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Health effects of annoyance induced by neighbour noise

Authors:
  • Landesamt für Umwelt, Gesundheit und Verbraucherschutz (retired)

Abstract and Figures

Traffic noise (road noise, train noise, flight noise, noise of parking cars), is the most dominant source of annoyance in the living environment for many people living in European countries. This is followed by neighbour noise (neighbouring apartments, staircase, playing children and noise within the apartment). The subjective experience of noise stress can, through central nervous processes, lead to an inadequate neuro-endocrine reaction and finally to regulation diseases. Within the context of the WHO-LARES-survey, annoyance induced by neighbour noise was collected and evaluated in connection with reported medically diagnosed illnesses. Adults who indicated chronically severe annoyance by neighbour noise were found to have an increased health risk in the cardio-vascular system, the movement apparatus, as well as increased risk of depression and migraine. With regards to elderly people there is generally a lower risk of noise annoyance induced illness than in other adults. It can be assumed that the effect of noise induced annoyance in older people is concealed by health consequences of age (with a strong increase of illnesses). With children, the effect of noise induced annoyance from neighbour noise is most evident in the respiratory system. The increased illness risks in the respiratory system in children do not seem to be caused primarily by air pollutants, but rather, as a result of emotional stress. Neighbour noise induced annoyance is therefore a highly underestimated risk factor for healthy housing. (c) 2007 Institute of Noise Control Engineering.
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Health effects of annoyance induced by neighbour noise
Christian Maschke
a)
and Hildegard Niemann
a)
(Received 2006 February 17; revised 2007 April 11; accepted 2007 April 18)
Traffic noise (road noise, train noise, flight noise, noise of parking cars), is the
most dominant source of annoyance in the living environment for many people
living in European countries. This is followed by neighbour noise (neighbouring
apartments, staircase, playing children and noise within the apartment). The
subjective experience of noise stress can, through central nervous processes, lead
to an inadequate neuro—endocrine reaction and finally to regulation diseases.
Within the context of the WHO-LARES-survey, annoyance induced by
neighbour noise was collected and evaluated in connection with reported
medically diagnosed illnesses. Adults who indicated chronically severe
annoyance by neighbour noise were found to have an increased health risk in the
cardio-vascular system, the movement apparatus, as well as increased risk of
depression and migraine. With regards to elderly people there is generally a
lower risk of noise annoyance induced illness than in other adults. It can be
assumed that the effect of noise induced annoyance in older people is concealed
by health consequences of age (with a strong increase of illnesses). With children,
the effect of noise induced annoyance from neighbour noise is most evident in
the respiratory system. The increased illness risks in the respiratory system in
children do not seem to be caused primarily by air pollutants, but rather, as a
result of emotional stress. Neighbour noise induced annoyance is therefore a
highly underestimated risk factor for healthy housing. © 2007 Institute of Noise
Control Engineering.
Primary subject classification: 62; Secondary subject classification: 52
1 INTRODUCTION
Noise is not only a physical stimulus, but also an
individually experienced noise-event with a corre-
sponding emotional reaction.
1,2
An insufficient ability
to cope with noise can therefore lead to an inadequate
neuroendocrine reaction and finally to regulation
diseases (e.g. Ref. 3). The health effects of permanent
noise stress can reveal themselves 1015 years later in
different functional systems.
4
The annoyance potential
by neighbour noise is relatively high. Neighbour noise
is a sound with a high information content, such as
speech, music or also the noise of footsteps. It is
natural for humans to have their attention drawn to such
informative sounds, even if the sound level is relatively
low. The annoyance potential from neighbour noise is
frequently heightened by the hearer’s knowledge of the
sound producer and the defencelessness against the
noise.
Until now, the question of what role annoyance
caused by neighbour noise plays in the development of
health impairments in daily life has not been answered
clearly. Normally the annoyance represents an environ-
mental effect category sui generis, which is character-
ised by a loss of quality of living (see Ref. 5).
The extent of the health impacts from neighbour
noise annoyance over a number of years in the residen-
tial environment can only be measured in appropriate
epidemiological studies, e.g. the WHO-LARES survey.
In the LARES survey, neighbour noise annoyance was
surveyed as an adverse housing condition and its
relation to reported medically diagnosed illnesses was
evaluated.
2 SHORT INTRODUCTION TO THE WHO-
LARES-STUDY
The LARES Survey (Large Analysis and Review of
European housing and health Status
6
) was conducted in
eight European cities from 2002 to 2003 by recommen-
dation of the European Housing and Health Task Force
(WHO) in order to fulfill the following objectives in
particular:
a)
Interdisciplinary Research Network “Noise & Health,
VWS-4, Müller-Breslau-Stra
e, (Schleuseninsel), 10623
Berlin GERMANY; email: forschungsverbund@laerm-
gesundheit.de
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Improvement of the knowledge about “evident”
or assumed effects of housing conditions on
health and on physical and mental well-being.
