Determinants of non-vaccination against seasonal influenza during pregnancy.

OBJECTIVE: The objective of this study was to identify the determinants of influenza non-vaccination during pregnancy in Canada. METHODS: Biological mothers of children born between December 2018 and March 2019 were surveyed about vaccinations they had received during pregnancy, reasons for non-vaccination, obstetrical history, and demographics. Simple and multiple logistic regression models were used to measure associations between various sociodemographic factors as well as obstetrical history, and non-vaccination against influenza. We analyzed data from 2361 mothers. RESULTS: Factors associated with non-vaccination included being followed during pregnancy by a midwife compared to by an obstetrician-gynecologist (OR 2.02; 95% CI, 1.17‒3.50); having two or more past live births compared to none (OR 1.58; 95% CI, 1.01‒2.49); having an education level below high school diploma compared to a bachelor's degree or above (OR 2.50; 95% CI, 1.06‒5.90); and having a household income below $60,000 (OR 2.46; 95% CI, 1.42‒4.24) or between $60,000 and $99,999 (OR 2.77; 95% CI, 1.70‒4.52) compared to a household income of $140,000 or more. The province or territory of prenatal care proved to be an important factor in non-vaccination, with statistically significant odds ratios for certain provinces: OR 7.50 (95% CI, 1.40‒40.26) for Ontario, 8.23 (95% CI, 1.53‒44.23) for Newfoundland and Labrador, and 11.39 (95% CI, 2.14‒60.60) for Quebec, as compared to the territories. CONCLUSION: Despite universal access to influenza vaccines in Canada during pregnancy, regional variations and socioeconomic disparities in non-vaccination are still observable.

RéSUMé: OBJECTIF: Identifier les déterminants de la non-vaccination contre la grippe pendant la grossesse au Canada. MéTHODES: Notre étude porte sur 2 361 mères biologiques d'enfants nés entre décembre 2018 et mars 2019 qui ont été interrogées sur les vaccins reçus pendant leur grossesse, les raisons de non-vaccination, leurs antécédents obstétricaux, et leurs caractéristiques démographiques. Des modèles de régression logistique simple et multiple ont été utilisés pour mesurer les associations entre divers facteurs sociodémographiques, les antécédents obstétricaux, et la non-vaccination contre l'influenza. RéSULTATS: Les facteurs associés à la non-vaccination comprennent le suivi de grossesse par une sage-femme par rapport à un obstétricien-gynécologue (RC 2,02; IC 95% : 1,17‒3,50); avoir eu deux naissances vivantes ou plus par rapport à aucune (RC 1,58; IC 95% : 1,01‒2,49); avoir une scolarité inférieure au diplôme d'études secondaires par rapport à un baccalauréat ou plus (RC 2,50; IC 95% : 1,06‒5,90); et avoir un revenu du ménage inférieur à 60 000 $ (RC 2,46; IC 95% : 1,42‒4,24) ou entre 60 000 $ et 99 999 $ (RC 2,77; IC 95% : 1,70‒4,52) par rapport à un revenu ménager de 140 000 $ ou plus. La province ou le territoire de soins prénataux s'est avéré un facteur important de la non-vaccination avec des rapports de cote statistiquement significatifs pour certaines provinces : RC 7,50 (IC 95% : 1,40‒40,26) pour l'Ontario, 8,23 (IC 95% : 1,53‒44,23) pour Terre-Neuve-et-Labrador, et 11,39 (IC 95% : 2,14‒60,60) pour le Québec, comparativement aux territoires. CONCLUSION: Malgré l'accès universel aux vaccins antigrippaux au Canada durant la grossesse, des variations régionales et des disparités socioéconomiques en non-vaccination persistent.

Determinants of parental vaccine hesitancy in Canada: results from the 2017 Childhood National Immunization Coverage Survey.

BACKGROUND: In 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS). METHOD: The 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents' Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated. RESULTS: Both unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2-2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4-3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among non-immigrant parents (aOR 0.4, 95% CI 0.3-0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3-12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1-22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed. CONCLUSION: Several sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs.

Racial disparities in COVID-19 vaccination in Canada: results from the cross-sectional Canadian Community Health Survey.

