Hair cortisol as a viable tool for the assessment of an association between environmental noise exposure and chronic stress.

Entrenched in the well-established link between stress and health, noise exposure as a potential contributor to stress-related health effects receives tremendous attention. Indeed, exposure to noise can act as a stressor as evidenced through increased heart rate, blood pressure, adrenaline, epinephrine, and cortisol. Cortisol is secreted from the adrenal glands in response to stressor-induced activation of the hypothalamic-pituitary-adrenal axis. For assessment of environmental noise and stress, repeated sampling in blood, saliva, or urine is necessary to evaluate the association between environmental noise exposure and protracted changes in cortisol. Controlling for the many variables that influence the secretion of cortisol at discrete sampling intervals is challenging. Studies suggest that systemically produced cortisol integrates and remains in hair as it grows, providing a measure that integrates a cortisol response over a longer period, circumventing several limitations associated with multiple sampling. Robust evidence supports the integration of cortisol into hair, yet recent studies call into question the notion that cortisol is retained with growth. The current paper discusses the strengths and limitations of hair cortisol analysis with an emphasis on its utility as a measure of chronic stress in environmental noise studies.

Implications of the COVID-19 pandemic on self-reported health status and noise annoyance in rural and non-rural Canada.

The Canadian Perspectives on Environmental Noise Survey (CPENS), conducted between April 12th, 2021 and May 25th, 2021 coincided with the third wave of the COVID-19 pandemic. Canadians 18 years of age and older (n = 6647) reported the degree to which the pandemic affected their physical health, mental health, stress, annoyance toward environmental and indoor noise, and overall well-being. Depending on the outcome evaluated, between 18 and 67% of respondents reported the measure as "somewhat" or "much worse" due to the pandemic. Stress was most affected, followed by mental health, overall well-being, physical health, annoyance toward environmental noise and annoyance toward indoor noise. Logistic regression models indicated that province, geographic region (rural/remote, suburban, urban), age, gender, poor physical/mental health, heart disease, a history of high sleep disturbance (in general) or diagnosed sleep disorders, anxiety/depression, working/schooling from home, and being retired significantly impacted the odds of reporting a worsening by the pandemic to varying degrees and directions, depending on the outcome. Indigenous status was unrelated to any of the modelled outcomes. Future research could address some of the noted study limitations and provide the data to determine if the observations on the reported measures of health are temporary, or long-lasting.

Impact of Noise Exposure on Risk of Developing Stress-Related Health Effects Related to the Cardiovascular System: A Systematic Review and Meta-Analysis.

Background: : Exposure to acute noise can cause an increase in biological stress reactions, which provides biological plausibility for a potential association between sustained noise exposure and stress-related health effects. However, the certainty in the evidence for an association between exposures to noise on short- and long-term biomarkers of stress has not been widely explored. The objective of this review was to evaluate the strength of evidence between noise exposure and changes in the biological parameters known to contribute to the development of stress-related adverse cardiovascular responses. Materials and Methods: This systematic review comprises English language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from January 1, 1980 to December 29, 2021. Where possible, random-effects meta-analyses were used to examine the effect of noise exposure from various sources on stress-related cardiovascular biomarkers. The risk of bias of individual studies was assessed using the risk of bias of nonrandomized studies of exposures instrument. The certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: : The search identified 133 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, vascular resistance, and cardiac output. Meta-analyses of blood pressure, hypertension, and heart rate suggested there may be signals of increased risk in response to a higher noise threshold or incrementally higher levels of noise. Across all outcomes, the certainty of the evidence was very low due to concerns with the risk of bias, inconsistency across exposure sources, populations, and studies and imprecision in the estimates of effects. Conclusions: : This review identifies that exposure to higher levels of noise may increase the risk of some short- and long-term cardiovascular events; however, the certainty of the evidence was very low. This likely represents the inability to compare across the totality of the evidence for each outcome, underscoring the value of continued research in this area. Findings from this review may be used to inform policies of noise reduction or mitigation interventions.

A comparison of self-reported health status and perceptual responses toward environmental noise in rural, suburban, and urban regions in Canada.