Neighbour noise induced annoyance was con-
sidered as part of adverse housing conditions.
Evaluation of the quality of European housing
stock in a holistic way, as well as the setting of
priorities in the evaluated cities, and the identi-
fication of general trends.
Development of a “practicable” instrument to
evaluate the effects of housing conditions on
health in cities or regions in Europe.
The LARES Study consisted of three instruments: the
inhabitant questionnaire, the inspection questionnaire
and the health questionnaire.
The inhabitant questionnaire was filled in during an
interview with one resident of the examined household.
The inhabitant questionnaire was used to collect data
regarding the perception of the dwelling and the
perception of the immediate residential environment.
The inspection questionnaire was carried out by
trained interviewers in order to obtain technical and
objective data about the examined apartment.
The health questionnaire was finally filled in by
every member of the examined household to include
the health information of all residents.
The objective of the LARES study was to register
the data of roughly 400 households with about 1000
inhabitants in every city. The coordination of the data
collection is outlined in Table 1. Overall, 1079
variables in 3382 households were collected from 8539
people (see Table 2).
The following article examines the strength of the
association between only noise-induced annoyances by
neighbours and stress mediated diseases.
3 ANNOYANCE AND CHRONIC
ILLNESSES IN THE WHO-
LARES-STUDY
The annoyance by outdoor and indoor noise sources
was determined by the question, “Thinking about the
last 12 months, when you are at home, how much
would you say noise from the following sources
bothers or annoys you?” The strength of noise annoy-
ance was rated by the five-step ICBEN scale of “none”
to “extremely” (compare with Fig. 1). The percentage
distribution of the annoyance for 6 selected noise
sources is represented in Fig. 1, each source divided
into the five annoyance categories. Note, that the
category “not at all” is not diagrammed and completes
each source to 100%.
The results show that about 39% of those surveyed
were troubled in their residence by road traffic noise
(9% rated the intensity of road traffic noise “strong” or
“extreme”). This was followed closely by 36% of the
respondents citing disturbances from neighbourhood
noise. Aircraft noise was noted by 13% of the respon-
dents; 6.8% of the respondents reported railway noise.
Note that the field of data acquisition included areas
partially effected by airport and railway noise, but did
not concentrate on areas specifically troubled by flight
patterns or railway noise. In such areas the flight or
railway noise are normally the most important noise
source. What is surprising is the high portion of
respondents (21%) who felt disturbed by the noise
vehicles made when parking.
The individual annoyances from neighbour flat
Table 1—Coordination of the data collection in the LARES-survey.
Before the data collection:
Communication and press release, recruiting
of interviewers,
training of the interviewers, random choice of
households
During the data collection: Quality control of the full questionnaires
After the data collection:
Data input, data base processing, handover of
controlled data
to the towns, preparation of temporary reports,
logistical
support
Table 2—Number of the surveyed households and
inhabitants in the eight examined Euro-
pean cities.
City Nation Households Inhabitants
Angers France 427 880
Bonn Germany 392 950
Bratslava Slovakia 338 892
Budapest Hungary 447 1086
Ferreira Portugal 357 1055
Forli Italy 403 1172
Geneve Switzerland 333 710
Vilnius Latvia 685 1794
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noise, stairwell noise, noise from children playing in
buildings, as well as the annoyance from noises within
the dwelling were summarised under the term “neigh-
bourhood” noise. This was because the majority of
respondents indicated that they were troubled by more
than one source of noise from neighbours. Each of the
mentioned neighbour noise sources was collected with
the five-step ICBEN scale (1 to 5 points). Therefore the
overall-variable “neighbourhood” annoyance ranges
from 4 to 20 points. This overall variable was divided
into three categories (non at all, moderate, and severe
7
annoyed). People with more than eight points were
classified as severely annoyed. All results were based
on this variable. Neighbor noise is not only evident
during the day but also at night when most people are
asleep. Therefore, reported sleep disturbances from
different noise sources were also collected in the
LARES study. The results show that about 10% of the
respondents sleep (adults, elderly, children) was
disturbed by road traffic noise, closely followed by
9.5% citing neighbour flat noise, as the source of
disturbance. The association between noise-induced
sleep disturbances and stress induced diseases will be
presented in an independent ar ticle.
