Literature Review Dissection and Synthesis using the matrix method.

MATRIX ASSIGNMENT TEMPLATE (EPI 50015)

Name: Kristen Septaric

Descriptive statement of the Environmental Health issue or problem and specific population that was researched in the literature review dissection and synthesis using the matrix method: Noise pollution is a nuisance and reduces the quality of life of the urban population, who experience higher levels of noise than rural residents around the world.

Article References

Year of publication

Study Design and Aim(s)

Recruitment and final number

enrolled

Major results Limitations Implications for Population Health

Barbosa, A. S. M.

2005 Cross- sectional; assessing hearing status of workers exposed to urban noise from vehicle traffic, compare workers with normal hearing status and those with

624 Transit Engineering Company employees; starting sample 1340 exposed workers evaluated at the Occupational Health Clinic of the University of São Paulo Hospital das Clínicas during 1997-1998, only 627 able to

Prevalence of noise- induced hearing loss (NIHL) (28.5%), working in higher noise level areas (38.8%), working in lower noise areas (24.2%), NIHL correlated with gender, age, TECA position, and prior exposure to workplace noise

Data was obtained using a standardized questionnaire, and it was not possible to get precise measurements of worker’s level of noise exposure; no information was collected on noise levels in previous exposures or other settings; degree of exposure and

Noise mapping demonstrated that noise levels in most areas of the city exceeded standards set for noise. Elevated levels of noise were associated with higher rates of hearing loss. Public health officials need to measure noise levels in urban

suggestive hearing loss

attend hearing evaluations, 3 excluded for having conductive hearing loss

outcome was measured simultaneously, so causality cannot be established

areas to evaluate whether they meet or exceed standards. If noise is exceeding standards, more regulations on traffic noise should be implemented.

Björk, J. 2006 Cross- sectional; investigate residential noise from road traffic and evaluate its relationship with perceptions of annoyance, disturbance of daily activities, and impact on health in general; special attention was paid to the health of those most annoyed and those

13,557 persons; A random sample of 24,945 persons from 60 stratified regions of southern Sweden were sent a large public health survey 1999-2000, 13,604 responded to the survey, and geocodes were only available for 13,557 persons

25% reported occasional disturbance from traffic noise during relaxation time and sleep in the highest exposure levels; no pattern was found between noise exposure and general health; significant associations were found between annoyance from traffic noise and issues concentrating (p=0.03) and treatment for hypertension (p=0.02), positive associations were found between noise exposure and health problems for women (hypertension), immigrants (sleep), unemployment (stress),

Participation was low at just 54% completing the survey; those who did not complete the survey varied significantly in demographic characteristics, thus bias was potentially introduced in the association between exposure and health issues examined; the questionnaire itself may have issues with validity of self-reported measures; any misclassification of hypertension status could have biased the results toward

Exposure to high levels of noise produced frequent annoyance and disturbances to activities of daily living; those frequently annoyed experienced more negative health effects; the effects of road traffic noise on disadvantaged subpopulations may be higher than the normal population so special attention should be given to these populations when

most vulnerable

and those with financial issues (difficulty concentrating)

the null; causality was not able to be established due to the nature of the study design

creating policy and interventions for reducing exposure to high levels of traffic noise

Dratva, J. 2009 Cross- sectional; evaluate the impact of traffic-related noise annoyance on health-related quality of life, investigate the possible gender-based differences in noise perception and annoyance, and the potential impact they may have on the relationship between noise and HRQL

5,021 persons; 8,047 participants from an original SAPALDIA cohort study conducted in 2001-2002 that comprised a random sample of adults aged 18-60 years from 8 locations in Switzerland were sent a follow-up survey; 5,672 persons returned the survey; 88 were excluded for missing information on noise annoyance and 563 were excluded for reporting deafness

Of the entire study population, 13% reported high annoyance due to traffic noise; women were more likely to report high annoyance to noise (adjOR 1.23, 95% CI 1.01-1.48), a significant negative association between noise annoyance and general health could not be established, but significant negative associations were observed for physical functioning, role physical, bodily pain, vitality, social functioning, role emotional, and mental health, mental component and physical component summaries; significant effect modification by

