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Special supplement
A review of the health effects of aircraft noise
Stephen Marrell, Richard Tay/or and David Ly/e
AUSTRALIAN AND NEW ZEAlAND JOURNAL OF PUBLIC HEALTH 1997 voc. 21 NO 2
971009934
219
REVIEW
A review of health effects of aircraft noise*
Stephen Morrell and Richard Taylor
Department of Public Health and Community Medicine, Universit;' of Sydney
David Lyle
New South Wales Health Department, Sydney
Abstract: Social surveys have established dose-response relationships between aircraft
noise and annoyance, v.rith a number of psychological symptoms being positively related
to annoyance. Evidence that exposure to aircraft noise is associate'cl with higher psychi-
atric hospital admission rates is mixed. Some evidence exists of an association between
aircraft noise exposure and use of psychotropic medications. People with a pre-existing
psychological or psychiatric condition may be more susceptible to the effects of exposure
to aircraft noise. Aircraft noise can produce effects on electroencephalogram sleep pat-
terns and cause \\'akefulness and difficulty in sleeping. Attendances at general practi-
tioners, self-reported health problems and use of medications, have been associated \\rith
exposure to aircraft noise, but some findings are inconsistent.
Some association between aircraft noise exposure and elevated mean blood pressure
has been observed in cross-sectional studies of schoolchildren, but with little confirma-
tion from cohort studies. There is no convincing e\1.dence to suggest that all-cause or
cause-specific mortality is increased by exposure to aircraft noise. There is no strong evi-
dence that aircraft noise has significant perinatal effects.
Using the "Vorld Health Organization definition of health, which includes positive
mental and social wellbeing, aircraft noise is responsible for considerable ill-health.
However, population-based studies have not found strong e,ridence that people living
near or under aircraft flight paths suffer higher rates of clinical morbidity or mortality as
a consequence of exposure to aircraft noise. A dearth of high quality studies in this area
precludes drawing substantive conclusions. (,lust N ZJ Public Health 1997; 21: 221-36)
AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOl. 21 NO 2
T
HE introduction ofjet aircraft on commercial
routes in the 19505 was associated \\ith major
increases in noise and disruption to residents
around large airports. Since the 1960s, ,.,'hen jet air-
craft came to dominate air traffic around airports,
increases in complaints to public officials and air-
ports have been a catalyst for research into the
effects of aircraft overflights in Australia and el5e-
,..;here.1 The grmvth in the literature has reflected
continuing and increasing concerns about the
effects of aircraft noise on the physical and mental
health of exposed populations. Populations near or
under the flight paths of Heathrow (London), Los
Angeles and Schiphol (Amsterdam) airports, in par-
ticular, have been studied in some detail.
Aircraft noise may produce a variety of psychoso-
cial and economic effects on humans, which
include: interference \'lith quality of life and
amenity. declines in property values, effects on
scholastic performance and various effects on
health.
Of the three major types of definitions of health,
that most commonly quoted is by the World Health
Organization: 'health is not merely the absence of
disease or infirmity but is a positive state of physical,
mental and social well-being'.'2 This definition is
Correspondence to A.ssociate Professor Richard Tay1or,
Department of Public Health and Community 1\1edicine, Faculty
of \1edicine, A'27, Cni\'ersit\' of Svdne\', :\'S\\' 2006. Fax (02)
9351 4l79. ..
" excluding auditory effects
inadequate for population-based studies, since it
does not include premature death (although it does
include illness and disability), and there is a lack of
agreed measures of wellbeing.
Health can be considered as successful adaptation
of individuals or groups to environmental circum-
stanceS. This requires that 'successful adaptation' be
defined. On an individual level, this is usually con-
sidered to be independent living and normal social
interaction, and therefore can include well-adjusted
people ,\1.th severe physical handicap. On a popula-
tion level, it may be considered as perpetuation of
the species at near zero population grmvth \vith min-
imal environmental disturbance, or adjustment to
en,1.ronmental changes with little or no social dislo-
cation. In relation to aircraft noise, those who adapt
would be considered healthv, while those '\'.;ho do
not might be considered unhealthy.
The third, or 'classical' approach is to consider
that people are healthy until they are detennined
not to be so, and to use a range of comparative pop-
ulation measures of mortality, morbidity and impair-
ment to determine the relative health of various
groups. This approach has the advantage of using
routinely available data, but there is difficulty in
defining 'disease' at the margins. For example, in
mental health the defmition and separation are
indistinct between clinical anxiety and depression
on the one hand, and anger, annoyance, irritation,
sadness, loss of morale and other normal sensations
on the other. Furthermore, disagreement in the
medical literature on the role played by 'stress' in
221
MORRELL ET Al
the aetioloblJ' of illness indicates current uncertainty
regarding plausible biological pathways for mental
and emotional states in 'determining' or 'predeter-
mining' physical health.
CI
Research on the health effects of noise has several
points of departure. In the least rigorous studies,
exposed persons relate not only what they consider
to be health concerns, but also attribute the cause to
aircraft noise (for example, on complaint hotlines
etc.). On firmer ground, health practitioners may
put together case series of instances in which an
adverse effect may plausibly be attributable to envi-
ronmental noise on the basis of knov,'Il patho-
physiology. The hest approach is open-ended or
hypothesis-driven studies, which seek to identify pos-
sible adverse health outcomes in populations (or
samples) by separately measuring noise exposure
and possible health effects, and changes in these
oyer time.
Possible health effects on individuals and
populations exposed to the noise of aircraft
movements
For this review, the possible (nonauditory) health
effects have been classified by the authors as: psy-
chological effects, acute physiological effects and
effects on sleep, possible chronic cardiovascular
effects, effects on morbidity and mortality of popu-
lations, and perinatal effects. The main explanatory
pathways proposed for physical health effect.,; of
noise is that they may be mediated by 'stress'
(including psychosocial stress), anxiety and/or per-
ceiyed lack of control over the source of exposure.
4
Furthermore, annoyance and cognitive effects of
noise, and ideation about the possibility ofa crash in
the context of aircraft noise may merge into psycho-
logical effects, particularly in the presence of addi-
tional effect modifiers (property O1\'nership,
atti tudes), which may then cause physical effects.
People who live in close proximity to aircraft flight
paths tend to be of lower socioeconomic status than
those who do not. Levels of morbidit\' and mortality
among populations v:ith low
haye long been known to be significantly higher
than among populations of average or high socio-
economic status." As a major source of potential con-
founding, socioeconomic status is particularly
difficult to correct, especially in ecological studies.
Complicating the picture is the possible influence of
factors, such as ownership of residence
(and concern with property values); individual sen-
siti\;!), to noise; and fear of an aircraft crash.
Moreover, as a result of the combination of exposure
and modifying factors on population migration,
people li,ing under flight paths in the long term
could well be a selected population.
There may be adverse health effects due to
sures taken to reduce the exposure to noise in the
domestic en\;ronment, such as reductions in outdoor
physical and social activities. Sealing and closure of
the home associated with sound insulation may
reduce ventilation and increase the spread of ai1:-
borne infections, or encourage the proliferation of
dust mite and thus increase the pre\'alence of asthma.
Finally, an important scenario to consider is that
physical effects of noise may manifest in susceptible
subgroups \\'ithin populations through psychologi-
cally rrtediated aggravation of existing physical or
mental conditions or precipitation of complications:
for example, triggering of dysrhythmias in persons
with heart disease, or acute psychotic episodes in
those with mental illness.
Methods and scope
This literature review includes international studies
of the relationship bervveen aircraft noise and
indices of psychological and physical health. It con-
centrates on English-language publications, and
focuses on studies that have examined the nonaudi-
torv health effects of aircraft noise. Auditor\' effects
of have been well described, but are con-
sidered of importance in relation to exposure to
ch'ilian aircraft noise. Aspects of cognitive and task
performance are not covered in detail. Death or
injUlT from aircraft crashes in populated areas is not
reviewed here, nor are studies of possible associa-
tions between health and atmospheric pollution
from aircraft emissions.