Health Canada, in collaboration with Advanis, conducted the Canadian Perspectives on Environmental Noise Survey (CPENS) to investigate expectations and attitudes toward environmental noise in rural and non-rural Canada. The CPENS, a 26-item questionnaire, was completed online by 6647 randomly selected Canadians, age 18 y and older between April and May 2021. The prevalence of reporting their area as often or always calm, quiet, and relaxing was 76.8%, 64%, and 48.4% in rural/remote, suburban, and urban, respectively. A high expectation of quiet was less prevalent yet followed the same pattern: rural/remote (58.2%), suburban (37.4%), and urban (21.8%). Self-reported health status and noise sensitivity were unrelated to geographic region. A high magnitude of non-specific sleep disturbance over the previous 12 months was reported by 7.8% overall; highest among urban dwellers (9.8%), followed by suburban (7.2%) and rural/remote (5.5%) dwellers (p < 0.01). High annoyance toward road traffic noise was 8.5% overall, and significantly higher in urban (10.5%), relative to suburban (7.9%) and rural/remote (6.6%) areas (p < 0.0001). Annoyance toward noise from rail, aircraft, mining, industry, marine activity, construction, wind turbines, and landscaping equipment is reported. The analysis also explores potential differences between Indigenous Peoples of Canada and non-Indigenous Canadians in their attitudes and expectations toward environmental noise.

Annoyance toward landscaping equipment noise in Canada.

Noise annoyance toward landscaping equipment was one of nine sources evaluated in the Canadian Perspectives on Environmental Noise Survey, completed online by 6647 Canadian adults. At 6.3% (95% confidence interval = 5.8-6.9), landscaping equipment ranked third after road traffic and construction noise. Stepwise multivariate logistic regression modelled factors associated with annoyance. The perceived impact of the COVID-19 pandemic on outdoor noise annoyance, education level, working/attending school from home, geographic region, province, noise sensitivity, sleep disturbance, duration of residency, and perceived changes in outdoor daytime noise influenced the odds of reporting high annoyance toward landscaping equipment noise over the previous year.

Self-reported occupational noise exposure and cardiovascular disease in Canada: Results from the Canadian Health Measures Survey.

Self-reported occupational noise exposure has been associated with impaired hearing, but its relationship with extra-auditory affects remains uncertain. This research assessed the association between self-reported occupational noise exposure and cardiovascular outcomes. Participants (n = 6318, ∼50% male) from the Canadian Health Measures Survey (2012-2015) aged 20-79 years were randomly recruited across Canada. An in-person household interview included basic demographics, perceived stress, diagnosed health conditions, and self-reported exposure to a noisy work environment. Direct physiological assessment in a mobile examination centre permitted the determination of biomarkers/risk factors related to cardiovascular function. Logistic or linear regression models explored the association between self-reported occupational noise exposure and several cardiovascular endpoints after adjusting for confounding variables. After adjustments, there was no evidence for an association between occupational noise and any of the evaluated endpoints, which included but were not limited to blood pressure, heart rate, blood glucose, insulin, lipids, diagnosed hypertension, medication for hypertension, myocardial infarction, stroke, or heart disease. There was no evidence that self-reported occupational noise exposure was associated with evaluated cardiovascular-related biomarkers, or cardiovascular diseases among Canadians aged 20-79 years. This study, and others like it, provides an important contribution to an evidence base that could inform policy related to occupational noise exposure.

High frequency hearing impairment and cardiovascular disease in Canada: Results from the Canadian Health Measures Survey.

Noise-induced stress may precipitate cardiovascular diseases. This research assessed the association between sensorineural bilateral high frequency hearing loss (HFHL), as an indication of excessive noise exposure, and cardiovascular outcomes. Participants (n = 6318, ∼50% male) 20-79 years were recruited through the cross-sectional Canadian Health Measures Survey. Questionnaires included several demographic and health-related variables. Audiometry and blood/urine collection took place in a mobile examination centre. Average thresholds ≥25 dB averaged across 3, 4, and 6 kHz defined HFHL. Logistic or linear regression models explored associations between HFHL and cardiovascular-related risk factors/outcomes. Adjusted models indicated elevated diastolic blood pressure in respondents with normal hearing, X¯ = 72.52 (95% confidence interval: 71.85-73.18) compared to the group with bilateral HFHL, X¯ = 70.28 (95%CI: 69.13-71.43), p < 0.05. Average total cholesterol, high-density lipoprotein, low-density lipoprotein and apolipoprotein A1 were elevated in the normal hearing group (p < 0.05). Insulin, high-sensitivity C-reactive protein, and average resting heart rate were elevated in the group with bilateral HFHL, p < 0.05. A stratified analysis by sex- and age, or history of loud occupational noise exposure, did not change the overall results. Although some findings warrant further exploration, the overall analysis did not provide compelling evidence for an association between HFHL and cardiovascular-related biomarkers, or cardiovascular diseases among Canadians aged 20-79 years.