Study failed to cite limitations (limitation in itself); only self- reported measures were collected; information on the actual level of noise experienced by study participants unknown; participants were obtained from a wide variety of geographic locations, and not limited to urban areas – thus level of traffic density near residential areas, which could impact annoyance scores, varies widely among participants; causality cannot be established due to study design

Traffic-related noise annoyance is significantly associated with lower HRQL; higher levels of annoyance in women suggests higher environmental awareness; women and chronically ill (more often occurring in women) should be treated as vulnerable populations for noise pollution; gender differences in perceptions of annoyance to noise should be taken into account when designing

gender for physical functioning, role physical and physical component summary; effect modification by chronic disease for both summary scales

interventions to reduce the impact of traffic-related noise on quality of life

Kim, M. 2012 Ecological; investigate the association between road traffic noise and potential health effects through the use of prediction models for a highly urbanized area

1,152,550 (Fulton County, GA daytime population) and 857,184 (Fulton County, GA nighttime population); aggregate data sets were collected from Fulton County, Georgia Department of Transportation, and the Atlanta Regional Commission from 2009-2011, city of Mountain Park was excluded due to small portion of

9.5% of the daytime population were at risk for being highly annoyed in the daytime; 2.3% of the nighttime population were at risk for having high levels of sleep disturbances; the city of Atlanta was most severely impacted by road traffic noise

Determinations of perceptions of noise annoyance and sleep disturbances were made based on equations without any validation from the residents of the county under investigation; the equations used were designed from surveys of European countries and may not reflect the characteristics of the US; buses and motorcycles were not included in the traffic noise

Highly urbanized areas may be exposed to levels of noise that put them at risk for being annoyed or having sleep disturbances, which in turn could affect other aspects of health and overall quality of life; policy makers should work to reduce ambient traffic noise levels in urban areas to improve QOL for residents

city being a part of the county

assessments; LandScan, the tool used for collecting population data, may not accurately reflect the geographic distribution of the population; railway and aircraft noise was not examined in the study, although the noise does contribute to overall noise level of the county; only predictions, not conclusive evidence, can be drawn from this study, causality cannot be established due to the study design

Vianna, K. M. dP.

2015 Cross- sectional; evaluate the perception and annoyance from noise in urban soundscapes during leisure

180 individuals, 60 in each soundscape, 30 exposed to high and 30 exposed to low levels of noise; three visits made to each of scenario sites and

70% of participants reported noticing noise and 41.7% reported some degree of annoyance associated with exposure to noise; 16.7% felt highly annoyed; no statistically significant

The Lden indicator used to construct the noise map may not be representative of exposure levels in all urban soundscapes; validity of the

The reactions of individuals to noise may be different in different environments; people tend to find noise in the home and work

time, at home, and at work in areas of high and low exposure to noise

included randomly selected individuals over the age of 20 years who agreed to answer the questionnaire; leisure scenario: conducted in parks during the week and weekend; work scenario: conducted in commercial establishments during slow times of the day; home scenario: interviews obtained during evenings and weekends in selected housing projects chosen in partnership with Camera do Porto

association between exposure and presence of chronic illness observed for work scenario; 97% of workers reported being adapted to urban noise; individuals in the urban soundscape exposed to noise reported significant annoyance by noise at a rate 4 times higher when compared to individuals of a non- exposed urban soundscape; the degree of annoyance regarding road traffic significantly increases with increases in levels of exposure

questionnaire in assessing noise and chronic conditions may have been affected by some bias when conducted in the workplace; noticeable language barriers especially amongst people whose native language was of another origin made completing the survey difficult, as a result Chinese- speaking individuals were excluded – this exclusion could affect the generalizability; the small study size may limit the reliability of the study; due to the nature of the study design, causality could not be established

environments to be more annoying than in leisure activities; adaptation or becoming “immune” to noise may affect emotional and physiological responses to noise for those used to living, working and playing in urban environments; public health officials should take into account the different scenarios in which one spends there time, find the scenario with the highest level of exposure and associated outcomes, and target that setting for interventions

Stansfeld, S. A.