BACKGROUND: Racial and ethnic disparities in COVID-19 vaccination coverage have been observed in Canada and in other countries. We aimed to compare vaccination coverage for at least 1 dose of a COVID-19 vaccine between First Nations people living off reserve and Métis, Black, Arab, Chinese, South Asian and White people. METHODS: We used data collected between June 2021 and June 2022 by Statistics Canada's Canadian Community Health Survey, a large, nationally representative cross-sectional study. The analysis included 64 722 participants aged 18 years or older from the 10 provinces. We used a multiple logistic regression model to determine associations between vaccination status and race, controlling for collection period, region of residence, age, gender and education. RESULTS: Nonvaccination against COVID-19 was more frequent in off-reserve First Nations people (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2-2.7) and Black people (adjusted OR 1.7, 95% CI 1.1-2.6), and less frequent among South Asian people (adjusted OR 0.3, 95% CI 0.1-0.7) compared to White people. INTERPRETATION: This analysis showed significant inequalities in COVID-19 vaccine uptake between racial/ethnic populations in Canada. Further research is needed to understand the sociocultural, structural and systemic facilitators of and barriers to vaccination across racial groups, and to identify strategies that may improve vaccination uptake among First Nations and Black people.

Childhood exposure to pyrethroids and neurodevelopment in Canadian preschoolers.

BACKGROUND: Pyrethroid insecticides are used both residentially and agriculturally and their toxicity targets the nervous system of insects. They might also interfere with development and function of the human brain. A few epidemiological studies suggest that exposure to pyrethroids may be associated with neurobehavioral problems in children but there is little data on potential associations with cognitive outcomes. Furthermore, many studies showed that the neurotoxic effects of several pesticides are modified by sex, hence, considerations of potential sex-differences are important to investigate. OBJECTIVE: To study the cross-sectional association between urinary levels of pyrethroid metabolites and neurodevelopment, including neurobehavioral and cognitive outcomes, in preschool-age children, and to examine whether sex might modify these associations. METHODS: We used data from a follow-up examination of the Maternal-Infant Research on Environmental Chemicals (MIREC), the MIREC Child Development study (MIREC-CD Plus) on children at age 3-4 years living in 6 Canadian cities. For each participant, we collected a urine sample for measurements of pyrethroids metabolites (cis-DBCA, cis-DCCA, trans-DCCA, 3-PBA, 4-F-3-PBA). We assessed neurodevelopment with the Wechsler Primary and Preschool Scale of Intelligence-III (WPPSI-III) and two scales of the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P). Parents reported children's behavior using the Behavior Assessment System for Children-2 (BASC-2) and the Social Responsiveness Scale-2 (SRS-2). We examined associations between children's urinary pyrethroid metabolite concentrations and neurodevelopmental scores with multiple linear regression models, adjusting for confounders, in boys and girls separately. RESULTS: The study included 179 children (mean age: 3.2 y, range 2.8-4.0). The detection frequencies were high for most pyrethroid metabolites (83-100%), but lower for 4-F-3-PBA (36%). Higher concentrations of cis-DBCA were significantly associated with lower verbal, performance and full-scale IQ scores in boys (e.g., for a 2-fold increase in cis-DBCA, ß = -2.0; 95% CI: -3.4, -0.6 for full-scale IQ). In girls, the only metabolite associated with cognitive scores was 3-PBA, which was associated with lower verbal IQ scores (ß = -1.3, 95% CI: -2.6, -0.1). For neurobehavioral outcomes in boys, there were associations between poorer BASC-2 Adaptive Skills scores with higher concentrations of cis-DCCA (ß = -1.6, 95% CI: -2.3, -0.9), trans-DCCA (ß = -1.5, 95% CI: -2.2, -0.8), 3-PBA (ß = -1.7, 95% CI: -2.5, -0.9), and sum of pyrethroid metabolites (ß = -1.8, 95% CI: -2.6, -0.9). In girls, we observed a significant association between higher concentration of cis-DCCA and better BASC-2 Adaptive Skills score (ß = 1.0; 95% CI, 0.2, 1.8), but not with other urinary pyrethroids metabolites. Scores on the SRS-2 and BRIEF-P were not associated with pyrethroid metabolites. CONCLUSION: There were associations between some pyrethroid pesticide metabolites and indicators of neurodevelopmental disorder, especially among boys. These associations are in agreement with previous studies and could suggest that exposure to pyrethroid pesticides represents a risk of potential toxicity for the cognitive development of children, and a risk for behavioral development. However, the cross-sectional nature of this study limits causal inferences.