The literature on stress and health, especially
regarding acute versus chronic effects, is briefly
appraised in relation to the major models of
stress-disease association that commonly' underpin
reported effects of aircraft noise on health.
Studies \vere assessed by standard epidemiological
criteria, including: study type, control of confound-
ing and bias, measurement of exposure and
response, strength of association and dose-response
effect, numbers of subjects, and statistical signifi-
cance. E\,;dence of causality "was assessed according
to criteria outlined by Bradford Hill.
6
Of the journal articles and report.'; examined, 129
separate references are included in this re\iew;
about 350 were found not to be sufficiently perti-
nent to be included, most often because the\' were
review articles rather than primary
Publications were obtained through automated
searches of several major bibliographic databases
including Medline and the Online Computer
Library Centre. and through secondary searches of
bibliographies accompanying relevant journal arti-
cles. A considerable proportion of the literaturf'
re\'iev>,'ed is not listed on Medline. :Many publications
\-",ere available only in report form, and these were
obtained from the organisations that produced the
reports.
Stress, anxiety and physical health
'Stress' has been suggested as the major mechanism
through which noise can affect mental and physical
health.' Physiologically, stress manifests as a complex
of autonomic endocrine processes centred on the
pituitary-adrenocortical axis.1> Se1ye employed the
term to refer to the physiological reaction of the
body to an en\ironmental threat or challenge, and
elaborated a stress response scenario called the 'gen-
eral adaptation syndrome'.!! An imp0rtant contribu-
tion was also made by Cannon's investigation of the
role of adrenaline in the 'flight or fight' response. Hi
222 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOl 21 NO 2
Stress can manifest itself as a prolonged or acute
phenomenon.
The stress response has been found to be modi-
fied innate or learned predispositions of the
organism.
11
For example, consistent cardiovascular
findings have emerged pOinting to a positive rela-
tionship betv..,'een coronary heart disease and hostil-
ity.':!-H
\'\11ile haemodynamic reactivity is regarded as a
marker for hypertension,15 at least one prospective
study presents evidence that heightened haemody-
namic stress can precede future elevated
blood pressure levels by a considerable period.
'6
Xeyertheless, increased blood pressure lability as a
result of long-term exposure to intermittent stres-
SOl'S has not been shown to be a cause of sustained
hypertension.l'i"11' The number of factors, both
endogenous and exogenous, that can contribute to
individual yariations in blood pressure is large.
Some of these include age, sex, body habitus and
somatotype, muscle mass, electrolyte and glucose
metabolism, habitual and recent dietary intakes of
salt, potassium, caffeine, alcohol and nicotine.
Cardiovascular conditions may result from situa-
tions percei\'ed by the respondent to be psychologi-
cally stressful, but findings have not been uniform.
Some studies have shO\\'11 a relation between per-
ceived stress and anxietv and fatal and/or nonfatal
coronary arterv events pointing to evidence of
an hetweed chronic psychological stress
and coronary heart disease. However, contrar)' evi-
dence comes from a study of 1040 bus drivers in San
Francisco whose self-reported stress was related
directly to gastrointestinal, respiratory and muscu-
loskeletal ailments but inversely related to levels of

Peaks of blood pressure are not as significant a
predictor for hypertension as mean 24-hour blood
pressure level.
22
Studies have yet to establish that sus-
tained hypertension in humans results from stress,
regardless of differing response modes to stressors,
and despite ample laboratory and naturalistic eyi-
dence of transitory blood pressure effects induced
by stressors, including that induced by noise (see
bibliography by
The role of acute stress (as distinct from chronic
stress) in precipitating arrhythmia and stroke is con-
\incing, and has often been deriyed from case series
or case-control studies that v-,'ere a byproduct of
other
Annoyance reactions to aircraft noise
Social sun'evs on noise annoyance have been carried
out in England, France,' Switzerland, Sweden,
l-nited States of America, "",'est Germanv, and
Australia.
l
Borsky is credited as the first to' assess
annoyance in terms of reported disturbance of spe-
cific activities including conversation, watching tele-
\ision, and sleeping.1.
311
Subsequent suryeys have also
prO\ided data on general annoyance, without direct
reference to specific acti\ities.
The predictive validity of noise metrics vis a vis
annoyance was examined bv Schultz when he svn-
thesised the results of 11' international
EFFECTS OF AIRCRAFT NOISE
between and 1974: six studies of aircraft noise,
four of traffic noise, and one railroad sun'ey. Schultz
found a consistent relationship bet\veen nonimpul-
sive noise exposure (measured by L
dll
, an average
day-night sound level) and community annoyance,
inespecth'e of its source."l The dose-response rela-
tionship has been reproduced in more recent com-
munity Support for Schultz's synthesis
has not been unanimous (for example, Griffiths:-\4).
Other studies have shown that the association
benveen noise exposure and annoyance does vary
according to source,35-37 while the level of back-
ground noise (for example, road traffic) may not
influence reported annoyance from aircraft
noise.3us.3Y
For their own 1981 population survey of residents
around Svdnev, Adelaide, Perth and Melbourne air-
ports, Hede and Bullen proposed using a lower level
of reaction as a cut-off point, one more broadly
based on affectedness, dissatisfaction, three annov-
ance ratings, and fear of an aircraft Their
outcome measure was designated as the percentage
'seriously .affected', rather than the percentage
'highly annoyed'. The investigators found that at
Australian noise exposure forecast (Ac"EF) of 20, 12
per cent of were seriously affected by air-
craft noise and 38 per cent were at least moderately
affected. At Aol\EF of 35, 36 per cent of residents
were seriously affected and 73 per cent were at least
moderately affected.
Bjorkman et al. found a significant relationship
bern'een exposure and annoyance 'when exposure
was measured as the number of noise events above
70 dBA-when these events occurred more than
three times daily.40 The finding suggests that annoy-
ance reaction may be more highly correlated ",:ith
exposure \vhen the basis is metrics Vlith counts of
extreme noise events rather than energy-averaged
measures.
It remains to be established if noise metrics based
partly on annoyance-reaction levels are appropriate
for conelating with possible health outcomes.
Despite the predictive yalue of noise measures
using aggregated data, noise metrics fail to predict
indi\idual responses to noise accurately. signifying
that noise is not the only factor inyolved in annoy-
ance reactions. Psychosocial factors affect percep-
tion and annoyance reactions to noise in community
suryeys.:\O.-4I--J:I ) ,
Annoyance reactions are greater in people who
indicate a fear of aircraft crashes, are concerned
about the health effects of noise, or report interfer-
ence \'\o1th acti\1ties such as watching tele\,ision, talk-
ing and Recorded aircraft noise, when it
interfered with tasks requiring concentration (for
instance, proofreading and figure-tracing), was per-
ceived to be more annoying and less pleasant than
the same noise when these tasks were not being
attempted.
44
People \'\-'ho report that they are sensi-
tive to noise, so called 'noise sensitive' people, are
also more likely to indicate intense anno)-"ance reac-
tions.I:H;Hh
Studies have been reported to show that: 1.
sociodemographic factors of age, sex, marital status
AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOl. 21 NO. 2 223
MORRELL ET Al
and socioeconomic status have low correlation \<\1th
individual reactions, and that socioeconomic status
correlates more strongly with complaint behayiour;:t!
and 2. complaint beha\10ur shows lower correlation
\\1th noise exposure than does noise reaction.:
t
!
Bullen concluded from these findings that: 'In gen-
eral, the number of complaints received is a very
poor guide to the extent of noise reaction in the
community... ' ,1
The relationship between annoyance and health
was examined in a residential survey (n ::::. 6000) of
aircraft noise and mental health London's
Heathrmv Airport:
fi
,48 Tarnopolsky et al. reported a
significant association between annoyance level and
reporting of individual psychosocial and physical
symptoms and the use of medications, ,,,,'hich \,,ras
independent of noise exposure leveL
4H
From the
same survey V\Tatkins et aL concluded:
The of psychotropic drugs, and the use of GP and out-
patient services, increase with increasing annoyance in both
low- and areas, though the increases do not in all
cases reach the 5% level of statistical significance. The use of
non-prescribed drugs, on the other hand, increases signifi-
cantly (P < 0.001) with annoyance in high noise, but no
relation with annoyance in low noise conditiom.
