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Health effects of noise pollution

By Alexander Ayzenband (LACC student #884850872) Health 11/Prof. Jitendra Kuckreja

Introduction
The framers of the Constitution, during their sessions in Philadelphia, had the nearby cobblestone streets covered with earth to prevent noise-induced interruptions in their work. This practice had even earlier precedents - some cities in Medieval Europe used to ban horse carriages and horses from the streets at night, or they covered the streets with straw. Even as far back as Ancient Rome people banned chariots from their streets at night to ensure peaceful sleep for residents. These examples highlight two major effects of noise from which men of all historical periods sought relief: interruption of sleep and interference with their work. The roads today are still among the most prominent sources of environmental noise, even though the noises are different from the ones in Ancient Rome or 18th century Philadelphia. Modern roadways (and airways) and the products of modern technology produce increasing levels of unwanted noise throughout the day and night that disturb sleep, concentration, and other functions.

Noise pollution is the combination of all of the unwanted uncontrollable and unpredictable sound produced by human activities in our immediate environment. It is not necessarily loud, prolonged or unexpected. It is, however, demonstrably affecting health and well being of population everywhere. While most of the health effects can be tied to a few specific areas of disease and discomfort, additional detrimental factors ascribed to noise come from studies of child

development and learning issues, decreased work productivity, as well as general quality and enjoyment of life.

World Health Organization (WHO) uses a parameter to describe and quantify the burden of an environmental factor causing disease or disability: DALY: Disability-adjusted life-years. It is calculated and based on exposure-response relationship, exposure distribution, background prevalence of disease and the weights of the disability by outcome. By conservative estimates, among all of Western European states the DALY number is around one million healthy life years lost every year due to traffic related noise alone in Europe, the main component of which is due to sleep disturbance and annoyance. [1] Taking into account that the population of the US is that of Western Europe, and that Americans generally drive not smaller, nor quieter vehicles, it is safe to estimate this figure for this country to be around 750,000 lost life years per year. [2]

Environmental risks constitute 24% of burden of disease, including exposure to noise from road, rail, air traffic, industrial sites, etc. It is estimated that one in three individuals is disturbed by the noise during the day and one in five is disturbed during the night.

"The idea that people get used to noise is a myth," the Environmental Protection Agency has reported. "Even when we think we have become accustomed to noise, biological changes still take place inside us." [11]

Even though assessment of health outcomes potentially related to noise exposure has so far been limited, there are specific areas of health and well-being where noise makes the most palpable impact.

Sources Of Noise, Measures Of Noise.


There are many different sources of environmental noise to which people are exposed, including, for example: transport (road traffic, rail traffic, air traffic); construction and industry; community sources (neighbors, radio, television, bars and restaurants); and social and leisure sources (portable music players, fireworks, toys, rock concerts, firearms, snowmobiles, etc.)

To understand and assess noise, we must mention the methods of measuring noise and sound in general. Sound traveling through the air has two major properties: the frequency (pitch) and the intensity. It is mainly the intensity, the amount of molecules packed together for each vibration, that determines the loudness of noise. Higher frequency (high-pitch) noise sounds louder.

Loudness is measured by a decibel scale (dB) and an adapted version of the scale (logarithmically) is used to measure the noise more accurately, as perceived by the human ear dBA. In this adopted scale an increase of 10 dBA indicates a doubling of loudness, and a 20 dBA increase has a quadrupling effect. To provide specific examples of this system: 20 dBA is an

approximate measurement of loudness for a whispered conversation, while normal conversation would be carried out at 50 to 60 dBA, shouting around 85 dBA, loud music over 120 dBA, etc.