Pertussis Non-Vaccination During Pregnancy Despite Advice From Prenatal Care Providers.

OBJECTIVE: The purpose of this study was to measure the proportion of non-vaccination for pertussis in mothers in Canada who had been advised by their prenatal care provider to get vaccinated, and to identify sociodemographic factors and beliefs associated with non-vaccination. METHODS: The Survey on Vaccination during Pregnancy (part of childhood National Immunization Coverage Survey) included biological mothers of children born from September 2018 to March 2019. This analysis was restricted to 2657 mothers who had been advised by their prenatal care provider to get vaccinated against pertussis during pregnancy and knew whether or not they had been vaccinated. RESULTS: Of those who had been advised to get vaccinated against pertussis, 21% were not. This rate varied across provinces and territories, ranging from 9% in Prince Edward Island to 32% in Newfoundland and Labrador. Factors independently associated with pertussis non-vaccination included lower household income, having had past live births, and having received prenatal care from an obstetrician-gynecologist or a midwife compared to a family doctor. The risk of pertussis non-vaccination despite prenatal care advice was higher for those who disagreed that the baby would be at greater risk of pertussis if the mother did not get vaccinated. It was also higher for those who disagreed with statements regarding perceived benefits of vaccination. Conversely, disagreement with statements on perceived barriers was negatively associated with pertussis non-vaccination. CONCLUSION: These findings highlight the underlying factors associated with non-vaccination against pertussis despite prenatal care provider recommendation. Some inaccurate beliefs about pertussis and vaccination during pregnancy persist, leading to non-vaccination.

Sociodemographic Disparities in COVID-19 Vaccine Uptake and Vaccination Intent in Canada.

Introduction: This study's objective was to examine sociodemographic disparities in COVID-19 vaccine uptake and vaccination intent in the Canadian provinces by identifying factors associated with vaccine uptake in seniors prioritized for vaccination at the time of the survey and vaccination intent in all adults. Data and methods: A cross-sectional survey of Canadian adults was conducted in all provinces from mid-April to mid-May 2021. In addition to sociodemographic characteristics, respondents (n=10,678) provided information on their COVID-19 vaccination status or their intent to get vaccinated. Logistic regression models were fitted using sociodemographic factors as explanatory variables and vaccination status (unvaccinated vs at least one dose) or vaccination intent (unlikely versus likely or already vaccinated) as outcomes. To account for vaccine prioritization groups, multiple regression models were adjusted for province of residence, age, Indigenous identity and health care worker status. Results: Seniors with a lower household income (less than $60,000) and those living in smaller communities (fewer than 100,000 inhabitants) had higher odds of being unvaccinated. Among Canadian adults, the odds of being unlikely to get vaccinated were higher for males (adjusted odds ratio [AOR] 1.3), individuals younger than 60 (AOR between 3.3 and 5.1), non-health care workers (AOR 3.3), those with less than a high school education (AOR 3.4) or a household income of less than $30,000 (AOR 2.7) and individuals who do not identify as South Asian, Chinese, Black, Filipino, Arab, Latin American, Southeast Asian, West Asian, Korean or Japanese (AOR 1.7). Interpretation: COVID-19 vaccine uptake (80%) and vaccination intent (95%) were high among Canadians; however, relative disparities were observed among specific groups. Continued efforts targeted toward these groups are essential in reducing potential inequity in access or service provision.

Measuring inequalities in COVID-19 vaccination uptake and intent: results from the Canadian Community Health Survey 2021.