4
"
Further analysis of the same community suney by
Kryter shmved that the psychiatric patients were dis-
proportionately annoyed by aircraft noise, indicat-
ing that aircraft noise may affect these people more
adversely than the general community.7
A study by Graeven found that a significant corre-
lation bet\veen annovance from aircraft noise and
the number of complaints reported in the
previous week was independent of other factors,
including level of noise exposure.
so
Fiedler and
Fiedler reported that about half the people both-
ered by aircraft noise attributed some kind of per-
sonal effect to it.
45
More than half of these effects
were psychological, especially nervousness and irri-
tability, and the frequency of these complaints did
not differ according to the airport noise zone.
A complaints hotline set up by the 1\'ew South
V,rales Health Department to monitor community
reaction to the opening of the new parallel runway
in 1994 at Svdney Airport produced the follOl,ing
result>: of about 1700 health-related complaints
attributed to aircraft noise (from about 450 callers),
about 20 per cent concerned sleeping difficulties; a
similar proportion ''''ere about increased (mental)
tension; 15 per cent about increased anxiet\'; and
about 10 per cent about fatigue. Other complaint'i
included headache, pollution effects, tinnitus,
breathing difficulties and sleeping and concentra-
tion difficulties of children. 1\0 infonnation on
exposure ,vas reported.
51
Results reported by Lercher of a survev of 1989
respondents from five villages in rural sug-
gest an association bet\veen aircraft noise exposure
above 55 dBA (assigned levels), and higher levels of
reporting of tiredness, nenrousness, 'loss of wellbe-
ing and safety', sleep disturbance, headache and
palpitations:):t These were adjusted for age, sex and
education. \"rhen annoyance was taken into account,
the association was stronger. The participation rate
for this study (62 per cent) could render some of its
findings biased in that the remaining 38 per cent of
the population would probably cOlltain a compara-
tively 10\,,' proportion of noise-sensitive persons.
From a review of general noise-reaction studies
between 1963 and 1985/>:'1 we estimated from the
quoted correlations pertinent to aircraft noise that,
on average, about 20 per cent of the \'ariation in
individual reaction (that is, individuals vvith indi\1d-
ually measured exposure levels) to aircraft noise is
explained by exposure level; and around 72 per cent
of group reaction is explained by the exposure level
(that is, ecological, in groups assigned to broad
exposure categories). Moreover, the findings of
Bjorkman et al. and Lercher appear to suggest that
annoyance and reaction is correlated more highly
exposure when the latter is measured as counts
of extreme events rather than as energy-averaged
noise levels.
Mental health
Psychiatric hospital admissions
In 1969 an ecological retrospective study of popula-
tions living in boroughs surrounding London's
Heathrow Airport reported significantly higher rates
of admissions to the Springfield psychiatric hospital
among the noise-exposed population than those liv-
ing in areas with low aircraft-noise exposure."4 Total
and first-time admissions over a t\vo-year period
(mid-1966 to mid-1968) were examined. Admission
rates for all groups taken together, all females (both
total and first-time admissions), all females over 45
years of age (both total and first-time admissions),
and all \\1dows (both total and first-time admissions)
were significantly higher in the noise-exposed popu-
lation than in the low-noise region. Obsen'ed values
were consistently higher than expected values for
the high-noise areas, even if statistical significance
was not reached in some strata. Potential con-
founders-for example, ease of access to mental
health care facilities or differences in age structure
and socioeconomic status of the populations being
compared-were not adjusted for.
The above admissions study was repeated for the
years 1970 to 1972.
5
:' .After adjustments were made
benveen the high-exposure and low-exposure popu-
lations for age, sex and marital status, the findings of
the earlier study were not replicated.
Jenkins et aJ.'s subsequent study of one of the psy-
chiatric hospitals in the Abey-\fickrama et aJ. study
(but covering a wider area and longer period) found
a negative relationship between aircraft noise and
admission rates.
56
A funher study of admissions to
three psychiatric hospitals around Heathrow Airport
byJenkins et al., after partial control of several mea-
sures of socioeconomic status, failed to find a con-
sistent relationship bet\veen noise exposure and
admission rate by hospital. There was a positive asso-
ciation bet\veen higher admission rates and noise
exposure at t\\'o hospitals, but a negative association
for the other.-17
In an attempt to resolve the apparent contradic-
tion bet\veen the negative dose-response relation-
ship in admission rates by hospital, Kryter
reanalysed data fromJenkins et alY and showed that
immigrant status in the study population was
224 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VQl. 21 NO 2
strongly and negatively correlated with psychiatric
hospital admission; that the proportion of immi-
grants in one hospital catchment area was signifi
cantly higher; and that the distribution of
immigrants was skewed more toward the higher
noise contours in that hospital's catchment area
than in the catchment areas for the other tv\'o hospi-
t a l s . ~ ' According to Kryter, the negative
dose-response result ofJenkins et al. was an artefact
because insufficient allowance was made for immi-
grant status of the population for that particular hos-
pital.
:\mong residents near Los Angeles International
Airport, admissions to mental hospitals from a high-
noise area were found to be 29 per cent higher than
in lownoise-area controls (significant at the 10 per
cent level).58 Potential effects of confounders-for
example, Mrican-Americans made up 25 per cent of
those from the exposed area, but only 2 per cent of
those from the control areas-were not allowed for.
Prevalence of psychological or psychosomatic
morbidity
If aircraft noise contributes to mental illness, it is
probable that differences in noninstitutional psy-
chological or psychiatric morbidity vl'Ould be evi-
dent.
The community survey of 6000 people from four
noise-exposure zones living near Heathrow Airport
produced variable results: significantly higher preva-
lence of recent onset of night waking, depression,
irritability (along with swollen ankles, minor acci-
dents including burns and cuts, and skin problems)
occurred in those from higher noise zones (based
on energy-averaged noise contours).48 Significantly
lO'\\'er prevalence of chronic irritability ",,ras noted in
lower noise zones. HO'wever, psychotropic drug
intake was found to have a significant negative asso-
ciation in relation to noise exposure, inconsistent
with a noise-psychiatric illness or noise-symptom
hypothesis.
49
These findings failed to replicate
results of the prior pilot study by Tarnopolsky et aI.,
in ,,'hich psychiatric measures showed an association
"ith noise only in those respondents v.ith high edu-
cation.
58
In a postal follow-up survey of annoyance and
noise sensitivity of a subsample of 77 women from
the same survey, repeated measures of le,'els of
annoyance were more highly correlated in those
sensitive to aircraft noise (r= 0.85) than in those sen-
sitive to road traffic or other noise (r = 0.51).
Sensitivity to noise was not a significant predictor of
pS"chological morbidity (as measured by the 30-item
General Health Questionnaire). 60
In the Netherlands, Knipschild found significantly
higher contact rates for psychological problems,
mental disorders' (consistent across degrees of
seyerity), and some 'psychosomatic complaints'
(spastic colon and lower back pain) in the tvo/O nois-
iest of four exposure zones around Schiphol airport
(near Amsterdam).61 However, some of the differ-
ences in contact rates could have been explained by
differences in socioeconomic status between expo-
sure zones rather than the exposure itself, since the
EFFECTS OF AIRCRAFT NOISE
fonner was not controlled for.
In 552 residents surveyed from five different noise
zones (including a quiet control zone) around San
Franciico Airport, significant correlations were
found bet\\'een noise av...'areness and annoyance and
the number of health problems reported from a
symptoms checklist. Fear of an aircraft crash
explained most of the variance in the quiet control
zone, whereas in the exposed areas most of the vari-
ance was explained by noise awareness and annoy-
ance.
50
Kryter reported on an ecological study of people
living near airports in the Soviet Union which found
a higher incidence of 'nervous diseases', among
other conditions.
52
Studies of the effects of aircraft noise on mental
health are summarised in Table 1.