The questions “Have you had one of the following
diseases in the last 12 months?, and “Was the illness
diagnosed by a physician?” were used in the LARES
study to access the period prevalence of 16 medically
diagnosed illnesses. The prevalence of selected
8
illnesses in adults, in the elderly and in children is
represented in Table 3. The results show that hyperten-
sion and allergies were the most frequently indicated
medically diagnosed illnesses for adults (12.1% and
11%, respectively), followed by arthritis and migraines
(9.6% and 9.5%, respectively). Depression was
reported by 6.1% of the respondents.
In the elderly participants in the LARES study,
hyper tension and arthritis were the most frequently
indicated medically diagnosed illnesses, with a preva-
lence of 41.7% and 37.5%, respectively. This was much
higher than for the adults group. Bronchitis (11.4%),
Table 3—Comparison of the prevalence of selected
medically diagnosed illnesses reported in
adults (1859 years of age), elderly and
children in the LARES study (multiple an-
swers).
Diseases
Adults
1859 years
N=5101
Elderly
60 years
N=1818
Children
18 years
N=1596
Hypertension 12.1% 41.7% 0.7%
Allergy 11.0% 8.8% 11.7%
Arthritis 9.6% 37.5% 1.2%
Migraine 9.5% 11.3% 3.6%
Depression 6.1% 10.1% 0.6%
Bronchitis 4.1% 11.4% 3.6%
Skin disease 3.4% 4.0% 3.1%
Asthma 3.0% 4.0% 4.4%
Fig. 1—Frequency of occurrence of annoyance (and annoyance classes from “slight” to “extreme;” “not
at all” completes to 100%) in the LARES study for 6 selected sources of noise (Adults, children
and elderly).
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migraines (11.3%) and depression (10.1%) followed
with decreasing frequency. The prevalence of illnesses
was again markedly higher in the elderly.
The results for children show clear differences
between the adults and elderly g roups. The most
frequently medically diagnosed illnesses for children in
the LARES study were allergies (11.7%), followed by
asthma (4.4%), bronchitis (3.6%) and migraines
(3.6%). With the exceptions of allergies, bronchitis und
skin diseases, the prevalence of illnesses in children
were markedly less than in adults (see Table 3).
Due to the different disease prevalence in children,
adults and the elderly the age groups have to be evalu-
ated separately.
Table 4—Control-variables divided in to five adjustment blocks.
Adjustment
blocks Label Control-variables
Block 1 Basic model Age, gender, city, traffic noise annoyance
Block 2
Socio economic
state
Socio-economic-state
Block 3 Risk factors
Consumption of alcohol, smoking behaviour,
sports
activity, body mass index
Block 4
General
environment
Satisfaction with residential areas, green areas
Block 5 Housing factors
The perception of: dampness in dwelling, air
quality in
dwelling, temperature and heating in winter,
daylight in
dwelling
Table 5—Results for diagnosed hypertension in relation to neighbour noise
annoyance in adults.
ADULTS
Adjusted for:
neighbour noise
annoyance N
disease
(rate per
1000)
Odds ratios for
hypertension
P-value for trend
1 d.f.OR (95% CI)
Basic model Not at all 2189 125,62 1,000 0,007
Moderately 1837 114,86 1,225 0,983–1,526
Severely 633 126,38 1,502 1,094–2,063
and:
Socio-
economic state
Not at all
Moderately
Severely
and:
Not at all 2040 130,39 1,000 0,018
Risk factor Moderately 1680 119,64 1,241 0,988–1,559
Severely 600 128,33 1,417 1,021–1,967
and:
Not at all
General Moderately
environment Severely
and:
Not at all
Housing Moderately
factors Severely
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4 METHOD
The examination of the statistical association
between neighbour noise annoyance and diseases must
take into account that diseases are affected by many
factors other than annoyance to noise. In order to gain
an accurate statistical analysis of the multiple relations,
the logistic regression method was applied. Thirteen
control variables were included in the analysis, which,
in the case of the diseases, are assumed to have influ-
enced the result. In total, fifteen control variables were
grouped into five analysis blocks (see Table 4) and the
significant blocks were used for the adjustment. Note
that the differences between European cities were taken
into account by using the variable “city” in the basic
model (Block 1). Furthermore, the annoyance by traffic
noise (airplane, train and road noise) was used
additionally within the basic model as a control
variable. Odds ratios (OR) were calculated as an
estimator of the relative risk (RR).
The odds ratio is a relative measure of risk. It tells us
how much more likely it is that someone who is
exposed to the factor being studied will develop the
outcome compared to someone who is not exposed. An
odds ratio is used to compare the odds for both groups,
in the same way that the relative risk is used to compare
risks. Therefore in many situations we will be able to
interpret odds ratios by treating them as relative risks.
