences and kindergartens. We calculated the residence–kindergarten-weighted greenness by assuming that children spent 16 hours per day at home and 8 hours at kindergarten. The problem behaviours of children were evaluated at kindergarten using the Childhood Behavioral Checklist (CBCL) and standardized into problem behavioural T scores. Linear mixed-effect models and linear-regression models were used to estimate the associations.

Results

We observed decreases in problem behaviours associated with kindergarten and residence–kindergarten-weighted surrounding greenness in preschool children. For example, a one-interquartile range increase in kindergarten and residence–kindergarten-weighted NDVI was associated with decreased T scores for total behaviour by −0.61 [95% confidence interval (CI): −1.09, −0.13) and −0.49 (95% CI −0.85, −0.12), anxiety and depression by −0.65 (95% CI: −1.13, −0.17) and −0.46 (95% CI: −0.82, −0.10), aggressive behaviour by −0.53 (95% CI: −1.01, −0.05) and −0.38 (95% CI: −0.75, −0.02) and hyperactivity and attention deficit by −0.54 (95% CI: −1.01, −0.07) and −0.48 (95% CI: −0.83, −0.12), respectively. Stratified analyses indicated that the associations of green-space exposure with problem behaviours were stronger in boys than in girls.

Conclusions

Children attending kindergartens with higher levels of surrounding green space exhibited better behavioural development. The mechanisms underlying these associations should be explored further.

Negative impact of noise and noise sensitivity on mental health in childhood

Introduction:

Noise and noise sensitivity have negative effects on mental health and are not well-studied in children and adolescents. In this study, we investigated these effects in the aforementioned population with respect to sociodemographic variables and environmental factors.

Materials and Methods:

In this population-based study conducted in two large cities in South Korea, 918 elementary and middle-school students were included. After direct measurements at the selected sites, a noise map was created using an interpolation method. The road traffic noise of the participants’ residential areas was calculated based on this noise map. Noise sensitivity was assessed on an 11-point Likert scale. Using multivariate logistic regression, we investigated the relationship among noise, noise sensitivity, and the Child Behavior Checklist. Further analyses were performed subdividing the data according to household income levels.

Results:

Noise sensitivity was significantly associated with internalizing, externalizing, and total behavioral problems. Noise was positively associated with total behavioral problems. In the low-income group, the degree of association with problem behaviors was higher, whereas the relationship between noise sensitivity and externalization problems disappeared in the high-income group.

Conclusion:

Noise and noise sensitivity are negatively associated with the mental health of children and adolescents, particularly in low-income groups. The findings of this study suggest that noise sensitivity and socioeconomic status should be considered in coping with negative effects of noise in children and adolescents.

Behavioral and Emotional Disorders and Transportation Noise among Children and Adolescents: A Systematic Review and Meta-Analysis

Children and adolescents may be particularly vulnerable to environmental influences such as noise which can affect mental well-being. The aim of this systematic review was to evaluate the effect of transportation noise on behavioral and emotional disorders in children and adolescents using a meta-analytic approach. Therefore, we searched four databases (Pubmed, Embase, PsychINFO, and PSYNDEX) and grey literature until February of 2019. We identified 14 articles from 10 studies examining the effect of transportation noise exposure on the mental health of children. These studies predominately used the Strength and Difficulties Questionnaire (SDQ) and mainly focused on schoolchildren and adolescents aged 9–10 years and 15–17 years in Europe. Three studies could be included in the meta-analysis. In sum, the odds for hyperactivity/inattention and total difficulties was significantly increased by 11% (Odds Ratio, OR = 1.11 (95% Confidence Interval, CI 1.04–1.19), respectively 9% (95% CI 1.02–1.16) per 10 dB road traffic noise. Thus, we obtained evidence for an effect of road traffic noise on hyperactivity/inattention and total difficulties, although we could consider few studies. Future studies are needed that use similar techniques to assess outcomes and exposures at schools and in homes. This would make it possible to conduct an individual participant data pooled analysis of the data.

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.