2015 Literature Review; examine the contributions of environmental noise exposure from road, rail and aircraft noise on health, relative to air pollution

N/A; literature review yielded 25 peer review articles; search conducted using PubMed including the following key terms: “noise, air pollution and health;” occupational studies and studies of hearing loss were excluded

5 studies found associations of road traffic noise with hypertension; 3 studies found associations between myocardial infarction and road traffic noise exposure, but 1 of the studies only found the association for those closest to the road; 3 studies found an association between aircraft noise and myocardial infarction and CVD hospital admission rates; traffic noise was not associated with fatal stroke; 1 study on road traffic noise and 2 studies on aircraft noise found an association with all-cause mortality

There is a possibility that important studies may not have been included in the literature review; the review itself does not help to establish causality; misclassification of noise modelling could have been a source of bias; exposure to multiple noise sources may not be accounted for by the studies; indoor noise exposure was not likely reflected in the studies under investigation; some of the studies lacked significant power in their attempt to test significance; temporal misalignment may be possible due to inability to establish causality in most studies as

Existing literature provides evidence in support of cardiovascular morbidity and mortality from road traffic and aircraft noise independent of air pollution effects; environmental planning should take into considerations the health impact of noise when designing residential areas in proximity to busy roads and airports; noise pollution should also be included in environmental policy targeting air pollution

they are cross- sectional in design; burden of disease evidence may not be reliable or generalizable to large populations; multiple confounding factors exist that could alter the results of the studies under investigation

Ma, J.

2018 Cross- sectional; extend literature by exploring socio-spatial differences in noise pollution in Beijing as well as examine the relationship between noise pollution and self-reported mental health

1125 individuals; 50 household members aged 18- 65 years old were randomly selected from 26 communities in Beijing March- May 2017, selected for their diversity in spatial location, housing condition, community type and built environment; 155 participants were excluded for lacking complete information on

Proximity to the main road was a significant indicator of urban residents’ mental disorders; those living the furthest away from a main road had lower odds of anxiety, fatigue and sleep disturbances; a 62.7% increase in self-reported mental health disorders was found for those with reported high levels of noise pollution verses those with low levels of reported noise; railway and commercial noise were the most significant sources of

Subjective rather than objective data were collected on noise exposure since China lacks noise pollution data on a geographical basis; without objective data, the mental health outcomes may have bias and not be statistically accurate; potential confounding variables such as body mass index, smoking and drug use were not included in the

More research is needed into the health effects of noise pollution on mental health; housing renovation and road traffic represent significant sources of noise for those living in urban environments; policy on reducing noise during renovation projects and other noise abatement interventions is

socio- demographics, social networks, housing conditions and evaluations on noise pollution

mental distress; moderate to high noise pollution from housing renovation was associated with significantly worse mental health than those who reported low levels of renovation noise

study; causality could not be established due to the nature of the study design

needed to reduce this significant source of noise pollution for those living in urban centers

Wu, J. 2019 Cross- sectional; analyze noise distribution in relation to building height of residential apartment buildings located adjacent to roadways and evaluate the effects of environmental noise on urban residents

528 participants; three apartment buildings were selected for their proximity to a new roadway constructed in the previous decade in Guangzhou, China; household members were randomly selected from each of the buildings with the following number of individuals completing the survey: 148 from building A, 153 from building B, and 227 from building C

72% of participants reported sensitivity to noise; negative perceptions of noise by source type in order of most to least negative are as follows: traffic noise, daily life, construction, entertainment and industry; residents of the building closest to the Pazhou Bridge (traffic center) experienced greater sensitivity to noise; 90% of the participants reported noise having an impact on their physical comfort level, with 21% reporting a serious physical impact; 65% of the

The noise prediction model used in the study was created by the research investigators, thus the tool may not be reliable or generalizable to other settings; measurements for physical and psychological impact were based on survey responses and may result in responder bias; temporality (causality) between noise exposure and health impacts could not be established due to