Adverse health effects appear to be related to total noise exposure from all sources rather than the noise from any single source. However health effects from low-frequency noise are thought to be more severe than from other forms of community noise. This form of noise is underestimated by usual types of sound measuring equipment. [8, 13]

Adverse Health Effects


1. Hearing Loss It is estimated that continued exposure to 85 dBA may cause permanent hearing loss - The so-called Noise Induced Hearing Loss (NIHL), affects about 10 million Americans, which is a quarter of people with any diagnosed hearing loss from all sources. [3]

The major cause of hearing loss is occupational exposure. The following chart shows steep decline in safe time periods per day that is allowable for a sustained noise of given loudness before incurring a permanent hearing damage. [4]

Noise induced hearing impairment may be accompanied by abnormal loudness perception (loudness recruitment), distortion (paracusis), and tinnitus (ringing in the ears). The latter can be temporary or may become permanent after a prolonged exposure. Hearing loss results in loneliness, depression, impaired speech, affected school and job performance, limited job opportunities, social isolation, etc.

There are studies suggesting that children seem to be more vulnerable to NIHL than adults. [5] In 2001, 12.5% of American children between 6 and 19 years of age had impaired hearing in one or both ears. [7] This figure was aided by the fact that as many as 80% of elementary school children use personal music players, many for extended periods of time and at high volume levels. Leisure-time exposure to loud music and noise (video-games, other entertainment) is generally unregulated and is increasing. In a recent survey a majority of youngsters reported experiencing tinnitus after attending a concert or a dance club. Very few of them considered this to be a problem (8%), even though slight majority (66%) would be motivated to use ear protection if they were aware of hazards of permanent hearing loss. [9]

Young people working in entertainment venues, music clubs and at concerts present specifically risky group for hearing damage due to necessity for them to be available for communication at their place of work, which precludes them from using any ear protection while being exposed to noise. It is reported that nearly a third of students who work part time at a university entertainment venue were found to have permanent hearing loss with ear sensitivity dropped for sound under 30 dB. [10] A very loud sound in a particular frequency range can damage the cochlea's hair cells that respond to that range, and thus reducing the ear's ability to hear those frequencies in the future. [6] The World Health Organization recommends unprotected levels of sound at no greater than 100 dB for the duration of 4 hours of less and no more frequent than 4 times per year. The threshold for pain is usually given at 140 dB (120 dB for children) - this level should never be exceeded. Fireworks and firecrackers, cap pistols and rock concerts can all cause sudden and

permanent hearing loss. Ears do not get used to loud noise the way eyes may get used to bright light. [5]

In S. Rosen's work on health effects and hearing loss, one of his findings derived from tracking Maaban tribesmen, who were insignificantly exposed to transportation or industrial noise. This population was systematically compared by cohort group to a typical U.S. population. The findings proved that aging is an almost insignificant cause of hearing loss, which instead is associated with chronic exposure to moderately high levels of environmental noise. [14]

The effects of noise on the fetus and newborn are unclear. Exposure to noise during pregnancy may increase the risk of high-frequency hearing loss in the newborn, shortened gestation, prematurity, and intrauterine growth retardation. Noise in the NICU may cause cochlear damage and may impair the growth and development of the premature infant. Even though studies have been inconsistent with respect to noise and congenital malformations, the data were sufficiently compelling for the National Research Council to recommend that pregnant women avoid noisy work settings. [15]

2. Sleep Disturbances. In words of Washington Post writer Rick Weiss "The romantic hears a train whistle differently from the insomniac". [11]

Uninterrupted sleep is one of the prerequisites for proper physiological and mental functions in a healthy individual. Environmental noise is one of the major causes of sleep disturbances. When sleep interruptions become regular the results are changes in mood, decline in performance and other effects on health and well-being. Most of the research in this area was done with the noise from aircraft, trains and roadways. It has become known that noise above 30 dB disturbs sleep.

Sleep disturbances begin with difficulty falling asleep and continue with frequent awakenings, waking too early, alteration in sleep stages and depth of sleep, and especially reduction in REM sleep. Apart from the effects on sleep itself, noise during sleep causes increased blood pressure, increased heart rate, vasoconstriction, cardiac arrhythmias and changes in respiration. For each of these effects the threshold and response relationship varies. Some responses, such as waking, may diminish with repeated exposures to noise, e.g. the person "gets used to" sounds and continues sleeping through, while for others (particularly cardiovascular) responses do not diminish. [12]

Secondary effects, which are measured the following day, include fatigue, depressed mood, decreased performance and irritability. Decreased alertness may lead to accidents, injuries and even death. Noise annoyance during the night increases total noise annoyance for the next 24 hours.