Acute physiological effects
Hormonal and autonomic effects
Specific autonomic, honnonal, muscular, skin and
respiratory changes occur in response to noise stim-
ulation. The pattern of somatic responses to unex-
pected noise is: a vascular response characterised by
peripheral vasoconstriction, minor changes in heart
rate, and increased cerebral blood flow; slO\v deep
breathing; a change in skin resistance to electricit)'!
(the galvanic skin response (GSR)); and a change in
skeletal muscle tension.
63
.64 Changes in gastrointesti-
nal motility in relation to noise exposure have also
been reported.
65
Responses to continuous or regular noise from
laboratory experiments on humans vary.7 Some stud-
ies have sho\\'11 a positive honnonal and autonomic
response to road traffic or aircraft noise;ti6-6!l some
have shov.'11 habituation to noise in skin response
and vasoconstriction;69 others found no statistically
significant changes in hormonal or autonomic reac
tivity.70
Regarding physiological reactions to continuous
or regular noise, Kryter concluded:
experimental eyidence demonstrates that autonomic syStem
responses that are probably stressful occur only after conscious
or unconscious cogniti\'e processes are completed. That is to
say, sound or noises are not inherenth' ayersive or a cause of
physiological stress except to the ear.'
This conclusion is supported by Osada et aL, who
found empirically that:
the effects of level and number of aircraft noise varied with
each physiological functions [sic] and that scarcely am' rela-
tion existed between the effects and ECP;\L [equivalent con-
tinuous perceived noise levdJ.67
Blood pressure
To date, investigations of the effects of noise on
blood pressure and heart rate have not produced
consistent findings. AJthough studies have shov,m
increased diastolic blood pressure to be associated
with exposure to various kinds of noise, the effect of
noise on systolic blood pressure and pulse rate
remains unclear.
Separate studies have shown decreases in systolic
blood pressure and heart rate and increases in dias-
tolic blood pressure 1.,rith exposure to different noise
sources./
1
-
74
Others have found significant decreases
AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOL 21 NO. 2 225
MORRELl ET Al
Table 1: Selected studies examining the effects of aircraft noise on mental health
EHect on Noise
"
Confounding factors
Authors location health measure Study type adjusted for Findings
Abey-Wickrama Heathrow, Admission to >55 NNI 0 or Ecological Sex-specific; no control Significantly higher
et 01.
52
London, UK psychiatric PNdBb >100 for age or admission rates in
hospital <55 NNI socioeconomic status exposed population
Gottoni and Heathrow, Admission to > 55 NNI Ecological Age-standardised; Positive result, not
Tarnopolsky 53 London, UK psychiatric <55 NNI (replication of rates specific for age significant
hospital Abey-Wickrama and marital status; no
"
control for
socioeconomic status
Meecham and Los Angeles Admission to >90 dB Ecological No adjustment for race 295 increase in high-
Smith 55 airport, US psychiatric <90 dB noise area (P = 0.1)
hospital
Tarnopolsky et Heathrow, Annoyance; >55 NNI Cross-sectional Subgroup analyses, Correlation between
01.
56
London, UK possible and -35 NNI population including by sex, annoyance and
confirmed survey education level psychiatric symptoms; no
psychiatric cases sigr,.jficant effect of
noise, except in high-
education group
Jenkins et 01. 56 Heathrow, Admissions to 25--34 NNI Ecological Age-standardised; Significant negative
London, UK psychiatric 35--44 NNI rates specific for sex result
hospital 35--54 NNI and marital status
>55 NNI
Tarnopolsky et Heathrow, Psychiatric <35 NNI Cross-sectional Age- and sex- Some acute symptoms
01.
46
London, UK illness; other 35--44 NNI population stondardised; increase with noise: no
acute and 45--54 NNI survey socioeconomic status obvious threshold
chronic >55 NNI accounted for
symptoms
Jenkins et 01. 45 Heathrow, Admissions to 25--34 NNI Ecological Age-standardised; Mixed result (2 hospitals
London, UK psychiatric 35--44 NNI rates specific for sex positive, 1 negative)
hospital 45--54 NNI and marital status;
>55 NNI control of measures of
socioeconomic status
Watkins et 01. 47 Heathrow, Use of <35 NNI Cross-sectional Age, sex and Uptake of medications in
london, UK medications and 35--44 NNI population socioeconomic status high-noise areas no
health services 45--54 NNI survey higher; higher
>55 NNI psychotropic drug use
and use of general
practitioners with
annoyance; variable
response of health
service use with noise
exposure
Kryter 54 Heathrow, Admissions to 25--34 NNI Ecological Migrant status, -40% higher admission
london, UK psychiatric 35--44 NNI (reanalysis of socioeconomic status, rates in groups exposed
hospitals 45--54 NNI Jenkins's data 45 age and sex to higher levels of
>55 NNI aircraft noise
Stansfield 57 Heathrow, Annoyance or <45 NNI longitudinal Sex and migrant status Noise sensitivity not 0
london, UK sensitivity, and
>45 NNI population study predictors of
psychological
(postal follow-up psychological morbidity;
morbidity
of subsomple of noise annoyance in
females from noise-sensitive subjects
Tornopolsky higher in zones with
sample) higher levels of aircraft
noise
Notes: (a) NNI = noise number index. (b) PNdB = perceived noise decibels. (c) Ecological", group-based geographic study.
226 AUSTRALIAN AND NEW ZEALAND JOllRNAL OF PlIBlIC HEALTH 1997 VOl. 21 NO 2
in systolic and increases in diastolic blood pressure,
but increase in heart rate owing to
Vasoconstriction has been observed to accompany
exposure to noise.'i-'!l Lehmann and Tamm found
an increase in peripheral arterial resistance in
response to noise, but not in heart rate or blood
pressure/IO ,,,,hile Manninen and Aro reported an
increase in diastolic pressure but no clear response
of systolic blood pressure to noise.
S
),8t
Relating more directly to aircraft noise, McLean
and Tarnopolsky reported on a thesis by Mosskov
which found significant elevation of diastolic blood
pressure after laboratory exposure to aircraft
The magnitude of the response ""'as depen-
dent on the duration of the noise exposure. Blood
pressure changes apparently attributable to aircraft
noise have also been found in schoolchildren (see
section on children, p. 230).
Sleep studies
The effects of noise on sleep have been sought vari-
ously by asking study subjects to record the number
of av:akenings or to rate the of the previous
night's sleep; by monitoring brain activity and sleep
quality during sleep using an electroencephalogram
(EEG); by monitoring levels of peripheral vasocon-
striction; or by measuring the amount of wakeful-
ness or sleep disturbance by an actimeter, an
instrument for measuring bodily movement. Sleep
loss and deprivation has also been studied in rela-
tion to autonomic, immunologic and endocrine
effects.
The effects of noise on brain wave activity during
sleep have been monitored extensively. Five stages of
sleep are measured by the EEG: stages 1 to 4 (some-
times called 'non-REM' or 'NREM') and rapid eye
movement sleep (REM), during which dreaming
occurs. The depth of sleep is said to increase in the
sequential stages 1 to 4, after which there is a slight
lightening to the REM stage. There are usually
about five cycles of sleep a night.
Loud aircraft noise simulated in a laboratory
experimental setting was shown to increase the num-
ber of awakenings; older males woke to less noise
than younger males-although the result was not
tested for statistical significance.
8
" In a survey of
1500 people living in four noise-level areas based on
distance fromJohn F. Kennedy (JFK) Airport in New
York, 60 per cent of respondents living within one
mile of the airport, 33 per cent of those five miles
away, and less than 10 per cent of persons residing
12 miles out reponed some sleep disturbance.
86
Another study found no difference in reported
sleep quality from exposure to 80 dBA and 65 dBA
laboratory simulated jet aircraft flyovers, although
there was significantly less disturbance to conical
activity during fast-V\'ave EEG activity when the qui-
eter stimulus applied. Hi Ando and Hattori, in a
naturalistic setting, found that deep sleep of babies
was disturbed by aircraft noise louder than 95 dBA
around Osaka airport.