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.

Survey of reported eye injuries from handheld laser devices in Canada.

BACKGROUND: Unprotected exposure to handheld lasers can cause temporary or permanent vision loss depending on the laser classification. OBJECTIVE: To evaluate the occurrence of, and details associated with, reported eye injuries resulting from handheld lasers. METHODS: A 14-item questionnaire developed by Health Canada was distributed by the Canadian Ophthalmological Society and the Canadian Association of Optometrists to their respective members. RESULTS: Questionnaire data were available from 909 respondents (263 ophthalmologists; 646 optometrists). Response rates were 23.1% and 12.7%, respectively. Validated data were available from 903 respondents, where 157 (17.4%) reported encountering at least 1 eye injury from a handheld laser. A total of 318 eye injuries were reported with an annual increase of 34.4% (95% CI 21.6%-48.7%, p < 0.0001) between 2013 and 2017. When respondents reported on only their most severe case, 77 (53.5%) reported vision loss that ranged from minor to severe, which persisted for more than 6 months in 42.9% of the cases. Another 59 (41.3%) noted the presence of retinal damage. The prevalence of eye injuries from handheld lasers was higher for males (82.5%) than females (14.0%), more frequent among those under the age of 50 years, and occurred predominately as a result of exposure from another person (67.6%) versus self-induced (26.1%) (p < 0.0001). CONCLUSIONS: Although this pilot study permits insight into the potential prevalence of injuries resulting from exposure to handheld laser devices in Canada, the results are not nationally representative. These findings support additional surveillance activities that may inform risk assessment and potential risk management strategies.

Wind turbine audibility calculations inside dwellings.

The objective of the current paper was to characterize indoor wind turbine sound pressure levels (SPLs) to assess the audibility of wind turbine noise indoors, accounting for window opening, frequency spectra, and presbycusis. Loudspeaker generated noise was used to determine the outdoor to indoor SPL differences at 11 representative dwellings using ISO 140-5:1998. The procedure was extended to 16 Hz. With windows closed, indoor broadband A- and C-weighted SPLs were lower by 25.9 and 15.3 dB, respectively, for wind turbine noise spectra. With windows opened, the corresponding results were 13.8 and 9.9 dB, respectively. Standard deviations for these results were 3 dB so that indoor and outdoor SPL would tend to be highly correlated. For 35 dBA outdoor SPL, the indoor SPL was potentially audible at frequencies as low as 31.5 Hz. Specifically, at 35 dBA, 80% to 100% of adults below the age of 60 years, would potentially be able to hear wind turbine noise indoors with windows partially open. This would drop to 10% to 30% with closed windows. Uncertainties around these estimates are discussed.

Derivation and application of a composite annoyance reaction construct based on multiple wind turbine features.