In particular, people with sleep disorders due to other causes suffer from noise as an additional factor preventing them from getting a good night's sleep. These people, along with the elderly, shift workers and people under heavier stress are more sensitive groups with this issue.

3. Cardiovascular Disturbances. Noise pollution has both temporary and permanent effects by way of the endocrine and autonomic nervous systems. It has been postulated that noise acts as a stressor eliciting reactions that prepare the body for a fight or flight response. For this reason, noise can trigger nervous system responses that affect the cardiovascular system and thus may be a risk factor for cardiovascular disease. These effects begin to be seen with long-term daily exposure to noise levels above 65 dB or with acute exposures to levels above 85 dB. [8]

Acute exposure to noise activates nervous and hormonal responses leading to temporary increases in blood pressure, heart rate and vasoconstriction. Studies of people exposed to sufficiently intense and continuous occupational and environmental noise show additional increase in blood viscosity and levels of blood lipids, shifts in electrolytes, increased levels of epinephrine, norepinephrine and cortisol (stress hormones). These hormones help a person deal with sudden emergencies. Blood pressure and heart rate go up in preparation for action. The blood becomes thick with oxygen-toting red blood cells. And the immune system gets suppressed as part of the shift toward fulfilling short-term needs rather than longer-term health. Such response can be lifesaving in an attack, but it is counterproductive when activated chronically. Over months and

years it can literally corrode the body, eating away at blood vessels and other organs and predisposing a person to other medical woes.

The Health Council of the Netherlands found that high levels of mechanical noise, such as that from a hospital's own air-conditioning equipment, can delay recovery in patients -- a reflection, perhaps, of the immune suppression that comes with an activated stress response. "This is the most disturbing thing about noise, because it means you are being exposed to this reaction all the time," said Roberto Bertollini of the World Health Organization's Special Program on Health and Environment. [11]

While temporary noise exposures produce physiological changes that are reversible, prolonged exposure to noise of sufficient intensity, especially sudden and unpredictable noise, may provoke changes that are not readily reversible. Even though the direct risk of noise-induced cardiovascular disease is small, noise pollution contributes to other factors in increasing overall risk of becoming ill, due to elevated blood pressure and stress-induced hormones.

4. Mental health, impaired task performance, impaired learning, annoyance. Noise pollution is not believed to be a cause of mental illness, but it is assumed to accelerate and intensify the development of latent mental disorders. It contributes to anxiety, stress, nervousness, nausea, headaches, emotional instability, argumentativeness, neurosis, hysteria and psychosis. As a result, the affected individuals may suffer impaired physical and psychological intimacy and connection to others, increased social conflicts, mood swings, etc. Studies of population have linked noise with mental health indicators, such as rating of well-being, symptom

profiles, the use of psychoactive drugs and sleeping pills, even mental hospital admission rates. Children, the elderly and patients with underlying depression are particularly vulnerable to noise annoyance due to lack of adequate coping mechanisms. [8]

Noise levels above 80 dB are associated with both an increase in aggressive behavior and a decrease in behavior helpful to others. These effects of noise may help explain some of the dehumanization seen in the modern congested urban environment. [8]

The effects of noise on cognitive performance have been well-studied. Noise pollution impairs task performance at school and work, increases errors and decreases motivation, according to researchers. [8, 11] Reading retention, problem solving and memory are all affected by noise. A now-classic study in the 70s was among the first to indicate effects of noise on learning abilities by noting how children living in lower, noisier floors of an apartment building overlooking a busy bridge in Manhattan New York had lower reading scores than those living higher up. Later, in another study, students from a noisy elementary school near train tracks in New York had grade levels of one year behind by the time they reached sixth grade, when compared to a group of students from the same school, whose classrooms were located in the quieter part of the building. Still later, a "natural" experiment in Germany helped clinching the case for noise, when the old Munich airport was shut down, and a new one opened at a distant site. Tests done on third- and fourth-graders before that switch, soon after and again later on - showed that students near the old airport initially scored lower than others on tests of memory and reading, but improved after the airport closed, while their counterparts living near the new airport saw a decline in scores after the switch occurred. [11]