HR
There is gen-
eral agreement in the literature that noise-induced
changes in EEG stages of sleep are not sujbect to
habituation. I
EFFECTS OF AIRCRAFT NOISE
A laboratory sleep study by Carter et al. of nine
adults with cardiac arrhythmia found that: en,iron-
mental noise levels (roa'd traffic and aircraft) of 65
to 72 d])A increased arousals from sleep by around
fivefold, regardless of sleep stage; the frequency of
ventricular premature contraction (VPC) was not
increased by noise in patients with heart disease and
moderately frequent low-grade VPCs; arousals
occurring during slow-wave sleep reduced the fre-
quency of VPCs (which otherwise increased during
slow-wave sleep without being related to noise
events); and urinary catecholamine levels were not
significantly affected by noise exposure.
89
Much of the preceding work on noise and sleep
was either laboratorv-based simulation or involved
sources of noise other aircraft. Kryter pre-
sented a detailed analysis of three studies of aircraft
noise conducted in the community. I The first, a
study by Globus et al. found a decrease in deep sleep
in six couples exposed to 77 dBA, but not in five con-
trol couples exposed to 57 dBA.
90
The second, a
study by Vallet et aI., ploued the probability of awak-
ening at different levels of noise exposure which
peaked at 'between 45 and 65 dBA.9J This did not
confonn to laboratory data suggesting that the num-
ber of awakenings increases in parallel with the
noise.
The third study referred to by Kryter was the air-
craft noise study by the Directorate of Operational
Research and Analysis (DORA) which provided data
on difficulties people had getting to sleep and awak-
enings caused by aircraft movements around
Heathrow and Gatwick Airports in London.
92
Correlations were charted betvveen aircraft noise
and difficulty getting to sleep on specific nights and
in generaL The authors concluded that sleep distur-
bance did not occur until the noise level reached
Leq (an average-energy noise metric comparable to
A'IEF) of 65 dBA, and that people had difficulty get-
ting to sleep when it was higher than Leq 70 dBA.
Kryter re-examined the DORA study graphs and
argued that the critical levels should be reduced by
lO dBA to 60 dBA each.'
Sumitsuji et aL used a facial electromyogram
(EMG), which records muscle contraction readings
as a prm,.. '''y for sleep disturbance, and found an
increase in the duration of contractions in sleepers
exposed to aircraft noise.
9
.'\ Contrary to some other
studies, one study found a decrease in heart rate
during sleep.'H Another study, by
VaBet et aL, found no habituation of the acute heart
rate response to aircraft flvovers after seven veal'S in
residents living near Roiss)' (Paris) airport.
9
':;'
An actimetric field sleep study of 400 subjects
around eight airports in the United Kingdom (total
of 5742 nights of monitored sleep), found that dif-
ferences in sleep disturbance did not vary greatly
",,1.th different levels of exposure, although males
were more likely to respond to aircraft noise events
than females.
B6
Results of field and laboratory studies of sleep dis-
turbance from aircraft noise were compared by
Maschke (Berlin) .97 Nocturnal awakenings associ-
ated with aircraft overflights increased by 100 per
AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOL. 21 NO 2 227
MORRELL ET Al
cent in laboratory subjects, compared with 80 per
cent in field study subjects; subjective sleep gnality
was 25 per cent and 30 per cent less in laboratory
and field study subjects respectively; and adrenaline
secretion was higher by 60 per cent in laboratory
snbjects, but only by 20 per cent in the field study
subjects (no indication of statistical significance
ayailable); all were compared with no exposure to
nocturnal aircraft noise. If similar studies can repli-
cate these findings, the validity of extrapolating lab-
oratory-based sleep effects without appropriate
adjustment would be doubtful, for it appears that
the effects of noise exposure in the laboratory on
sleep is greater than in the natural setting.
Sleep deprivation has been shown to affect the
immune system in various laboratory and field set-
tings, in both animal
98
and human studies.!19 Human
immune system effects from sleep disturbance or
mild sleep deprivation have not been established.
Long-term effects on health
The long-term effects of noise on health have been
considered in occupational settings and residential
communities. 'Stress' has been suggested as the
major mechanism by which noise affects physical
and mental health,' operating through psvchologi-
cal rather than direct physiological means, and in
response to the disruption of nonnal activities or
emotional feelings (fear, annoyance ete.) that the
noise is known to be associated with. The proposed
relationship between stress and health is complex,
not fully understood, lOO and in some dispute.
Cardiovascular disease effects
In the early 1980s several independent experts were
organised to review critically 83 papers investigating
the relationship of noise (industrial, transport ete.)
to elevated blood pressure.
101
Only one of the three
cohort studies reviewed demonstrated a positive
association betvveen elevated blood pressure and
noise exposure. Most (44 of 55) of the cross-sec-
tional studies showed a positive association between
noise and elevated blood pressure, \\'ith the preYa-
lence of high blood pressure in the noise-exposed
groups being betvveen 1.6 and 2.8 times that the
unexposed groups. Problems identified in these
studies included: failure to measure indi\;dual noise
exposure, lack of a standard blood pressure mea-
surement technique and failure to adjust for knmvn
confounders. The reviewed evidence, ""hile of poor
quality, was considered sufficient to justify further
research in this area.
During the 1970s a series of community studies
into the health effects of aircraft noise were carried
out around Schiphol airport in Holland hy
Knipschild et al. These studies examined by survey
and physical examination the relationship between
noise exposure and community prevalence of car-
diovascular disease in 6000 residents (42 per cent of
the total) aged 35 to 64 years. After allowing for
smoking, age, sex, height and weight differences
between the different populations, Knipschild
found that treatment rates for 'heart trouble' and
hypertension and taking of medications for cardio-
vascular disease (especially in women) were higher
in the exposed area.
102
Prevalence of hypertension
and 'pathological heart shape' on x-ray were also
found" to be greater in the exposed area.
'Cardiovascular impairment' was found to be 50 per
cent higher in the exposed areas. The prevalence of
hypertension was highest in villages exposed to
higher than 37 1\'1\'1 (noise number index). The
study was affected by a high rate of nonresponse (58
per cent), which may have resulted in selection bias
(where a higher proportion of annoyed or noise-sen-
sitive persons from the high-noise areas may have
participated than from the low-noise area).
Although there was adjustment for age, sex, smok-
ing, adiposity and size of village, socioeconomic sta-
tus was only partly controlled, while dietary factors
were not considered.
From a study of attendance rates (per population)
for 19 general practitioners servicing the population
in three villages around Schiphol airport,
Knipschild found that attendances for cardiovascu-
lar disease in the highest noise area was greater than
for the lower noise areas (see below also); and that
the usage rate of antihypertensive medication
among v\"Omen in the noisiest area was higher.
103
This study, \vhile reporting positive findings, does
not provide strong evidence because it "''as con-
ducted over a short period, not repeated, and did
not make adjustments for possible confounders.
Stronger evidence comes from a longitudinal aggre-
gate study by Knipschild et al. of pharmacy drug pur-
chase data over a four-year period. This study found
that purchase rates per population of cardiovascular
drugs (especially antihypertensive medication) cor-
related positively with increasing aircraft noise lev-
els.
104
In 1993 a small-area (ecological-aggregate) study
of routinely collected hospital admissions data for
areas around Schiphol airport was conducted by the
Dutch National Institute of Public Health and
Environmental Protection,lOS as part of a mandatory
environmental impact assessment accompanying
future expansion plans for the airport. Spatial pat-
terns of hospital admission rates around the airport
for acute myocardial infarction and hypertension
during 1991 were investigated. ~ A . f t e r empirical
Bayesian methods had been used to smooth highly
variable rates (which occur with small underlying
denominator populations), no discernible noise-
related geographical pattern in hospital admissions
for the outcome conditions was found. The negative
finding was not surprising, because the units of
aggregation (local government areas) ,vere too large
to conform uniformly to exposure conditions.
In a number of cross-sectional, case-control and
cohort studies of acute myocardial infarction,
Babisch et al. found prevalence and incidence of
ischaemic heart disease to be 10 to 30 per cent
higher in high-traffic-noise-exposed populations
than in those exposed to low levels of traffic noise. lOG
"Kone of the quoted results reached statistical signif-
icance at the 5 per cent level.