This is due to the fact that when events are rare, risks
and odds are very similar. Even when events are quite
common the odds ratio and the relative risk will be very
similar provided the odds ratio is close to 1. Otherwise,
the odds ratio can be a misleading approximation of
relative risk if the event rate is high.
Why did we use odds ratio as an estimator of relative
risk, if the odds ratio is difficult to interpret? Because
of logistic regression, we need to take confounding
factors into account via odds ratios. For a meaningful
interpretation of the results the odds ratios could be
compared with the unadjusted disease rate. All statis-
tical analyses were carried out with the software
package “SPSS 12.
In the tables, the disease rate and the odds ratios
including the 95% confidence interval are represented
for people who have felt annoyed by neighbourhood
noise (moderately, severely) in the last 12 months. This
is compared with people who did not indicate any
annoyance from the analysed noise sources (compari-
son group). A recorded odds ratio is statistically
significant if the associated confidence interval does
not include the value 1.
In addition, in the last column in the tables the level
of significance is recorded for a linear trend within the
Table 6—Results for diagnosed depression in relation to neighbour noise
annoyance in adults.
ADULTS
Adjusted for:
neighbour noise
annoyance N
disease
(rate per
1000)
Odds ratios for
Depression
P-value for
trend
1 d.f.OR (95% CI)
Basic model Not at all 2189 61,67 1,000 0,005
Moderately 1837 52,25 1,166 0,846–1,603
Severely 663 88,98 1,800 1,252–2,824
and:
Socio-
economic state
Not at all 2108 61,19 1,000 0,010
Moderately 1761 52,81 1,169 0,849–1,609
Severely 644 85,40 1,782 1,183–2,684
and:
Risk factors Not at all 1968 62,50 1,000 0,008
Moderately 1610 56,52 1,228 0,888–1,697
Severely 582 87,62 1,786 1,179–2,707
and:
General
environment
Not at all 1859 62,39 1,000 0,012
Moderately 1498 58,07 1,214 0,877–1,679
Severely 546 89,74 1,755 1,149–2,679
and:
Housing
factors
Not at all 1788 63,19 1,000 0,041
Moderately 1449 57,97 1,147 0,826–1,592
Severely 531 88,51 1,601 1,044–2,455
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annoyance categories (1 degree of freedom=1 d.f.) to
prove a dose-effect relationship (an increase in risk
with increasing annoyance).
5 RESULTS FOR ANNOYANCE INDUCED
BY NEIGHBOUR NOISE
Annoyance is defined as a feeling of discomfort
which is related to adverse influence upon an individual
or a group by any substance or circumstance. Annoy-
ance expresses itself, for example, by malaise, fear,
threat, trouble, uncertainty, the feeling of a restriction
of freedom, excitability or defencelessness. In this
sense, neighbour noise induced annoyance is emotional
stress.
5.1 Adults
The LARES study confirms that chronic annoyance
from neighbour noise can be associated with an
increased risk to the cardio-vascular system in adults. A
significantly higher risk of “high blood pressure”
(hyper tension) was shown in subjects severely and
chronically annoyed by neighbour noise (see Table 5).
The trend within the annoyance categories (from “not
at all” to “severely”) was significant and supports a
dose-effect relationship between hypertension and
chronic annoyance induced by neighbour noise.
Marked effects of chronic annoyance by neighbour
noise were also recorded for mental health. Medically
diagnosed cases of “depression” rose significantly with
severe chronic annoyance by neighbour noise (see
Table 6). The trend within the annoyance categories
(from “not at all” to “severely”) was significant and
suggests a dose-effect relationship between depression
and chronic annoyance induced by neighbour noise.
In addition, an increased risk of migraines was
recorded with severe annoyance by neighbour noise
(see Table 7). Here too the trend within the annoyance
categories (from “not at all” to “severely”) was signifi-
cant and supports a dose-effect relationship between
migraine and chronic annoyance induced by neighbour
noise.
The results of the LARES-survey demonstrate that
chronic severe annoyance induced by neighbour noise
must be classified as a serious health risk for adults.
5.2 Elderly
In elderly people, the effects of chronic annoyance
by neighbour noise were only apparent in the locomo-
tive system. A significantly increased risk of arthritis
was recorded for elderly people who indicated moder-
ate chronic annoyance by neighbour noise (see Table
8). For elderly people who indicated severe chronic
Table 7—Results for diagnosed migraine in relation to neighbour noise an-
noyance in adults.