This study provided evidence of an urban area exceeding national noise standards set by the government; as a result, more stringent penalties should be in place to enforce noise standards in urban settings to promote the health of urban residents; noise pollution effects on local resident populations should be considered in the developmental

participants reported noise having an impact on their psychological comfort; the most common symptoms included emotional instability, low working efficiency, fatigue, and insomnia; noise levels increase closer to the ground level and decrease slightly at the highest floors in the building; the noise levels in the buildings along the bridge far exceeded national standards for noise levels both during the day and at night

the exposure and outcome being conducted at the same time

phase of any major roadway, railway, or airport construction

Written Narrative of Literature Synthesis (1-2 paragraphs, approximately 250 words): Major collective findings that pertain directly to the environmental health problem / issue researched through the literature review dissection and synthesis, based upon the categories of column headings in the matrix: The current body of literature on noise pollution in urban areas provides evidence in support of an association between high noise levels and negative health outcomes including annoyance, mental health disorders, sleep disturbances, hypertension and other related cardiovascular diseases. Noise level measurements taken in many urban residential areas throughout the world exceed standards set by respective legislation. This finding demonstrates the need for better policy on noise abatement for urban areas as well as more stringent penalties for violating noise standards. Traffic-related noise and proximity to noise source (i.e. major roadway) represent the bulk of noise pollution reviewed in literature thus far. More research is needed into the contributions to noise pollution from sources such as aircraft, construction, housing renovation and sounds from the indoors. Primary public health

interventions should target environmental planning of major roadways, railways and airports to minimize noise for local residents. As a secondary strategy, public health officials should then target policy to control the existing sources of noise. The major limitation of this literature review is that the majority of articles included are cross-sectional, and none of the studies were able to establish a temporal relationship between noise exposure and negative health outcomes. This limitation is due to the lack of causal studies (RCT, cohort etc.) in current literature. A thorough search was completed using Academic Search Complete and PubMed for any articles containing the key words of “noise pollution,” “noise,” “noise exposure,” “health outcome,” “health,” and “urban.” Despite this thorough search, I was only able to find cross-sectional, ecological and literature review studies. My search was validated through the literature review paper included in my review which contained primarily cross-sectional studies and no studies that established causality. Although randomized control trials would not be appropriate for studying urban noise exposure, more research is needed using cohort and case-control study designs to investigate any causal associations that may exist.

References

Barbosa, A. S. M., & Cardoso, M. R. A. (2005). Hearing loss among workers exposed to road traffic noise in the city of São Paulo in

Brazil. Auris Nasus Layrnx, 32, 17-21. doi:10.1016/j.anl.2004.11.012

Björk, J., Ardö, J., Stroh, E., Östergren, P.-O., Albin, M. (2006). Road traffic noise in southern Sweden and its relation to annoyance,

disturbance of daily activities and health. Scandinavian Journal of Work, Environment & Health, 32(5), 392-401.

Dratva, J., Zemp, E., Dietrich, D. F., Bridevaux, P-O., Rochat, T., Schindler, C., Gerbase, M. W. (2009). Impact of road traffic noise

annoyance on health-related quality of life: results from a population-based study. Quality of Life Research, 19, 37-46. doi:

10.1007/s11136-009-9571-2.

Kim, M., Changg, S. I., Seong, J. C., Holt, J. B., Park, T. H., Ko, J. H., & Croft, J. B. (2012). Road traffic noise: Annoyance, sleep

disturbance, and public health implications. American Journal of Preventative Medicine, 43(4), 353-360.

http://dx.doi.org/10.1016/j.amepre.2012.06.014

Ma, J., Li, C., Kwan, M-P., & Chai, Y. (2018). A multilevel analysis of perceived noise pollution, geographic contexts and mental

health in Beijing. International Journal of Environmental Research and Public Health, 15(7), 1479.

doi: 10.3390/ijerph15071479.

Stansfeld, S. A. Noise effects on health in the context of air pollution exposure. International Journal of Environmental Research and

Public Health, 12, 12735-12760, doi:10.3390/ijerph121012735.

Vianna, K. M. dP., Cardoso, M. R. A., & Rodrigues, R. M. C. (2015). Noise pollution and annoyance: An urban soundscapes study.

Noise and Health, 17(76), 125-133.

Wu, J., Zou, C., He, S., Sun, X., Wang, X., & Yan, Q. (2019). Traffic noise exposure of high-rise residential buildings in urban area.

Environmental Science and Pollution Research, 26, 8502-8515. https://doi.org/10.1007/s11356-019-04640-1