228 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VQl. 21 NO 2
General health surveys
Illness and morbidity
I\.oszarny et al. are reported to have found signifi-
cantly more health complaints in women, but not
men. living in a high-noisE-exposure area. 107
Grandjean et aL are reported by Kryter to have
found a significantly higher use of tranquillisers and
sleeping tablets as noise exposure increased.i,lO/i
Kryter attributes this increased consumption to 'the
interference effects of the noise with sleep and
speech communications','
Knipschild's general practitioner survey provides
an estimate of incidence rates over a one-week
period. All the doctors (practically the sole source of
primary health care) in the four villages near the air-
port were surveyed.lOC> Significantly higher atten-
dance rates per population for psychological
problems, 'mental disorders' and some 'psychoso-
matic complaints' (spastic colon and lower back
pain) occurred in noisy than quieter areas. The con-
tact rate for other conditions, such as cardiovascular
disease, allergic diseases, headache and a control
condition, did not differ significantly between the
areas. However, Knipschild noted that one doctor,
,,hen running a clinic for aged people in the low-
noise-exposure area, had recorded all the atten-
dances as being for cardiovascular problems. This
would have tended to lessen differences in cardio-
\'ascular attendance rates between the exposure
zones.
Knipschild's graphic presentation of total contact
rate, mental disorders, psychosomatic illness, and
cardiovascular disease (restricted to persons age 15
to 64 years) over the four noise-exposure groups
demonstrated clear dose-response effects (although
statistical significance was not given). There
appeared to be a threshold for the general practi-
tioner consultation rate concerning mental disor-
ders and cardiovascular diseases at 30 l\'NI. 103 The
author stated that adjustment for age and sex was
incorporated into these analyses, and \vhile there
were minor differences in socioeconomic status, 'it
is improbable that these small differences can
explain the big differences in contact rate' .103
.\djustment for factors knov:n to cause such condi-
tions as cardiovascular disease, such as smoking sta-
tus. was not possible.
Kryter tabulated data from the same study' pre-
sented in a later publication10Y and showed signifi-
cant dose-response effects across three noise-
exposure categories for psychological problems, psy-
chosomatic problems, cardioyascular disease and
hypertension. It is not clear whether these results
were adjusted for age and sex, and it was stated that
socioeconomic status was not taken into account.
Knipschild and Oudshoorn conducted a before-
and-after aggregate study of drug purchases in two
\illages near Schiphol airport.
I04
One of the villages
experienced increased exposure to aircraft noise,
while noise exposure in the other (control)
remained unchanged. Purchases of prescription
drugs used to treat sleep disturbances, psychological
and psychosomatic complaints, and cardiovascular
and hypertensive disease were examined. The out-
EFFECTS OF AIRCRAFT NOISE
come measure, a drug index, was computed from
the ratio of the number of drugs purchased in a
given year over the adult population in that area for
that 'tear. Changes in aircraft noise exposure were
monitored over the four years of the study. The drug
index increased with the noise level in the exposed
area, while remaining stable in the control area.
During the study period, the area initially experi-
encing increased aircraft noise later had its
exposure levels lowered, and the drug index Corre-
spondingly declined. The authors did no statistical
testing because of the exploratory nature of the
study. Despite this, aggregate evidence of this kind
where the outcome measure and the study factor
vary together over time is more convincing than sta-
tic associations.
Meier and Muller found an increased consump-
tion of hypnotic drugs in relation to aircraft noise.
lID
This finding is in contrast to the results of the
Heathrow community survey, which found a signifi-
cant negative relationship bet\veen psychotropic
drug use and noise exposure.
49
In response to the opening of the new parallel
runway in 1994 at Sydney airport, a general practice
survey was conducted by Doctors Educating About
Flyovers (DEAF) involving 100 of 155 doctors in
affected areas during the first half of 1995.
51
The
study found that of 1488 symptom complaints attrib-
uted to aircraft noise (from 1016 individuals), 28 per
cent were for sleep loss; 19 per cent for (mental)
tension and a similar proportion for 'nonspecific'
effects; headache, pollution effects, anxiety, difficul-
ties in hearing and tinnitus, breathing difficulties,
fatigue, and child sleep and concentration deficits
made up the remainder. Exposure information was
not reported.
Mortality
Two studies of mortality rates around Los Angeles
International Airport were conducted in the 1970s.
Meecham and Shaw, in an ecological study, observed
higher overall mortality in noise-exposed areas.
1ll
The data from the study was subsequently re-
analysed by Frerichs et aI., vvith adjustment for age,
sex and race, who found mortality rates to be no
higher, suggesting that the difference found In
Meecham and Shavv's study was confounded by
other determinants of mortality. 112
A similar stud" of aircraft flyover and mortality in
Sydney was repC:rted in 1979.
11
:
1
The exposed p ~ p u
lation, consisting of residents of local government
areas predominantly under the main aircraft flight
paths, were compared to residents of all other local
government areas y..rithin 10 kilometres of the air-
port as controls. A significantly higher number of
deaths (age- and sex-standardised where appropri-
ate) above expected rates for Sydney was found in
the noise-exposed population. Subgroup analyses
\vere performed for specific conditions (for exam-
ple, circulatory system disease, hypertensive disease,
congenital malformations) in 0- to 5-year-olds, 45 to
64-year-old females. and people 65 years and older
(groups thought to be most exposed or susceptible
to health effects of noise). These showed further sig-
AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOL 21 NO. 2 229
MORRELL ET AL
nificant differences between the exposed popula-
tion, Sydney as a ",,'hole, and the control region.
These results should to be interpreted cautiously,
because, while some of the regions studied were
demographically similar, the authors did not con-
sider other important socioeconomic and ethnic fac-
tors associated with mortality.
In a subsequent ecological study of Sydney air-
port, Taylor and Lyle compared local government
areas and postcodes exposed to aircraft noise with
unaffected areas 'with similar socioeconomic and
demographic status within the Sydney Statistical
Area.
114
In this study, exposure to aircraft noise was
defined as the proportion of the population of an
area or postcode to lie within the contour.
Outcome measures for the period 1985 to 1988
included mortality (all-cause and selected causes),
hospital separations, and cancer incidence and
mortality. Confounding variables controlled for
included age, sex and immigrant composition based
on individual data, and socioeconomic status based
on aggregate data for the areas. No strong or consis-
tent correlations between morbidity and mortality
rates and exposure to aircraft noise were found.
Meecham and Shaw reported a further ecological
study of routinely collected mortality data for resi-
dents around Los Angeles airport for the years 1970
to 19ii.ll-, Tracts in the 90-dBA-and-above noise
zone were aggregated as the test group, and selected
census tracts below 90 dBA matched on racial com-
position as the control zone (roughly 100 000
people per zone). The authors reported a slightly
higher overall mortality rate (5 per cent) in the
noise-exposed area compared with the control.
Statistically significant findings were: compared with
the group in the control area, in the noise-exposed
area cardiovascular disease mortalitv was around 18
per cent higher in those aged 75 and over; the
rate of accidental death was 60 per cent higher in
those aged 75 years and over; and the suicide rate
was 100 per cent higher in the 45- to 54-year age
group. No sex breakdown was provided, and mean
income levels behveen the exposure areas were sim-
ilar. Although the reported higher suicide mortality
rate ma;' appear alanning, it should be noted that
this is a rare event with high stochastic variabilir:-.
A summaI1' of selected studies is shown in Table 2.
Perinatal and childhood effects
Perinatal
Several studies have examined the association
behveen aircraft noise and low birth,'\'eight, prema-
ture birth and fetal abnormality. Ando and Hattori
examined reproductive of women who
had moved from quieter locations to the city of
Itami, near the Osaka International Airport in
Japan.
116
Birthweight was correlated ",:ith estimates
of intensity and duration of noise exposure. As well,
there were significantly more babies ,vith 100v birth-
weight 3000 g) born in ltami over a three-year
period than in neighbouring cities. However, the
authors did not adjust for several important deter-
minants of birthweight, such as prematurity and the
mother's age, weight, smoking status and socioeco-
nomic status.