ADULTS
Adjusted for:
neighbour noise
annoyance N
disease
(rate per
1000)
Odds ratios for
Migraine
P-value for
trend
1 d.f.OR (95% CI)
Basic model Not at all 2189 90,45 1,000 0,001
Moderately 1837 85,46 1,226 0,941–1,599
Severely 633 131,12 1,798 1,271–2,545
and:
Socio-
economic state
Not at all
Moderately
Severely
and:
Risk factors Not at all 2040 93,13 1,000 0,002
Moderately 1680 88,69 1,249 0,956–1,634
Severely 600 130,00 1,767 1,244–2,510
and:
Not at all 1928 93,36 1,000 0,007
General
environment
Moderately 1565 91,37 1,232 0,941–1,612
Severely 559 125,22 1,629 1,143–2,321
and:
Not at all 1854 92,77 1,000 0,022
Housing
factors
Moderately 1509 90,12 1,205 0,919–1,579
Severely 542 127,31 1,510 1,056–2,161
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annoyance by neighbour noise the significance is
missing, but the trend within the annoyance categories
was significant and supports a dose-effect relationship
between arthritis and chronic annoyances induced by
neighbour noise.
Regarding annoyance by neighbour noise, the results
of the LARES Study can not verify that elderly people
should be classified as risk group.
5.3 Children
The effects of chronic annoyance by neighbour noise
shows up in children in the respiratory system. Severe
chronic annoyance was accompanied by significantly
increased risks of bronchitis (see Table 9). The trend
within the annoyance categories was highly significant.
An increased risk of asthma in children could not be
substantiated statistically.
The high risks of contracting a respiratory disease
support the assumption that children subject to neigh-
bour noise annoyance should be classified as a risk
group.
6 DISCUSSION
An assessment of the quality of the LARES study
and its results on the health effects of neighbour noise
induced annoyance shows that many quality require-
ments were met. Due to random sampling and thanks to
quality control by WHO, chance and bias can almost
entirely be ruled out. The analysis of the data took
place with an extensive number of control variables,
which for the first time comprehensively took into
account living and environmental conditions. The
number of control variables can however still not be
considered complete, given the large number of
examined illnesses. Thus known factors such as genetic
predisposition are missing. Nevertheless, the overall
control of disruptive influences can be categorized as
very comprehensive in view of noise effect studies.
Biological plausibility is given, due to what we know
from psychophysiology (e.g. Ref. 9), psychosomatic
medicine (e.g. Ref. 10) as well as from emotion (e.g.
Refs. 1 and 11) and stress research (e.g. Ref. 12), and is
persistently supported by the clear dose-effect relation-
ships. Noise induced pathological changes can
manifest themselves in the cardiovascular system (see
Ref. 13), in the respiratory system (see Ref. 14) as well
as in the musculoskeletal system (see Ref. 15) or can
appear as psychic disturbances (see Ref. 16).
On the other hand, pathological changes reduce
more or less the state of mental well-being and there-
fore may increase the susceptibility to (neighbour)
noise. From this point of view the epidemiological
Table 8—Results for diagnosed arthritis in relation to neighbour noise an-
noyance in the elderly.
ELDERLY
Adjusted for:
neighbour noise
annoyance N
disease
(rate per
1000)
Odds ratios for
Arthritis
P-value for
trend
1 d.f.OR (95% CI)
Basic model Not at all 1142 378,28 1,000 0,028
Moderately 353 368,27 1,302 0,962–1,765
Severely 101 415,84 1,571 0,937–2,633
and:
Socio-
economic state
Not at all 1122 377,89 1,000 0,021
Moderately 343 373,17 1,319 0,972–1,791
Severely 100 420,00 1,617 0,961–2,721
and:
Risk factors Not at all 955 359,16 1,000 0,013
Moderately 302 367,54 1,382 1,015–1,882
Severely 85 411,76 1,642 0,969–2,783
and:
Not at all
General
environment
Moderately
Severely
and:
Not at all
Housing
factors
Moderately
Severely
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association between neighbour noise induced annoy-
ance and health-endpoints could be interpreted as
caused by the diseases. Due to analogy reasoning it can
be assumed that chronic severe noise annoyance could
start a vicious circle with the elements: annoyance—
negative emotional reaction—neurovegetative-
hormonal regulation disturbances—illness. The cycle
is completed when the illness feeds back into an
increased noise annoyance.
Comparison of the age groups shows that adults
suffer mostly from an increased risk in the cardio-
vascular system as well as running a higher risk of
depression and migraines. Elderly people on the other
hand only show increased risks in the locomotive
system (arthritic) and not in the cardio-vascular
system. In the interpretation of the results one has to
consider however that in this stage of life, age-related
illnesses increase significantly with or without noise
annoyance (see Table 3, chronic illness of elderly
people). In this way, an existing connection between
severe annoyance and rate of disease can be so
“watered down” that it is no longer statistically recog-
nisable.