BACKGROUND: By July 2021, Canada had received enough COVID-19 vaccines to fully vaccinate every eligible Canadian. However, despite the availability of vaccines, some eligible individuals remain unvaccinated. Differences in vaccination uptake can be driven by health inequalities which have been exacerbated and amplified by the pandemic. This study aims to assess inequalities in COVID-19 vaccination uptake and intent in adults 18 years or older across Canada by identifying sociodemographic factors associated with non-vaccination and low vaccination intent using data drawn from the June to August 2021 Canadian Community Health Survey (CCHS). METHODS: The CCHS is an annual cross-sectional and nationally representative survey conducted by Statistics Canada, which collects health-related information. Since September 2020, questions about the COVID-19 pandemic are asked. Adjusted logistic regression models were fitted to examine associations between vaccination uptake or intent and sociodemographic and health related variables. Region, age, gender, level of education, Indigenous status, visible minority status, perceived health status, and having a regular healthcare provider were considered as predictors, among other factors. RESULTS: The analysis included 9,509 respondents. The proportion of unvaccinated was 11%. Non-vaccination was associated with less than university education (aOR up to 3.5, 95% CI 2.1-6.1), living with children under 12 years old (aOR 1.6, 95% CI 1.1-2.4), not having a regular healthcare provider (aOR 1.6, 95% CI 1.1-2.2), and poor self-perceived health (aOR 1.8, 95% CI 1.3-2.4). Only 5% of the population had low intention to get vaccinated. Being unlikely to get vaccinated was associated with the Prairies region (aOR 2.2, 95% CI 1.2-4.1), younger age groups (aOR up to 4.0, 95% CI 1.3-12.3), less than university education (aOR up to 3.8, 95% CI 1.9-7.6), not being part of a visible minority group (aOR 3.0, 95% CI 1.4-6.4), living with children under 12 years old (aOR 1.8, 95% CI 1.1-2.9), unattached individuals (aOR 2.6, 95% CI 1.1-6.1), and poor self-perceived health (aOR 2.0, 95% CI 1.3-2.9). CONCLUSIONS: Disparities were observed in vaccination uptake and intent among various sociodemographic groups. Awareness of inequalities in COVID-19 vaccination uptake and intent is needed to determine the vaccination barriers to address in vaccination promotion strategies.

Pertussis Vaccination in Canadian Pregnant Women, 2018-2019.

OBJECTIVE: This study was undertaken to measure the uptake of pertussis vaccination during pregnancy in Canada and to identify sociodemographic factors associated with non-vaccination. METHODS: A total of 5091 biological mothers of children born between September 2, 2018, and March 1, 2019, were interviewed about pertussis vaccination during their pregnancy. RESULTS: Among 4607 mothers who recalled whether they had been vaccinated for pertussis, 43% had been vaccinated and 57% had not. The main reason given by mothers for not having been vaccinated was not being aware that pertussis vaccination was recommended. Factors independently associated with non-vaccination were being born outside Canada, lower household income, living in a province or territory where pertussis vaccination was not provided free of charge, having had previous live births, and having received maternity care from a midwife. CONCLUSION: Advice from the maternity care provider is an important driver of pertussis vaccination during pregnancy.

Sleep actigraphy time-synchronized with wind turbine output.

Studies have yielded inconsistent evidence for an association between long-term average wind turbine sound pressure level (SPL) and disturbed sleep. Transient changes in sleep may be more susceptible to short-term variations in wind turbine SPL throughout the sleep period time. We analyzed sleep actigraphy data (participant sleep nights = 2,094, males = 151, females = 192) in 10 min intervals time-synchronized to wind turbine supervisory control and data acquisition. Calculated indoor wind turbine SPL was considered after adjusting for turbine rotor speed and closed/open bedroom windows. Maximum calculated nightly average wind turbine SPL reached 44.7 dBA (mean = 32.9, SD = 6.4) outdoors and 31.4 dBA (mean = 12.5, SD = 8.3) indoors. Wind turbine SPL in 10 min intervals, and nightly averages, was not statistically associated with actigraphy outcomes. However, the variability in wind turbine SPL due to changes in wind turbine operation across the sleep period time, as measured by the difference between the 10 min SPL and the nightly average SPL (∆SPL), was statistically related to awakenings (p = 0.028) and motility (p = 0.015) rates. These diminutive differences translate to less than 1 min of additional awake and motility time for a 5 dBA increase over a 450 min sleep period time. Overall results showed that wind turbine SPL below 45 dBA was not associated with any consequential changes in actigraphy-measured sleep. Observations based on ∆SPL provided some indication that a more sensitive assessment of sleep may be one that considers variations in wind turbine SPL throughout the sleep period time.