Schell found an association bervveen aircraft noise
and gestational age in female babies, after control-
ling for maternal age, smoking and socioeconomic
status.
I
" Rehm and Jansen obseIYed higher unad-
justed prematurity rates with higher noise exposure,
but statistically the result was not significant.I!H
Mever et al. referred to the article by Knipschild,
which showed a significant association between low
, birthweight and noise exposure in female babies,
after controlling for parental income.
lJ9
,120
A controversial ecological study of congenital mal-
formations around Los Angeles International
Airport found a significantly higher rate of birth
defects in black people exposed to aircraft noise-
after exclusion of polydactylism, a congenital anom-
aly-compared \\rith unexposed black people.
l21
This report \\'as subsequently criticised because of
the lack of completeness and accuracy of the birth
defects data, and because potential confounding fac-
tors were not taken into
Edmonds et al. found that residence in high-noise
areas L
dn
) near Atlanta airport was significantly
associated with a single birth defect, spina bifida
with hydrocephalus, but not spina bifida ,vithout
hvdrocephalus.
m
This result was likelv to have been
an artefact of multiple comparisons, because, as
pointed out by the authors, there is no e\ridence of
differing aetiologies for each type of spina bifida
that might have caused only the one type to occur.
The authors analvsed all births from 1968 to 19i6 of
babies 'with tube defects, in a matched
case-control analvsis, and found a null result (p::::
0.1) after adjusting for hospital of birth, socioeco-
nomic status and race. Edmonds et at concluded
that:
Although no statistically significant association was found
behveen the high-noise area and neural tube malformation the
data do not rule out slight association. [2'\
Studies of the effects of aircraft noise on perinatal
health have been hampered by serious methodolog-
icallimitations, both in terms of the measurement of
exposure and outcome, and failure to control for
other known determinants of the outcomes under
investigation. The lack of properly controlled stud-
ies makes it difficult to draw conclusions about
which effects aircraft noise have on perinatal out-
comes.
Children
eohen et al. studied pupils from four primary
schools in Los Angeles exposed to high levels of air-
craft noise and compared them with pupils from
three low-noise schools on blood pressure, dis-
tractibility and helplessness.
124
The effects of noise
abatement procedures (acoustic treatment) intro-
duced at noisy schools were also assessed.
12
?> The
high-noise school students were more likely to give
up on a cognitive task after previous failure (unsolv-
able puzzle, a measure of helplessness); were less
easily distracted if they had attended the school for
up to h\'o years, about the same as the quiet group
for two to four years' attendance; but were more eas-
ily distracted if they had attended the noisy school
for four years or more. No differences in reading or
230 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOl. 21 NO. 2
EFFECTS OF AIRCRAFT NOISE
Table 2: Selected reviewed studies examining the effects of aircraft noise on cardiovascular disease and general measures of
health
Effect on Noise
Confounding factors
Authors location health measure Study type adjusted for Findings
Graeven 48 San Francisco, Symptom <30 NEF 0 Cross-sectional Age, sex, beliefs Noise exposure did not
US checklist 30-34 NEF survey predict number of
35-39 NEF (prevalence] symptoms, but
~ 4 0 NEF a nnoyonce level did
Knipschi\d 58 Schiphol, Attendance at <20 NNlb Incidence study: Age and sex; no Significant increase in
Amsterdam, general 20-33 NNI consultation and adjustment for psychosomatic and
Netherlands practitioner for 33-50 NNI prescribing rates socioeconomic status, cardiovascular
various smoking conditions
conditions and
prescriptions
Knipschild 58 Sch;phol, Prevalence of <20-36 NNI Crowsectional Age, sex, obesity, Significant association of
Amsterdam, cardiovascular >37 NNI survey of smoking; inadequate noise with hypertension
Netherlands disease levels individuals in 3 adjustment for and treatment; crude
villages socioeconomic status dose- response
and diet relationship for village
exposure levels
Knipschild and Sch;phol, Purchase of <20 NNI Ecological' No adjustment Increased purchases of
Oudshoorn 96 Amsterdam, selected 33-50 NNI Iongi tudinal hypnotics, sedatives,
Netherlands medications antacids and
cardiovascular drugs
Meecham and Los Angeles, US Deaths, stroke 40-50 dBA Ecological No adjustment Significant increase in all
Show \03
and liver >95 dBA deaths and deaths from
disease liver disease
Environmental Sydney, Mortality <20 ANEF d Ecological Age and sex Significant increase in
Impact Reports Australia >20 ANEF selected subgroups: >65
"5
years, females 45-64
years, children 0-5
years
Frerichs et 01. \ O ~ Los Angeles, US Mortality 40-50 dBA Ecological Age, sex and race No increase
>95 dBA
Taylor et 01. 106 Sydney, Mortol;ty, Proportion Ecological Age, sex, ethnicity, No difference
Australia morbidity within 2:':20 socioeconomic status
ANEF
Meecham and Los Angeles, US Mortality <90 dBA Ecological Age and race Significant increase: in
Show 107
>90 dBA suicide, 45-54 years;
accidental death and
cardiovascular disease,
2:':75 years
Notes: (a) NEF '" noise exposure forecast, (b) NNI '" noise number index. (c) PNdB '" perceived noise decibels. (c) Ecological'" group-based geographic
study. Id) dBA", decibels (A weighted]. (e) ANEF '" Austrolian noise exposure forecast.
mathematics skills were found between exposed and
unexposed schoolchildren.
Subsequent follow-up of the same schools a year
later showed that differences in distractibility
between exposed and unexposed children tended to
converge ,vith the time attending the school; and
helplessness measures (puzzle-sohi.ng) were incon-
clusive. Both noise- and noise-abated children gave
up more easily than quiet-school children on puzzle-
solving (after initial failure); and there ,,'as a higher
proportion of puzzles solved in the noise-abated
classrooms. Longitudinally, these results remained
unchanged, except that there was no longer evi-
dence of children in noise-abated classrooms solving
puzzles more successfully than those in noisy class-
rooms. ]26
Kryter referred to a longitudinal study by Maser et
al. of aptitude scores in students from schools
exposed to aircraft noise and found that scores
declined in the exposed group for low-aptitude stu-
dents from grades 3 to 10.'t'" Kryter also reported
results of an unpublished survey of school teachers,
AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOL. 21 NO 2 231
MORRELL ET Al
,,-hich found that aircraft noise at levels of around 70
dB in the classroom occasionally interfered with
classroom activities.' '
In a study of blood pressure in children, Cahen et
al. found mean systolic and diastolic blood pressures
to be significantly higher in the noise-exposed
schools; the magnitude of the difference ".."as about
3 mm Hg. ]24 These differences narrowed as years
spent at the school increased. Reporting on the fol-
low-up stage of the study, Cohen et al. found that
mean blood pressure readings of exposed children
in classrooms that were noise-abated were not signif-
icantly different from those from the unabated class-
r o o m ~ at noisy 5chools.
12
.:; No longitudinal effects,
such as a widening of the difference in mean blood
pressure betvveen exposure groups, were found.
This negative result may have been due to attrition
bias, because a disproportionate number of children
from the noisier schools who had elevated first-
round blood pressure readings had left in the inter-
Yening period. vVhile comparison schools were
similar socioeconomical1y, high-noise schools had 32
per cent Mrican-Americans, compared and lm't'-
noise schools had 18 per cent Mrican-Americans.
,," study by Karsdorf and KJappach, referred to in
Cohen et al., found a positive correlation between
noise levels in the classroom from road traffic noise
and systolic and diastolic blood pressure levels in
children.124.J27
Two other studies examining the effects of domes-
tic aircraft noise on hearing in children found no
significant difference betvveen the noise-exposed
and quiet groups.12R.12Y
Table 3 shows a summary of studies examining the
effects of aircraft noise on children and babies.