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Another insidious effect of noise is its cultivation of what is now called "learned helplessness." Children given puzzles in moderately noisy classrooms are not only more likely to fail to solve them but are also more likely to surrender early. [11]

Probably the most disturbing non-auditory effect of noise pollution is that it undermines generosity. [11] In one study people were less likely to help someone pick up a bundle of dropped books when the noise of a lawn mower was present. Another showed that in a noisy environment, people playing a game were more likely to see their fellow players as disagreeable or threatening. Still another study found a drop in helpful behavior when loud "annoying music" was played. However, the helping behavior increased when similarly loud "uplifting music" was played, which points to complicated relationship of noise content and our cognitive processes. Uplifting music, nevertheless, may not be considered noise, in a strict sense of the word, if we maintain the definition of noise as only "unwanted" and "unexpected" sounds.

This characteristic of sound as "unwanted" and "unwarranted" explains the annoyance effect of noise. People report being far less annoyed by noises they willingly accept or actively select, such as riding a motorcycle, than by the noises they have no control over (car alarms outside of one's window).

Strong evidence to noise annoyance being not a small matter is the fact that loud, noisy music has been used to torture countless prisoners, most notably, the interrogations of Panamanian

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dictator Manuel Noriega, cult leader David Koresh, as well as in recent "cooperation inducing" techniques in war prisons of Iraq and Guantanamo Bay, Cuba. [11]

More than 40 percent of Americans whose homes have any traffic noise at all classify that noise as "bothersome", according to the 2005 American Housing Survey, conducted by the U.S. Census Bureau. One-third of those say the noise is so bothersome they want to move. All told, more than 100 million Americans are regularly exposed to noise levels in excess of the 55 dB that federal agencies have deemed a reasonable background intensity. [11]

Conclusion
Domestic tranquility is one of the six guarantees in the United States Constitution, a guarantee that is echoed in some form or other in every state Constitution as well. In 1972, the Noise Control Act was passed by Congress, declaring that it is the policy of the United States to promote an environment for all Americans free from noise that jeopardizes health and welfare. In 1974, the Environmental Protection Agency (EPA) estimated that nearly 100 million Americans lived in areas where the daily average noise levels exceeded those identified as being safe. [16]

However, in 1982, the government abruptly terminated federal funding for the Office of Noise Abatement and Control, the vehicle by which the public was to be protected from the adverse effects of noise. The lack of funds threw total responsibility for noise control to the states, which have had a spotty and generally poor record with respect to noise abatement. Since the Act itself was not repealed, local and state governments may have been deterred from trying to regulate

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noise. Furthermore, failure to repeal the Act sent the message that noise was not an important environmental concern.

As a result, in the United States, many police departments seem to be unwilling or unable to respond to noise-related problems in a way that provides any measure of genuine or timely control. Yet, in most cities, as noise pollution continues to grow-some say as much as sixfold in the past 15 years-so do complaints about noise. Complaints to police and other officials about noise are among the most frequent complaints by residents in urban environments; in 1998, noise was the number one complaint to the Quality of Life Hotline in New York City. The number of people exposed to unhealthy levels of noise in the United States is unquestionably greater than it was in 1974; the degree of oversight and control is unquestionably less.

Our history is filled with failures to recognize the agents that cause disease; once the causes have been recognized, we have responded reluctantly, slowly, and often inadequately. The case with tobacco is an instructive one. It took many years of lobbying by dedicated individuals before legislators and the general public recognized the links between the hazards of tobacco smoke and disease; as a result, laws were finally enacted and behaviors changed accordingly.

Despite the evidence about the many medical, social, and economic effects of noise, as a society, we continue to suffer from the same inertia, the same reluctance to change, and the same denial of the obvious that the anti-tobacco lobby faced a couple of decades ago. This inertia and denial are similar to those that delayed appropriate action on lead, mercury, and asbestos. Now we seem unable to make the connection between noise and disease, despite the evidence, and despite

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the fact, which we all recognize, that our cities are becoming increasingly more polluted with noise.