OBJECTIVES: Noise emissions from wind turbines are one of multiple wind turbine features capable of generating annoyance that ranges in magnitude from not at all annoyed to extremely annoyed. No analysis to date can simultaneously reflect the change in all magnitudes of annoyance toward multiple wind turbine features. The primary objective in this study was to use principal component analysis (PCA) to provide a single construct for overall annoyance to wind turbines based on reactions to noise, blinking lights, shadow flicker, visual impacts, and vibrations evaluated as a function of proximity to wind turbines. METHODS: The analysis was based on data originally collected as part of Health Canada's cross-sectional Community Noise & Health Study (CNHS). One adult participant (18-79 years), randomly selected from dwellings in Ontario (ON) (n = 1011) and Prince Edward Island (PEI) (n = 227), completed an in-person questionnaire. Content relevant to the current analysis included the annoyance responses to wind turbines. RESULTS: The first construct tested in the PCA explained 58-69% of the variability in total annoyance. Reduced distance to turbines was associated with elevated aggregate annoyance scores among ON and PEI participants. In the ON sample, aggregate annoyance was effectively absent in areas beyond 5 km (mean 0.12; 95% CI 0.00, 1.19), increasing significantly between (2 and 5] km (mean 2.13; 95% CI 0.92, 3.33), remaining elevated, but with no further increase until (0.550-1] km (mean 3.37; 95% CI 3.02, 3.72). At ≤ 0.550 km, the average overall annoyance was 3.36 (95% CI 2.03, 4.69). In PEI, aggregate annoyance was essentially absent beyond 1 km; i.e., (1-2] km (mean 0.21; 95% CI 0.00, 0.88); (2-5] km (mean 0.00; 95% CI 0.00, 1.37); > 5 km (mean 0.00; 95% CI 0.00, 1.58). Annoyance significantly increased in areas between (0.550 and 1] km (mean 1.59; 95% CI 1.02, 2.15) and was highest within 550 m (mean 4.25; 95% CI 3.34, 5.16). CONCLUSION: The advantages and disadvantages to an aggregated annoyance analysis, including how it should not yet be considered a substitute for relationships based on changes in high annoyance, are discussed.

The association between self-reported and objective measures of health and aggregate annoyance scores toward wind turbine installations.

OBJECTIVE: An aggregate annoyance construct has been developed to account for annoyance that ranges from not at all annoyed to extremely annoyed, toward multiple wind turbine features. The practical value associated with aggregate annoyance would be strengthened if it was related to health. The objective of the current paper was to assess the association between aggregate annoyance and multiple measures of health. METHODS: The analysis was based on data originally collected as part of Health Canada's Community Noise and Health Study (CNHS). One adult participant per dwelling (18-79 years), randomly selected from Ontario (ON) (n = 1011) and Prince Edward Island (PEI) (n = 227), completed an in-person questionnaire. RESULTS: The average aggregate annoyance score for participants who indicated they had a health condition (e.g., chronic pain, Pittsburgh Sleep Quality Index (PSQI) > 5, tinnitus, migraines/headaches, dizziness, highly sensitive to noise, and reported a high sleep disturbance) ranged from 2.53 to 3.72; the mean score for those who did not report these same conditions ranged between 0.96 and 1.41. Household complaints about wind turbine noise had the highest average aggregate annoyance (8.02), compared to an average of 1.39 among those who did not complain. CONCLUSION: A mean aggregate annoyance score that could reliably distinguish participants who self-report health effects (or noise complaints) from those who do not could be one of several factors considered by jurisdictions responsible for decisions regarding wind turbine developments. However, the threshold value for acceptable changes and/or levels in aggregate annoyance has not yet been established and could be the focus of future research efforts.

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.

Estimating annoyance to calculated wind turbine shadow flicker is improved when variables associated with wind turbine noise exposure are considered.

The Community Noise and Health Study conducted by Health Canada included randomly selected participants aged 18-79 yrs (606 males, 632 females, response rate 78.9%), living between 0.25 and 11.22 km from operational wind turbines. Annoyance to wind turbine noise (WTN) and other features, including shadow flicker (SF) was assessed. The current analysis reports on the degree to which estimating high annoyance to wind turbine shadow flicker (HAWTSF) was improved when variables known to be related to WTN exposure were also considered. As SF exposure increased [calculated as maximum minutes per day (SFm)], HAWTSF increased from 3.8% at 0 ≤ SFm < 10 to 21.1% at SFm ≥ 30, p < 0.0001. For each unit increase in SFm the odds ratio was 2.02 [95% confidence interval: (1.68,2.43)]. Stepwise regression models for HAWTSF had a predictive strength of up to 53% with 10% attributed to SFm. Variables associated with HAWTSF included, but were not limited to, annoyance to other wind turbine-related features, concern for physical safety, and noise sensitivity. Reported dizziness was also retained in the final model at p = 0.0581. Study findings add to the growing science base in this area and may be helpful in identifying factors associated with community reactions to SF exposure from wind turbines.