Discussion
Research into the relationship of exposure to air-
craft" noise to health brings into focus several ques-
tions concerning tne definition of health and the
boundary, if any, between social reaction and ill-
health. Such research also poses questions concern-
ing the quality of evidence that can be accepted for
decision-making, since most studies of aircraft noise
and health would be judged as inadequate by stan-
dard epidemiological criteria.
Using a definition of health that incorporates a
positive sense of mental and social wellbeing, there
can be no question that exposure to aircraft noise
causes ill-health. There appears to be general agree-
ment that 'energy-averaged measures of aircraft
noise exposure over a 24-hour period currently pro-
vide the best method for assessing community reac-
tion to noise exposure. Social and community
sUDreys and other research indicate that noise from
airports is a significant cause of community reaction
Table 3: Reviewed studies examining the effects of aircraft noise on perinatal and child health
Effect on Noise Confoundi ng factors
Authors Location health measure Study type adjusted for Findings
Ando and Osaka, Japan Low birthweight <80 dB Ecological
0
No adjustment Significant increase in
Hattori 80
[<3000 91 >80 dB proportion of babies
with low birthweight in
exposed areas
Jones and Los Angeles, US Birth defects <90 dBA Ecological Race only Significant increase in
Tauscher 113
>90 dBA black people
Edmonds et 01. Atlanta, US Birth defects <65L.
b
Ecological and Hospital of birth, No significant result
'"
'"
2':65 L
dn
case-control socioeconomic status,
race
Rehm and Dusseldorf, Premature birth 3 noise leve!s Cross"sectional No adjustments No significant result
Jansen 110 Germany (metric not (trend noted)
stated}
Schell
109
US Birthweight, <90 dBA Cross"sectional Socioeconomic status, Significant negative
gestational age 90-99 dBA parents' weight and correlation of noise with
>100 dBA height, smoking gestation for female
babies only
Cohen et 01. 116 Los Angeles, US Blood pressure Quiet area; Cross-sectional Control schools Mean diastolic and
Ai r corridor matched for systolic pressures -3 mm
upt 10 95 dBA socioeconomic status, Hg higher (significant)
but unadiusted for race
Cohen et 01. 117 Los Angeles, US Blood pressure Quiet area; Longitudinal Control schools No significant result
Air corridor matched for
up to 95 dBA socioeconomic status,
but unadjusted for race
Notes: (al Ecological = group-based geographic study. (b) L
dn
= 24-hour day"and-night energy averaged measure.
232 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOL. 21 NO 2
and social disturbance. Social surveys in Australia
and overseas, using grouped data that have been
used to set environmental standards for land use
around airports, have established a clear dose-
response relationship. Annoyance responses have
been correlated with measures of psychosocial func-
tioning and other symptomatic complaints in some
studies.
Several studies, including those by Tarnopolsky et
al. and Kryter, have shown a possible association
between exposure to aircraft noise and the preva-
lence of psychological and psychiatric symptoms.
Anxiety and depression is more prevalent in those
exposed to aircraft noise, which would be classified
as ill-health using both the positive and negative def-
initions. 'Whether these symptoms are due to aircraft
noise exposure per se is difficult to assess because
most evidence is cross-sectional.
Studies of psychiatric admissions in relation to air-
craft noise have been contradictof\'. '''"bile several
early studies suggested an effect of ;ircraft noise on
psychiatric admissions around Heathrow and Los
Angeles International Airports, subsequent studies
around Heathrov,' failed to replicate the findings.
The early studies were ecological and exploratory in
"pe, while the later negative studies by Tarnopolsky
et al. considered the effects of se\'eral important
confounding factors, so providing better quality evi-
dence. Re-analysis of the latter data by Kryter lends
support again to the original findings.
Although responses to unexpected noises cause
physiological reactions in humans, the findings con-
cerning continuous or regular (predictable) noise
are \'aried, It has been suggested that acute physio-
logical changes observed in association v...ith expo-
sure to noise are mediated through psychological
mechanisms. vVhether this is due to mechanisms
associated ""i.th personality constructs such as hostil-
ity or aggression or to noise sensitivity remains
unclear. vVhile there is evidence that noise exposure
may cause elevation in blood pressure, e\i.dence for
sustained elevation when exposure is removed is not
strong.
Overall, the evidence is relatively consistent that
aircraft noise is associated with sleep loss and awak-
enings, reduced quality of sleep and EEG changes,
and rudimentary dose-response relationships have
been produced. V\l1ile it is unclear how much sleep
loss is required before being considered a health
effect. no studies have detailed secondarv' effects on
health of sleep loss (for example, imrr'Iunological
effects) from aircraft noise. Interference ",,;th sleep
compromises positive mental wellbeing.
Thompson reported frequent association bet\veen
noisy environments and hypertension. 1nl However,
the association is primarily cross-sectional in nature,
and a clear relationship between noise exposure and
hypertension has not been confirmed by cohort
studies, although the number of these studies has
been small. A cross-sectional association betvo.,'een air-
craft noise and blood pressure of schoolchildren was
found in one study,124 the implications of which are
not clear. A causal association bet\veen aircraft noise
and other forms of cardiovascular disease is not sup-
EFFECTS OF AIRCRAFT NOISE
ported by available epidemiological data because
studies \\ith designs capable of testing the hypothe-
sis have not been conducted.
There is no convincing evidence to suggest that
general population mortality is increased by expo-
sure to aircraft noise, as differences observed
around airports appear to be related to other factors
such as age and sex distribution, socioeconomic sta-
tus and ethnicity.
General measures of community health such as
attendances at general practitioners and prevalence
of self-reported halth problems have been associ-
ated with exposure to aircraft noise. The
tions are based primarily on ecological and
cross-sectional data, and a clear relationship has not
be sought by cohort studies. The purchase of psy-
chotropic and hypertension medications have been
shown by Knipschild to be associated \"'>1th changes
in aircraft noise exposure over time.
Studies of effects of aircraft noise on perinatal
health has been hampered by serious methodologi-
callimitations, both in terms of the measurement of
exposure and the failure to control for other knov"n
determinants of the outcomes under investigation.
The lack of properly controlled studies makes it dif-
ficult to draw conclusions about what effects aircraft
noise have on perinatal outcomes.
Future research could focus on the relationship of
annoyance reactions to measures of mental and
health, using relevant study designs that
altO'w control of bias and confounding factors. In
particular, bias in exposure measurement needs to
be addressed. Measurement and adjustment for
occupational and domestic noise exposure from
other sources remains a significant problem when
researchers are t1)i.ng to assess the effects of aircraft
noise. Detailed medical, psychological and social
case studies would be of value in refining hypotheses
for more detailed investigation. A cohort study of
sufficient size and scope, controlling for knm\'n con-
founding variables, and conducted under condi-
tions of Changing exposures to aircraft noise, would
be valuable in providing evidence for causation and
quantification of possible acute, adaptative and
long-term effects on health from exposure to air-
craft noise. Such studies could be supplemented by
small-area ecological analyses of routinely or spe-
cially collected data such as mortality, hospital and
morbidity and general practitioner sur-
veys, using the smallest census units (roughly 200 to
300 households) rather than postcodes or munici-
palities. which are generally too large for accurate
assignment to noise exposure levels.
'\.llile there is a lack of strong evidence support-
ing the hypothesis that aircraft noise causes long-
term effects on health, not all the hypothesised
health risks, such as aspects of mental health and
perinatal outcomes, have been studied in detail.
Other effects, because of possible long latency
bet\\'een exposure and their manifestation, and
because of difficulties in measuring exposure and
confounding variables, require large long-term stud-
ies on populations in which individuals are followed
over an extended period under changing conditions
AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1997 VOL. 21 NO. 2 233
MORRELL ET Al
of exposnre.
It is alv.;ays possible to criticise studies no matter
how well designed these may be. In the case of air-
craft noise and health, ver;.: few studies capable of
prmiding high quality causal evidence have been
conducted. Accordingly, despite the lack of strong
e\idence linking aircraft noise to ill-health, it should
always be borne in mind that little, weak or no e\i-
dence does not constitute evidence for little, weak or
no effect.
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Because of its length, a financial contribution was required of the
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The Editor
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