Effect of sleep disturbance on biomarkers related to the development of adverse health outcomes: A systematic review of the human literature.

Literature suggests that unrestricted and undisturbed sleep is vital for basic human function and performance; however, it is unclear as to what amount of sleep disturbance leads to dysregulation in biomarkers, which may underscore the development of adverse health effects. This systematic review aims to identify the amount of sleep disturbance that contributes to biomarker changes as a potential precursor to the development of adverse health effects. English-language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from 1 January 1980 to 31 July 2021 were searched. Where possible, random-effects meta-analyses were used to examine the effect of sleep disturbances on adverse health effects. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool and the Risk of Bias of Nonrandomised Studies - of Exposures instruments and the certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The search identified 92 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, cardiac output, waist circumference, cortisol, adrenaline, noradrenaline, immune system markers, glucose, insulin, cholesterol, and triglyceride levels. Although some meta-analyses suggested there may be an association between sleep disturbances and certain outcomes, the certainty in the evidence was very low due to concerns with risk of bias, inconsistency across exposures, populations, and imprecision in the estimates of effects. Further research is needed to explore the point at which types, levels and duration of sleep disturbances may begin to increase the risk of developing adverse health outcomes to inform and tailor health interventions.

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.

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.

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.

Assessing community noise annoyance: A review of two decades of the international technical specification ISO/TS 15666:2003.

The robust assessment of noise annoyance is of key importance given that it is the most prevalent community response in populations exposed to environmental noise. In 1993, the International Commission on Biological Effects of Noise Community Response to Noise team began formalizing a standardized methodology for assessing noise annoyance which resulted in reporting guidelines and recommendations later published as a Technical Specification (TS) in 2003 by the International Standards Organization (ISO) [(2003). ISO/TS 15666]. This TS, intended to inform the international community on the quantification of the exposure-response relationship between noise exposure and annoyance, has been in circulation for nearly two decades and was updated in 2021 by ISO [(2021). ISO/TS 15666] by an international working group (ISO TC43/SC1/WG62). This paper reviews use of the 2003 TS, identifies common adaptations in use, and summarizes the revisions. Methodological issues arising from the use of the 5-point verbal and the 11-point numeric scale questions and the scoring of "highly annoyed" are discussed. The revisions are designed to encourage further standardization in noise annoyance research. The paper highlights research needs that, if addressed, would strengthen the methodology underlying the assessment of noise annoyance including multidimensional assessments of annoyance.

Prevalence of loud leisure noise activities among a representative sample of Canadians aged 6-79 years.

This population-based study estimates the prevalence of loud leisure noise exposure and hearing protection usage among Canadians, as well as the population potentially at-risk using an occupational limit of 85 dBA, LEX 40 h, which denotes a typical occupational noise limit for a 40 hour work week. A total of 10 460 participants, aged 6-79 years, completed a Canadian Health Measures Survey household questionnaire. Loud leisure noise was defined by vocal effort required while communicating at arm's length except for loud personal listening device (PLD) usage with earbuds/headphones, which included both volume setting and vocal effort. The most prevalent loud leisure noise activities were amplified music, car/home stereo listening, and power tools, with 40% reporting each source, followed by sporting/entertainment (25%), gasoline engines (23%), and loud PLD listening (19.5%). Loud leisure noise was more prevalent among 12-39 year olds and males. Hearing protection usage was uncommon, from 44.2% (firearms) to 20.3% (power tools) and below 3% during amplified music and sporting/entertainment events. Calculations using self-reported duration of loud leisure noise activities estimated that 6.6 × 106 Canadians were in the high cumulative noise exposure category. A large proportion of Canadians would be expected to develop some degree of noise-induced hearing loss should this pattern persist over years.

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.

Prevalence of Hearing Loss Among a Representative Sample of Canadian Children and Adolescents, 3 to 19 Years of Age.