Social disparities in exposure to noise at public schools in the contiguous United States

Children are vulnerable to environmental hazards and spend significant portions of their days at school. However, just one national-level study has examined school-level environmental inequalities (in air pollution exposures), and none have examined disparate exposures to noise pollution, even though noise impacts children's health and development. We integrated data from 2014-2015 on the locations and socio-demographics of each public school in the contiguous US (n=94,432) with road and aviation transportation noise estimates. Using bivariate and multivariate statistics, we tested for disparities in road and aviation noise exposure across schools. Among the 49,697,890 children attending contiguous US public schools, we found that those attending schools most highly exposed to road noise or aviation noise were significantly more likely to be eligible for free/reduced price meals (economically deprived), and to be Hispanic, black, or Asian/Pacific Islander (API). They were less likely to be white or of another race. In multivariate generalized estimating equations (GEEs) controlling for school district effects, we found that schools with greater proportions of Hispanic, black or API students, schools with higher enrollment, and schools serving the youngest students had significantly more road noise and greater odds of aviation noise exposure. In the GEEs, a higher proportion of economically-deprived students in schools was associated with greater road noise, but not aviation noise. Overall, our analyses indicate that America's racial/ethnic minority children bear the brunt of transportation noise exposures at school, which may unequally impact their academic performance, health, and future potential.

Traffic noise exposure of high-rise residential buildings in urban area

Noise pollution is a major factor of environmental complaints in many cities, which has significant impacts on human health. As a dominating source of environmental noise, the impact of road traffic noise is increasing. Residents living in high-rise buildings along the main road are severely affected by traffic noise. In order to assess the noise level of urban area along the main road in Guangzhou, three buildings were selected to conduct traffic noise measurements, and the questionnaire about traffic noise impact on human being was completed. Through the questionnaire, around 70% of participants consider the traffic noise has negative effect, and about 60% of participants consider the noise has moderate or much higher impact on physical comfort. Around 65% of participants consider the noise had moderately or much higher impact on their psychological comfort. By analyzing the measured data, all of the measured noise levels in three buildings exceed the recommended limit of 55 dB (A) in the daytime and 45 dB (A) in the night for residence, and the exceeded value can be up to 16 dB (A). By comparing the fitting curve of noise level transfer function on each floor relative to the reference floor, the quadratic polynomial was selected to plot the transfer function rather than cubic polynomial.

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Quality of Life, Wellbeing and Mental Health

This systematic review assesses the quality of the evidence across studies on the effect of environmental noise (road traffic noise, aircraft noise, railway noise, wind-turbine noise) on quality of life, wellbeing and mental health. Quantitative studies of noise effects on children and adults published from January 2005 up to October 2015 were reviewed. A total of 29 papers were identified. 90% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. Outcomes included depression and anxiety, medication use and childhood emotional problems. The quality of the evidence across the studies for each individual noise source was assessed using an adaptation of the GRADE methodology. Overall, given the predominance of cross-sectional studies, most evidence was rated as very low quality, with evidence of effects only being observed for some noise sources and outcomes. These ratings reflect inconsistent findings across studies, the small number of studies and a lack of methodological robustness within some domains. Overall, there are few studies of clinically significant mental health outcomes; few studies of railway noise exposure; and studies of large samples are needed. The lack of evidence for noise effects across studies for many of the quality of life, wellbeing and mental health domains examined does not necessarily mean that there are no effects: rather, that they have not yet been studied robustly for different noise sources.

Traffic noise, noise annoyance and psychotropic medication use

BACKGROUND

Road-traffic noise can induce stress, which may contribute to mental health disorders. Mental health problems have not received much attention in noise research. People perceive noise differently, which may affect the extent to which noise contributes to poor mental health at the individual level. This paper aims to assess the relationships between outdoor traffic noise and noise annoyance and the use of psychotropic medication.

METHODS

We conducted a survey to assess noise annoyance and psychotropic medication among residents of the Helsinki Capital Region of Finland. We also assessed the associations of annoyance and road-traffic noise with sleep disorders, anxiety and depression. Respondents were randomly sampled from the Finnish Population registry, and data was collected using a self-administered questionnaire. Outdoor traffic noise was modelled using the Nordic prediction model. Associations between annoyance and modelled façade-noise levels with mental health outcome indicators were assessed using a binary logistic regression while controlling for socioeconomic, lifestyle and exposure-related factors.