The significant connection between severe annoy-
ance by neighbourhood noise and respiratory diseases
in children is informative for noise effect research.
Since noise from the neighbours is not connected with
traffic-related air pollutants, it can be assumed that the
increased risk of bronchitis in children is not caused by
traffic-related air pollutants. A probable cause is
emotional stress.
7 CONCLUSIONS
The results of the LARES-survey confirmed on an
epidemiologic level the thesis that neighbour noise
affects health via long lasting severe annoyance. It has
to be assumed that chronic neighbour noise annoyance
is not only connected with a risk for cardiovascular
symptoms, but also with risks for respiratory
symptoms like bronchitis as well as arthritis and
migraine. Neighbour noise induced annoyance is there-
fore a highly underestimated risk factor for healthy
housing. With this background, increased requirements
for the sound insulation between dwellings (e.g.
regarding the German VDI 4100
17
) should be accepted
as obligatory in multi-family dwellings.
8 REFERENCES
1. W. B. Cannon, “Neural organisation of emotional expression,
C. Michison (ed): Feeling and Emotions, Worcester, (1928).
2. K. Hecht, H. P. Scherf, and O. König, (Hrsg), “Emotioneller
Stress durch Überforderung und Unterforderung. (Emotional
Table 9—Results for diagnosed bronchitis in relation to neighbour noise an-
noyance in children.
CHILDREN
Adjusted for:
neighbourhood
noise annoyance N
disease
(rate per
1000)
Odds ratios for
bronchitis
P-value for
trend
1 d.f.OR (95% CI)
Basic model Not at all 574 15,67 1,000 0,002
Moderately 687 37,84 1,998 0,886–4,507
Strongly 251 79,68 3,893 1,609–9,322
and:
Socio-
economic
state
Not at all 542 16,60 1,000 0,004
Moderately 652 36,80 1,895 0,838–4,288
Strongly 243 82,30 3,595 1,484–8,709
and:
Risk factors Not at all
Moderately
Strongly
and:
Not at all
General
environment
Moderately
Strongly
and:
Not at all
Housing
factors
Moderately
Strongly
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
8 Noise Control Eng. J. 55 (3), 2007 May-June
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PROOF COPY 009703NCE
PROOF COPY 009703NCE
stress by exzessive demand and underchallenge), Schibri Ver-
lag, Berlin, Milow, Strasburg, (2001).
3. M. Frankenhäuser and U. Lundberg, “Psychological reactions to
noise as modified by personal control, Reports from the De-
partment of Psychology, U. Stockholm, 471, (1976).
4. Ch. Graff, F. Bockmüphl, and V. Tietze, “Lärmbelastung und
arterielle (essentielle) Hypertoniekrankheit beim Menschen.
(Noise exposure and arterial (essential) hypertension disease in
man). In: Nitschkoff, S.; Kriwizkaja, G.: Lärmbelastung, akus-
tischer Reiz und neurovegetative Stör ungen. (Noise exposure,
acoustic stimulus and neurovegetative disorders). Georg-
Thieme Verlag, 112–126, (1968).
5. G. Schuschke and C. Maschke, “Lärm als Umweltfaktor. (Noise
as an environmental factor), W. Dott, H. F. Merk, H. Neuser,
and R. Osieka, R. (Hrsg.): Lehrbuch der Umweltmedizin. (Text-
book of the environmental medicine). Stuttgart, Wissenschaftli-
che Verlagsgesellschaft mbH, (2002).
6. WHO, “World Health Organisation The LARES project (Large
Analysis and Review of European housing and health Status),.
www.euro.who.int/Housing/activities/200207111, (2006).
7. In previous presentations we use the term strongly annoyed. To
avoid further confusion regarding the ICBEN-scale we changed
to the term severe annoyance.
8. Unlisted health endpoints: diabetes, stroke, malignant tumour,
osteoporosis, cataract, gastric or duodenal ulcer and tuberculo-
sis.
9. R. Schandry, Lehrbuch Psychophysiologie, Textbook psycho-
physiology, Beltz, Psychologie Verlags Union, Weinheim,
(1998).
10. T. von Uexküll, R. H. Adler, J. M. Herrmann, K. Köhle, W.
Langewitz, O. W. Schonecke, and W. Wesiak, (eds) “Psychoso-
matische Medizin—Modelle ärztlichen Handelns, Psychoso-
matic medicine—Models of medical action, 6. Auflage. Urban
& Fischer, München, Jena, (2003).