OBJECTIVES: There are no nationally representative hearing loss (HL) prevalence data available for Canadian youth using direct measurements. The present study objectives were to estimate national prevalence of HL using audiometric pure-tone thresholds (0.5 to 8 kHz) and or distortion product otoacoustic emissions (DPOAEs) for children and adolescents, aged 3 to 19 years. DESIGN: This cross-sectional population-based study presents findings from the 2012/2013 Canadian Health Measures Survey, entailing an in-person household interview and hearing measurements conducted in a mobile examination clinic. The initial study sample included 2591 participants, aged 3 to 19 years, representing 6.5 million Canadians (3.3 million males). After exclusions, subsamples consisted of 2434 participants, aged 3 to 19 years and 1879 participants, aged 6 to 19 years, with valid audiometric results. Eligible participants underwent otoscopic examination, tympanometry, DPOAE, and audiometry. HL was defined as a pure-tone average >20 dB for 6- to 18-year olds and ≥26 dB for 19-year olds, for one or more of the following: four-frequency (0.5, 1, 2, and 4 kHz) pure-tone average, high-frequency (3, 4, 6, and 8 kHz) pure-tone average, and low-frequency (0.5, 1, and 2 kHz) pure-tone average. Mild HL was defined as >20 to 40 dB (6- to 18-year olds) and ≥26 to 40 dB (19-year olds). Moderate or worse HL was defined as >40 dB (6- to 19-year olds). HL in 3- to 5-year olds (n = 555) was defined as absent DPOAEs as audiometry was not conducted. Self-reported HL was evaluated using the Health Utilities Index Mark 3 hearing questions. RESULTS: The primary study outcome indicates that 7.7% of Canadian youth, aged 6 to 19, had any HL, for one or more pure-tone average. Four-frequency pure-tone average and high-frequency pure-tone average HL prevalence was 4.7 and 6.0%, respectively, whereas 5.8% had a low-frequency pure-tone average HL. Significantly more children/adolescents had unilateral HL. Mild HL was significantly more common than moderate or worse HL for each pure-tone average. Among Canadians, aged 6 to 19, less than 2.2% had sensorineural HL. Among Canadians, aged 3 to 19, less than 3.5% had conductive HL. Absent DPOAEs were found in 7.1% of 3- to 5-year olds, and in 3.4% of 6- to 19-year olds. Among participants eligible for the hearing evaluation and excluding missing data cases (n = 2575), 17.0% had excessive or impacted pus/wax in one or both ears. Self-reported HL in Canadians, aged 6 to 19, was 0.6 E% and 65.3% (aged 3 to 19) reported never having had their hearing tested. E indicates that a high sampling variability is associated with the estimate (coefficient of variation between 16.6% and 33.3%) and should be interpreted with caution. CONCLUSIONS: This study provides the first estimates of audiometrically measured HL prevalence among Canadian children and adolescents. A larger proportion of youth have measured HL than was previously reported using self-report surveys, indicating that screening using self-report or proxy may not be effective in identifying individuals with mild HL. Results may underestimate the true prevalence of HL due to the large number excluded and the presentation of impacted or excessive earwax or pus, precluding an accurate or complete hearing evaluation. The majority of 3- to 5-year olds with absent DPOAEs likely had conductive HL. Nonetheless, this type of HL which can be asymptomatic, may become permanent if left untreated. Future research will benefit from analyses, which includes the slight HL category, for which there is growing support, and from studies that identify factors contributing to HL in this population.

Chronic noise exposure in the spontaneously hypertensive rat.