Temporal variation of total mercury levels in the hair of pregnant women from the Maternal-Infant Research on Environmental Chemicals (MIREC) study.

Prenatal exposure to total mercury (T-Hg) comes from both natural and anthropogenic sources. T-Hg can cross the blood-brain and placental barriers, and may be associated with future neurological and physiological dysfunctions. Scalp hair is an optimal and non-invasive indicator of chronic T-Hg exposure. As part of the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, hair samples from 350 women were collected within weeks after giving birth, to determine temporal variations in T-Hg levels from preconception to delivery, and to compare these levels to corresponding levels measured in other matrices (maternal and umbilical cord blood, and infant's meconium). A maximum of 12 one-cm hair segments were cut starting at the scalp; segments closer to the scalp reflected recent exposure (within the last month). For proper comparison, the hair segments were matched with the collection dates for other matrices. GM hair T-Hg levels greatly decreased during pregnancy, from 0.26 µg g-1 (preconception or full-length hair) to 0.18 µg g-1 (at delivery or segments closer to the scalp). A similar decreasing trend was found for T-Hg in maternal blood: 1st trimester (0.60 µg L-1) to 3rd trimester (0.47 µg L-1). The median hair-to-blood ratios of T-Hg levels varied from 364 (1st trimester), to 408 (3rd trimester), to 229 (cord blood). Very low T-Hg levels were detected in meconium. Mercury levels in blood and hair correlated with consumption of large predatory fish.

Prevalence of laser beam exposure and associated injuries.

BACKGROUND: An increasing number of consumer laser products are available to Canadians, many being purchased from online retailers. Of particular concern are high-powered, handheld laser devices. This study was conducted to assess the impact of this influx of laser products on the number of laser-associated injuries in Canada. DATA AND METHODS: The rapid response component of the 2014 Canadian Community Health Survey collected data from 19,765 Canadians on the prevalence of laser product exposure and usage, the type of laser product used, and the incidence of eye or skin injuries. RESULTS: Approximately half of Canadians (48.1%) reported using or being exposed to a laser product in the previous 12 months. The highest laser product usage or exposure was among those with university education (58.6%) and those with higher income categories (p ⟨ 0.0001). The highest prevalence of exposure or usage involved laser scanners (38.7%), laser pointers (11.1%) and lasers for entertainment (9.7%). Overall, about 1% of Canadians reported discomfort or injury involving a laser product in the past 12 months. Over half the injuries (59.1%) occurred to the eyes. Most of the injuries (74.9%) resulted from someone else's use of the device. The majority of the reported injuries were caused by lasers for cosmetic treatment or laser pointers. DISCUSSION: Despite the prevalence of laser product usage and exposure among Canadians, a low percentage of respondents reported injuries. This is likely because most laser devices are low-powered and typically do not represent a hazard. Nonetheless, efforts to increase awareness of laser product risks may be beneficial given the findings of this study.

Tanning equipment use: 2014 Canadian Community Health Survey.

BACKGROUND: Tanning equipment use is related to the early onset of cancer, with the risk increasing as the duration and repetition of exposure increase. In 2009, the International Agency for Research on Cancer classified tanning equipment use as carcinogenic to humans, and according to the World Health Organization, the risk of skin melanoma increases significantly when use begins before age 35. DATA AND METHODS: The rapid response component of the 2014 Canadian Community Health Survey collected data on the use of tanning equipment in the previous 12 months, including reasons for use, frequency/duration of use, precautions taken, and adverse reactions or injuries. This analysis examines the prevalence of self-reported indoor tanning in a nationally representative sample of Canadians aged 12 or older in the 10 provinces. RESULTS: In 2014, 4.5% of Canadians (an estimated 1.35 million) reported that they had used tanning equipment in the past year; 70.3% of them were female, and just over half of female users were aged 18 to 34. The prevalence of indoor tanning was highest among people with some postsecondary education and among those in higher income households (trend p-value ⟨ 0.0001). Most users reported fewer than 10 sessions in the past year. The most common reason (62.0%) was to develop a "protective" base tan. INTERPRETATION: Females made up the majority of tanning equipment users, particularly at ages 18 to 34. Efforts to increase awareness of the risks may be beneficial, given the high percentage of users who believed that indoor tanning offers some level of skin protection from future sun exposure.