RESULTS

A total of 7321 respondents returned completed questionnaires. Among the study respondents, 15%, 7% and 7% used sleep medication, anxiolytic and antidepressant medications, respectively, in the year preceding the study. Noise annoyance was associated with anxiolytic drug use, OR = 1.41 (95% CI: 1.02-1.95), but not with sedative or antidepressant use. There was suggestive association between modelled noise at levels higher than 60 dB and anxiolytic or antidepressant use. In respondents whose bedroom windows faced the street, modelled noise was definitively associated with antidepressant use. Noise sensitivity did not modify the effect of noise but was associated with an increased use of psychotropic medication.

CONCLUSION

We observed suggestive associations between high levels of road-traffic noise and psychotropic medication use. Noise sensitivity was associated with psychotropic medication use.

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.

Residential road traffic noise and general mental health in youth: The role of noise annoyance, neighborhood restorative quality, physical activity, and social cohesion as potential mediators

Given the ubiquitous nature of both noise pollution and mental disorders, their alleged association has not escaped the spotlight of public health research. The effect of traffic noise on mental health is probably mediated by other factors, which have not been elucidated sufficiently. Herein, we aimed to disentangle the pathways linking road traffic noise to general mental health in Bulgarian youth, with a focus on several candidate mediators - noise annoyance, perceived restorative quality of the living environment, physical activity, and neighborhood social cohesion. A cross-sectional sample was collected in October - December 2016 in the city of Plovdiv, Bulgaria. It consisted of 399 students aged 15-25years, recruited from two high schools and three universities. Road traffic noise exposure (L_den) was derived from the strategic noise map of Plovdiv. Mental health was measured with the 12-item form of the General Health Questionnaire (GHQ-12). Noise annoyance, perceived restorative quality of the living environment, commuting and leisure time physical activity, and neighborhood social cohesion were assessed using validated questionnaires. Analyses were based on linear regression mediation models and a structural equation modeling (SEM) to account for the hypothesized interdependencies between candidate mediators. Results showed that higher noise exposure was associated with worse mental health only indirectly. More specifically, tests of the single and parallel mediation models indicated independent indirect paths through noise annoyance, social cohesion, and physical activity. In addition, the SEM revealed that more noise annoyance was associated with less social cohesion, and in turn with worse mental health; noise annoyance was also associated with lower neighborhood restorative quality, thereby with less social cohesion and physical activity, and in turn with worse mental health. However, causality could not be established. Further research is warranted to expand our still limited understanding of these person-environment interactions.

The mediating effect of self-esteem on the relationship of living environment, anxiety, and depression of underprivileged children: A path analysis in Chinese context

This study aimed to explore the relationships of living environment, self-esteem, anxiety, and depression of children in poverty. A sample of 1314 children (grades 4-9) was collected by a school-based survey in Xiushui city, Mainland China. Structural equation modeling was adopted to analyze the data and verify the hypothesized model. Results showed that living environment was negatively correlated with poor children's anxiety and depression levels, and self-esteem had a mediating effect on the relationship between living environment and the mental health of underprivileged children. Based on these findings, we proposed relevant theoretical and practical implications.

Effect of mass housing settlement type on the comfortable open areas in terms of noise

The layout of the structures according to the noise source is an important parameter in terms of the level of noise reaching to both open usage areas and the structure surfaces. In this paper, it is aimed to reveal the effect of mass housing settlement type on the size of suitable open usage areas in terms of noise. Comfortable open usage areas in 25 mass housing alternatives are determined for the case of being affected by three different road noises. The reliability of the simulation results is validated by on-site noise level measurements. As a result, it is seen that better results are obtained in linear, L, C, and U type alternatives than point-type blocks. Especially in alternatives consisting of point-and linear-type blocks, if the noise level is above 75 Leq (dBA), the percentage of comfortable open usage areas is very low. It is determined that the percentage of comfortable open areas increases between 50 and 100% by means of appropriately designed noise barriers.