11. H. C. Traue, “Emotion und Gesundheit—Die psychobiolo-
gische Regulation durch Hemmungen, Emotion and health—
The psycho-biological regulation by inhibitions, Spektrum,
Akademischer Verlag, Heidelberg, Berlin, (1998).
12. C. Maschke and K. Hecht, “Noise and stress, L. Luxon (ed),
Noise and it’s effects, Whurr-Publisher, (2003).
13. W. Babisch and H. Ising, “Noise induced stress is a risk factor in
cardiovascular disease, The 2001 International Congress Noise
Control Engineering. The Hague, The Netherlands, (2001).
14. W. Langewitz and M. Solèr, “Asthma bronchiale (Asthma bron-
chial), R. H. Adler, J. M. Herrmann, K. Köhle, W. Langewitz,
O. W. Schonecke, T. von Uexküll, and W. Wesiak (eds), Uexküll
Psychosomatische Medizin—Modelle ärztlichen Handelns. 6.
Auflage. Urban & Fischer, München, Jena, 891–907, (2003).
15. W. Eich, “Chronische Polyarthritis and Fibromyalgie (Chronic
polyarthritis and Fibromyalgie). In: Adler, R. H.; Herrmann, J.
M.; Köhle, K.; Langewitz, W.; Schonecke, O. W.; Uexküll von,
T.; Wesiak, W. (eds): Uexküll Psychosomatische Medizin—
Modelle ärztlichen Handelns. 6. Auflage. Urban & Fischer,
München, Jena, 941–946, (2003).
16. C. Maschke, U. Wolf, and T. Leitmann, Epidemiologische Un-
tersuchungen zum Einfluss von Lärmstress auf das Immunsys-
tem und die Entstehung vonArteriosklerose. Umweltforschung-
splan des Bundesministeriums für Umwelt, Naturschutz und
Reaktorsicherheit, Abschlussbericht des Forschungsvorhabens
Z.2.2–60424/107 im Aktionsprogramm “Umwelt und Gesund-
heit” (UFOPLAN) 298 62 515, WaBoLu-Hefte 01/03, Umwelt-
bundesamt Berlin (2003).
17. VDI 4100, The Association of German Engineers, Schallschutz
von Wohnungen—Kriterien für Planung und Beurteilung,
Noise control in housing—Criteria for planning and assess-
ment, Beuth Verlag GmbH 1994–09, Berlin, (1994).
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
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Introduction: Transportation noise is a major source of concern in urban areas. Motorcycle riders,on the other hand, are the most exposed to traffic noise while riding. This study was carried out on 363 respondents (no-helmet: 121 respondents, half-face helmet: 121 respondents, and full-face helmet: 121 respondents) who were exposed to traffic noise while riding their motorcycles on the same noisy route, having the same exposure hours. The purpose of this study was to determine whether wearing a helmet protects against various traffic noise-induced psychophysiological health issues. It also tried to determine whether the riders were more affected than the pillion riders as a result of traffic noise exposure. Method: The psychophysiological factors of the respondents, such as annoyance, tiredness, depression, headache, and sleeping problem, were obtained using a standard questionnaire in accordance with ISO 15666, Beck et al. (1961), and Eriksen et al. (1999), respectively. The effect of wearing a helmet on traffic noise-induced psychophysiological reactions was investigated using structural equation modelling. Results: SEM route analysis revealed these significant relationships: (i) helmet use and gender (p- value: 0.017), (ii)) helmet use and marital status (p-value: 0.043), (iii) riders/pillion-riders and annoyance (p-value: < 0.001), (iv) riders/pillion-riders and gender (p-value: < 0.001). It was also observed that motorcyclists suffer from higher traffic noise-related health issues than pillion riders. SEM analysis further revealed that use of helmet can negatively affect the traffic noise induced annoyance, tiredness, depression, headache, and sleeping problem. Paired test data shows that there are significant differences in traffic noise induced annoyance level, tiredness, headache, depression, sleeping problems, and equivalent noise level. Conclusion: The use of a full-face helmet protects motorcyclists against a variety of traffic noise-related health problems. Practical implications: This study presents a thorough overview of the benefits of wearing a helmet against traffic noise pollution.