Exposure to wind turbine noise: Perceptual responses and reported health effects.

Health Canada, in collaboration with Statistics Canada, and other external experts, conducted the Community Noise and Health Study to better understand the impacts of wind turbine noise (WTN) on health and well-being. A cross-sectional epidemiological study was carried out between May and September 2013 in southwestern Ontario and Prince Edward Island on 1238 randomly selected participants (606 males, 632 females) aged 18-79 years, living between 0.25 and 11.22 km from operational wind turbines. Calculated outdoor WTN levels at the dwelling reached 46 dBA. Response rate was 78.9% and did not significantly differ across sample strata. Self-reported health effects (e.g., migraines, tinnitus, dizziness, etc.), sleep disturbance, sleep disorders, quality of life, and perceived stress were not related to WTN levels. Visual and auditory perception of wind turbines as reported by respondents increased significantly with increasing WTN levels as did high annoyance toward several wind turbine features, including the following: noise, blinking lights, shadow flicker, visual impacts, and vibrations. Concern for physical safety and closing bedroom windows to reduce WTN during sleep also increased with increasing WTN levels. Other sample characteristics are discussed in relation to WTN levels. Beyond annoyance, results do not support an association between exposure to WTN up to 46 dBA and the evaluated health-related endpoints.

Personal and situational variables associated with wind turbine noise annoyance.

The possibility that wind turbine noise (WTN) affects human health remains controversial. The current analysis presents results related to WTN annoyance reported by randomly selected participants (606 males, 632 females), aged 18-79, living between 0.25 and 11.22 km from wind turbines. WTN levels reached 46 dB, and for each 5 dB increase in WTN levels, the odds of reporting to be either very or extremely (i.e., highly) annoyed increased by 2.60 [95% confidence interval: (1.92, 3.58), p < 0.0001]. Multiple regression models had R(2)'s up to 58%, with approximately 9% attributed to WTN level. Variables associated with WTN annoyance included, but were not limited to, other wind turbine-related annoyances, personal benefit, noise sensitivity, physical safety concerns, property ownership, and province. Annoyance was related to several reported measures of health and well-being, although these associations were statistically weak (R(2 )< 9%), independent of WTN levels, and not retained in multiple regression models. The role of community tolerance level as a complement and/or an alternative to multiple regression in predicting the prevalence of WTN annoyance is also provided. The analysis suggests that communities are between 11 and 26 dB less tolerant of WTN than of other transportation noise sources.

Self-reported and measured stress related responses associated with exposure to wind turbine noise.

The current study was the first to assess stress reactions associated with wind turbine noise (WTN) exposure using self-reported and objective measures. Randomly selected participants, aged 18-79 yr (606 males; 632 females), living between 0.25 and 11.22 km from wind turbines, were exposed to outdoor calculated WTN levels up to 46 dBA (response rate 78.9%). Multiple regression modeling left the great majority (77%-89%) of the variance in perceived stress scale (PSS) scores, hair cortisol concentrations, resting blood pressure, and heart rate unaccounted for, and WTN exposure had no apparent influence on any of these endpoints. PSS scores were positively, but weakly, related to cortisol concentrations and resting heart rate (Pearson r = 0.13 and r = 0.08, respectively). Across WTN categories, modeled mean PSS scores ranged from 13.15 to 13.84 (p = 0.8614). Modeled geometric means for hair cortisol concentrations, resting mean systolic, diastolic blood pressure, and heart rate were 150.54-191.12 ng/g (p = 0.5416), 113.38-116.82 mmHg (p = 0.4990), 67.98-70.34 mmHg (p = 0.5006), and 68.24-70.71 bpm (p = 0.5223), respectively. Irrespective of WTN levels, diastolic blood pressure appeared to be slightly (2.90 mmHg 95% CI: 0.75,5.05) higher among participants highly annoyed by blinking lights on turbines (p = 0.0081). Collectively, the findings do not support an association between exposure to WTN up to 46 dBA and elevated self-reported and objectively defined measures of stress.