INTRODUCTION: Epidemiological studies have suggested an association between the relative risk for developing cardiovascular disease (CVD) and long-term exposure to elevated levels of transportation noise. The contention is that this association is largely owing to an increase in stress-related biomarkers that are thought to be associated with CVD. Animal models have demonstrated that acute noise exposure is capable of triggering a stress response; however, similar studies using chronic noise models are less common. MATERIALS AND METHODS: The current study assessed the effects of intermittent daily exposure to broadband 80 kHz bandwidth noise of 87.3 dBA for a period of 21 consecutive days in spontaneously hypertensive rats. RESULTS: Twenty-one days of exposure to noise significantly reduced body weight relative to the sham and unhandled control groups; however, noise had no statistically significant impact on plasma adrenocorticotropic hormone (or adrenal gland weights). Noise was associated with a significant, albeit modest, increase in both corticosterone and aldosterone concentrations following the 21 days of exposure. Interleukin 1 and interleukin 6 levels were unchanged in the noise group, whereas both tumour necrosis factor alpha and C-reactive protein were significantly reduced in noise exposed rats. Tail blood sampling for corticosterone throughout the exposure period showed no appreciable difference between the noise and sham exposed animals, largely due to the sizeable variation for each group as well as the observed fluctuations over time. DISCUSSION: The current pilot study provides only modest support that chronic noise may promote stress-related biological and/or developmental effects. More research is required to verify the current findings and resolve some of the unexpected observations.

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.

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.

An assessment of quality of life using the WHOQOL-BREF among participants living in the vicinity of wind turbines.

Living within the vicinity of wind turbines may have adverse impacts on health measures associated with quality of life (QOL). There are few studies in this area and inconsistent findings preclude definitive conclusions regarding the impact that exposure to wind turbine noise (WTN) may have on QOL. In the current study (officially titled the Community Noise and Health Study or CNHS), the World Health Organization QOL-BREF (WHOQOL-BREF) questionnaire provided an evaluation of QOL in relation to WTN levels among randomly selected participants aged 18-79 (606 males, 632 females) living between 0.25 and 11.22 km from wind turbines (response rate 78.9%). In the multiple regression analyses, WTN levels were not found to be related to scores on the Physical, Psychological, Social or Environment domains, or to rated QOL and Satisfaction with Health questions. However, some wind turbine-related variables were associated with scores on the WHOQOL-BREF, irrespective of WTN levels. Hearing wind turbines for less than one year (compared to not at all and greater than one year) was associated with improved (i.e. higher) scores on the Psychological domain (p=0.0108). Lower scores on both the Physical and Environment domains (p=0.0218 and p=0.0372, respectively), were observed among participants reporting high visual annoyance toward wind turbines. Personal benefit from having wind turbines in the area was related to higher scores on the Physical domain (p=0.0417). Other variables significantly related to one or more domains, included sex, age, marital status, employment, education, income, alcohol consumption, smoking status, chronic diseases and sleep disorders. Collectively, results do not support an association between exposure to WTN up to 46 dBA and QOL assessed using the WHOQOL-BREF questionnaire.

Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013 Canadian Health Measures Survey.

BACKGROUND: In Canada, population-level estimates of hearing loss have been based on self-reported data, yielding estimates of 4% or 5%. Self-reported hearing difficulties may result in underestimates of hearing loss, particularly among people with mild loss and among older adults. DATA AND METHODS: The 2012/2013 Canadian Health Measures Survey (cycle 3) collected audiometric and self-reported data to estimate the prevalence of hearing loss and limitations in a population-based sample of Canadians aged 20 to 79. Weighted frequencies and cross-tabulations were used to calculate measured and self-reported hearing levels by sociodemographic characteristics. All estimates were weighted at the person-level to represent the population. RESULTS: Based on a pure-tone average of four frequencies that are important in speech, 19.2% of Canadians aged 20 to 79 had measured hearing loss in at least one ear; 35.4% had high-frequency hearing loss. These levels exceeded the self-reported estimate of hearing difficulty--3.7%--derived from responses to questions from the Health Utilities Index Mark 3. The prevalence of measured hearing loss rose with age from no more than 10% among people younger than 50 to 65% at ages 70 to 79. Men were more likely than women to have a hearing loss, a difference that emerged around age 60. Canadians with low household income and/or educational attainment were more likely than those in higher income/education households to have a hearing loss. INTERPRETATION: This analysis presents the first population-based audiometric data on the prevalence of hearing loss among the adult household population of Canada, and highlights the disparity between measured and self-reported outcomes.