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The work of Bard is reviewed, showing how the localization of the expressive reactions of rage in decortical preparations depends on the integrity of the posterior half of the diencephalon. This region has been shown by other workers to be the center of the sympathetic nervous system. This diencephalic region is a part of the "old brain" which is common to all members of the vertebrate series and has served throughout not only for the integration of the external expression, but for the internal mobilization of bodily forces in emergency. If cognative consciousness is associated with cerebral function, then the neural mechanisms for the more primitive emotional expressions operate in a region outside the range of consciousness. This would explain such experiences as "feeling possessed by rage," "surges up within us," and the like. The compactness of this diencephalic control also offers evidence and explanation for the uniformity of visceral response in emotion. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Effects of personal control over noise intensity were studied in experimental situations where subjects performed mental arithmetic under noise exposure. Every other subject was offered a choice between noise intensities, and the next subject, serving as his yoked partner, had to submit to the same noise. Mean measures of catecholamine and cortisol excretion, and of heart rate and subjective effort and discomfort showed that subjects were more aroused in the yoked situation. There were, however, considerable interindividual differences, subjects classified as ‘internals’ or ‘externals’ on the basis of the Internal-External Locus of Control Scale responding to the two experimental conditions in congruence with their general beliefs and attitudes with regard to control.
Emotioneller Stress durch Überforderung und Unterforderung. (Emotional stress by exzessive demand and underchallenge)," Schibri Verlag
  • K Hecht
  • H P Scherf
  • O König
K. Hecht, H. P. Scherf, and O. König, (Hrsg), "Emotioneller Stress durch Überforderung und Unterforderung. (Emotional stress by exzessive demand and underchallenge)," Schibri Verlag, Berlin, Milow, Strasburg, (2001).
Lärmbelastung und arterielle (essentielle) Hypertoniekrankheit beim Menschen. (Noise exposure and arterial (essential) hypertension disease in man)
  • Ch
  • F Graff
  • V Bockmüphl
  • Tietze
Ch. Graff, F. Bockmüphl, and V. Tietze, " Lärmbelastung und arterielle (essentielle) Hypertoniekrankheit beim Menschen. (Noise exposure and arterial (essential) hypertension disease in man). " In: Nitschkoff, S.; Kriwizkaja, G.: Lärmbelastung, akustischer Reiz und neurovegetative Störungen. (Noise exposure, acoustic stimulus and neurovegetative disorders). Georg- Thieme Verlag, 112–126, (1968).
Lärm als Umweltfaktor. (Noise as an environmental factor)
  • G Schuschke
  • C Maschke
  • W Dott
  • H F Merk
  • H Neuser
  • R Osieka
G. Schuschke and C. Maschke, " Lärm als Umweltfaktor. (Noise as an environmental factor), " W. Dott, H. F. Merk, H. Neuser, and R. Osieka, R. (Hrsg.): Lehrbuch der Umweltmedizin. (Textbook of the environmental medicine). Stuttgart, Wissenschaftliche Verlagsgesellschaft mbH, (2002).
Textbook psychophysiology , Beltz, Psychologie Verlags Union
  • R Schandry
  • Lehrbuch Psychophysiologie
R. Schandry, Lehrbuch Psychophysiologie, Textbook psychophysiology, Beltz, Psychologie Verlags Union, Weinheim, (1998).
Psychosomatische Medizin-Modelle ärztlichen Handelns, Psychosomatic medicine-Models of medical action
  • T Uexküll
  • R H Adler
  • J M Herrmann
  • K Köhle
  • W Langewitz
  • O W Schonecke
  • W Wesiak
T. von Uexküll, R. H. Adler, J. M. Herrmann, K. Köhle, W. Langewitz, O. W. Schonecke, and W. Wesiak, (eds) "Psychosomatische Medizin-Modelle ärztlichen Handelns, Psychosomatic medicine-Models of medical action," 6. Auflage. Urban & Fischer, München, Jena, (2003).
Emotion und Gesundheit-Die psychobiologische Regulation durch Hemmungen, Emotion and health-The psycho-biological regulation by inhibitions
  • H C Traue
H. C. Traue, "Emotion und Gesundheit-Die psychobiologische Regulation durch Hemmungen, Emotion and health-The psycho-biological regulation by inhibitions," Spektrum, Akademischer Verlag, Heidelberg, Berlin, (1998).
Noise induced stress is a risk factor in cardiovascular disease
  • W Babisch
  • H Ising
W. Babisch and H. Ising, "Noise induced stress is a risk factor in cardiovascular disease," The 2001 International Congress Noise Control Engineering. The Hague, The Netherlands, (2001).
Asthma bronchiale (Asthma bronchial )
  • W Langewitz
  • M Solèr
  • R H Adler
  • J M Herrmann
  • K Köhle
  • W Langewitz
W. Langewitz and M. Solèr, " Asthma bronchiale (Asthma bronchial ), " R. H. Adler, J. M. Herrmann, K. Köhle, W. Langewitz, O. W. Schonecke, T. von Uexküll, and W. Wesiak (eds), Uexküll Psychosomatische Medizin—Modelle ärztlichen Handelns. 6.