The role of traffic noise on the association between air pollution and children's lung function

Although it has been shown that traffic-related air pollution adversely affects children's lung function, few studies have examined the influence of traffic noise on this association, despite both sharing a common source. Estimates of noise exposure (L_dn, dB), and freeway and non-freeway emission concentrations of oxides of nitrogen (NO_x, ppb) were spatially assigned to children in Southern California who were tested for forced vital capacity (FVC, n=1345), forced expiratory volume in 1s, (FEV_1, n=1332), and asthma. The associations between traffic-related NO_x and these outcomes, with and without adjustment for noise, were examined using mixed effects models. Adjustment for noise strengthened the association between NO_x and reduced lung function. A 14.5mL (95% CI -40.0, 11.0mL) decrease in FVC per interquartile range (13.6 ppb) in freeway NO_x was strengthened to a 34.6mL decrease after including a non-linear function of noise (95% CI -66.3, -2.78mL). Similarly, a 6.54mL decrease in FEV₁ (95% CI -28.3, 15.3mL) was strengthened to a 21.1mL decrease (95% CI -47.6, 5.51) per interquartile range in freeway NO_x. Our results indicate that where possible, noise should be included in epidemiological studies of the association between traffic-related air pollution on lung function. Without taking noise into account, the detrimental effects of traffic-related pollution may be underestimated.

A preliminary investigation of noise impact within metro stations in the urban city of Guangzhou, China

The noise in the metro station is synthesized from a variety of different noise sources. Excessive noise exposure will bring serious impacts on humans' health. To alleviate the shortage of the urban land, most metro stations are planning to develop convenience stores and shopping malls. In order to evaluate the potential noise impact on humans' comfort in the metro stations, this study selected four representative stations of Guangzhou Metro Line 1 to carry out a preliminary questionnaire survey of 226 respondents for the perception and perform a noise measurement. Additionally, platform screen doors as a potential method for noise mitigation were examined. The results show that the noise caused by trains was dominant in the metro stations; however, the noise impact by public broadcast and passengers cannot be ignored. The noise levels of the transfer stations were obviously greater than the normal stations, especially during the peak hours. In addition, people in the metro stations have potential exposure to noise that the noise levels exceed the criteria limit of China, which would bring discomfort for humans; however, the normal activities of people would not be impacted. The platform screen doors should be further improved or relevant noise mitigation methods should be taken into account to reduce the noise level within the criteria limit.

Effects of noise on telephone calls to the Madrid Regional Medical Emergency Service (SUMMA 112)

BACKGROUND

Although the effects of noise on population morbidity and mortality have been observed both in the short and long term, the morbidity and mortality indicators used to date have not enabled information on such health effects to be accessed in real time. At an international level, there are relatively few studies, mostly recent, which have considered an alternative indicator, such as the demand for medical attention provided by emergency services, taking into account environmental factors other than noise.

OBJECTIVES

To ascertain the short-term effect of road-traffic noise levels on medical care, broken down by organic, circulatory and respiratory causes, provided by the Madrid Regional Medical Emergency Service (Servicio de Urgencia Médica de Madrid/SUMMA 112).

METHODS

We used an ecological time-series study and fitted Poisson regression models, to analyse the number of daily, cause-specific episodes of care provided in situ by SUMMA 112, via emergency ambulance dispatches, across the period 01/01/2008-31/12/2009. To this end, we considered diurnal (Leqd: 7-23h), nocturnal (Leqn: 23-7h) and daily (Leq24: 24h) noise (in db(A)) as the principal factor, and chemical air pollution (µg/m³) and temperature (°C) as the control variables. We also controlled for trend and seasonalities, the autoregressive nature of the series, and day of the week.

RESULTS

Nocturnal noise exceeded the WHO threshold (55 db(A)) on 100% of nights, despite displaying a downward trend across the study period. For all causes, with the exception of emergency calls due to ischaemic disease, it was nocturnal rather than diurnal noise levels that had a short-term effect (lags 0-1) on SUMMA 112 calls, with this impact being greater for respiratory than for circulatory causes. Hence, for every increase of 1db in Leqn, the relative risks (RRs) were as follows: 1.11 (95% CI 1.09-1.13) for organic causes; 1.14 (95% CI: 1.11-1.18) for respiratory causes; and 1.08 (95% CI: 1.05-1.10) for circulatory causes.

CONCLUSION

SUMMA 112 data give access to real-time information on the health effects associated with increases in noise levels, which cannot be obtained via mortality or hospital-admission data, since these are collected in the longer term. Accordingly, this is something that would be immediately applicable in any future implementation of a syndromic surveillance system focusing on the effects of environmental pollutants on health.