A Systematic Review and Meta-Analysis of Noise Annoyance as a Determinant of Physiological Changes Linked to Disease Promotion.

This systematic review investigates the certainty of evidence (CoE) regarding noise annoyance as a determinant of biological changes known to contribute to disease development. We searched PubMed MEDLINE, EMBASE, Cochrane Central, and CINAHL for English-language comparative studies conducted on humans of any age from 1 January 1940, to 28 August 2023. Further, studies that provided quantitative data on the relationship between noise annoyance and biomarkers of interest were included. Where possible, random-effects meta-analyses were used to calculate the odds ratios of noise annoyance on biomarkers and biological conditions considered to be risk factors for developing health effects. The risk of bias of individual studies was assessed using the Risk of Bias of Non-randomized Studies of Exposures (ROBINS-E) instrument. The CoE for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The search identified 23 primary studies reporting on relevant biomarkers. Although some studies and pooled estimates suggest a possible association between noise annoyance and biological measures, the CoE overall is very low due to concerns with the risk of bias, inconsistency, and imprecision in the estimates of effects. In the context of environmental impact assessment, where guidelines aim to mitigate the prevalence of populations experiencing a high level of noise annoyance, our results suggest that such practices should be grounded in the understanding that annoyance is health-relevant because it reflects an undesirable reaction to noise, rather than a precursor to chronic physical health conditions.

Audiometric thresholds and portable digital audio player user listening habits.

OBJECTIVE: To examine the relationship between portable digital audio player listening behaviours and (1) measured sound pressure levels, (2) audiometric measures, (3) self-reported hearing loss symptoms. DESIGN: A questionnaire to evaluate listening behaviours, including self-reported hearing loss symptoms and listening duration/volume settings. Multivariate regression analysis was used to determine the relationship between these variables, audiometric evaluation, calculated exposure levels, Lex(8hr), and measured sound pressure levels, Leq(32sec). STUDY SAMPLE: This study included 103 males and 134 female subjects aged 10 to 17 years. RESULTS: Calculated Lex(8hr) and measured Leq(32sec) levels increased with age and self-reported usage time. Audiometric thresholds averaged over 4 and 8 kHz were higher when usage exceeded five years as compared to less than one year. Higher measured sound pressure levels were associated with worse audiometric thresholds at (0.5, 1, 2 kHz, averaged) and 4 kHz. Self-reported hearing loss symptoms were reported by 33% to 50% of subjects. CONCLUSIONS: In this cohort sample, our results support a statistical association between hearing acuity and (1) Self-reported weekly usage in hours; (2) Tightness of fit; (3) Years of usage; and (4) Measured sound pressure levels. Generalizing these results beyond the current sample would require additional research.

Variation in the stringency of COVID-19 public health measures on self-reported health, stress, and overall wellbeing in Canada.

Evidence is building regarding the association between government implemented public health measures aimed at combating COVID-19 and their impacts on health. This study investigated the relationship between the stringency of public health measures implemented in Canada and self-reported mental health, physical health, stress, and wellbeing among a random sample of 6647 Canadians 18 years of age and older. The analysis was based on self-reported health data from the Canadian Perspectives on Environmental Noise Survey. This data was combined with the Oxford COVID-19 Government Response Tracker database, which included overall stringency index (SI), and four of its sub-components, i.e., school and business closures, restrictions on gatherings, and stay at home policies. Adjusted multivariate logistic regression models indicated that the magnitude of the overall SI was associated with higher or lower odds of reporting worse physical health, mental health, stress and/or overall wellbeing, depending on the measure evaluated. Similarly, policy directed at the four sub-components had varying impacts on the odds of reporting worse health, depending on the sub-component, the strength of the policy restriction, and the health outcome evaluated. The association between the strength of the public health measures and self-reported health, and how this may inform future policy, is discussed.