Our society is beset by noise, which is intrusive, pervasive, ubiquitous, and most important of all, unhealthy. While many various sounds in our environment to which we are exposed can be viewed necessary, we are nevertheless receiving all of the sounds from radio, television, toys, jet engines, rail crossings, at all times, whether wanted or unwanted. Most reasonable people would agree that much of the environmental noise to which we are subjected serves no useful purpose and is therefore undesirable. The variety of noise polluting devices and activities is large and seems to be growing on a daily basis, although there is no consensus about what items are useful and desirable or noise polluting and unnecessary.

Noise is an important public health problem that can lead to hearing loss, sleep disruption, cardiovascular disease, social handicaps, reduced productivity, impaired teaching and learning, absenteeism, increased drug use, and accidents. It can impair the ability to enjoy one's property and leisure time and increases the frequency of antisocial behavior. Noise adversely affects general health and well-being in the same way as does chronic stress. Local control of noise has not been successful in most places. This points out the need for improved methods of local control that should include public education, enlightened legislation, and active enforcement of noise ordinances by local law enforcement officials. While learning about the problem and its effects can be the first step to a solution, along with individuals resolving to consciously avoid experiencing and producing noise on a personal level, still larger part of the solution definitely requires federal

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or state legislation aimed at supporting local efforts or the restoration of federal funding for the Office of Noise Abatement and Control.

References:
[1] Lin Fritschi, A. Lex Brown, Rokho Kim, Dietrich Schwela, Stelios Kephalopoulos, eds. Burden of disease from environmental noise. Quantification of healthy life years lost in Europe. World Heath Organization, 2011.

[2] Encyclopaedia Britannica. Britannica Book of the Year. Encyclopaedia Britannica, 2008.

[3] Dangerous Decibels, a program of Oregon Health & Science University. http://www.dangerousdecibels.org/education/information-center/noise-induced-hearing-loss/. Accessed September 4th, 2011.

[4] Stansfeld, S.; Haines, M.; and Brown, B. Noise and Health in the Urban Environment. Reviews of Environmental Health 2000. 15:4382.

[5] Berglund B, Lindvall T. (eds.) Community Noise. Archives of the Center for Sensory Research. 1995;2:1-195.

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[6] A HeadWize Headphone Guide. Preventing Hearing Damage When Listening With Headphones. http://gilmore2.chem.northwestern.edu/articles/hearing_art.htm Accessed September 4th, 2011.

[7] Niskar AS, Kieszak SM, Holmes AE, et al. Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: the third national health and nutritional examination survey 1988-1994, United States. Pediatrics 2001;108:40-43.

[8] Lisa Goines, RN; Louis Hagler, MD. Noise Pollution: A Modern Plague. Southern Medical Journal. 2007;100(3):287-294

[9] Chung JH, Des Roches CM, Meunier J, et al. Evaluation of noise-induced hearing loss in young people using a web-based survey technique. Pediatrics 2005;115:861-867.

[10] Sadhra S, Jackson CA, Ryder T, et al. Noise exposure and hearing loss among student employees working in university entertainment venues. The Annals Of Occupational Hygiene. Oxford. 2002;46:455-463.

[11] Rick Weiss. Noise Pollution Takes Toll on Health and Happiness. Washington Post. 06/05/2007

[12] Hobson JA. Sleep. Scientific American Library. W.H. Freeman and Company, New York, 1989.

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[13] Leventhal HG. Low frequency noise and annoyance. Noise Heath 2004;6:59-72.

[14] S. Rosen and P. Olin. Hearing Loss and Coronary Heart Disease. Archives of Otolaryngology, 82:236 (1965)

[15] Bronzaft AL. Noise: Combating a ubiquitous and hazardous pollutant. Noise Health 2000;2:1-8.

[16] Information on levels of environmental noise requisite to protect public health and welfare with an adequate margin of safety (EPA/ONAC Report 550/9-74-004). U.S. Environmental Protection Agency. Washington, DC, 1974. Available at: http://www.nonoise.org/library/levels74/levels74.htm. Accessed September 14th, 2011.

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